Former President Jimmy Carter’s announcement that he has cancer has raised more questions than answers – including the type of cancer he has, his treatment options, and if it is life-threatening.
But cancer specialists say one thing is certain: The 90-year-old’s disclosure that the disease has spread to other parts of his body suggests he may face an uphill battle to beat it.
In addition, Carter’s advanced age and strong family history of pancreatic cancer -- three of his siblings and his father died from it – also increase his risks, experts say. Researchers estimate that people with three or more close relatives with pancreatic cancer – which kills most patients it strikes within a year of diagnosis – are 57 times more likely to get it themselves.
Carter announced Wednesday that he has cancer and that he will be getting treatment at Emory Healthcare in Atlanta. On August 3 he underwent a procedure "to remove a small mass in his liver" – surgery that revealed the cancer, the Carter Center said in a press statement.
"Recent liver surgery revealed that I have cancer that now is in other parts of my body," Carter said in the statement. "I will be rearranging my schedule as necessary so I can undergo treatment by physicians at Emory Healthcare."
While the statement makes clear that Carter's cancer is widely spread, it does not say where it originated, or even if that is known at this point.
When cancer is found in the liver, it has often spread from somewhere else in the body – often the pancreas – according to the American Cancer Society. But other cancers can also spread to the liver, including those that originate in the colon, esophagus, and gastrointestinal tract.
Doctors typically design cancer treatments, including chemotherapy, based on a cancer’s origins. But they also take other factors into consideration – including a patient’s age, overall health, and how far the disease has advanced – in recommending treatment options, experts note.
In general, when cancer spreads from one area to elsewhere in the body, it is considered Stage IV cancer – the most advanced stage. Although some types can be treated, Stage IV cancer is usually incurable.
Len Lichtenfeld, M.D., deputy chief medical officer of the American Cancer Society, noted there is limited information about Carter’s cancer diagnosis.
"It is the decision of former President Carter and his family as to how much information they wish to share. We should not speculate on a diagnosis or treatment until we learn more details," he old Newsmax Health
. "It is not firm at this time whether the cancer started in the liver or spread from another part of the body. The likelihood is that this is a cancer from outside the liver, but we don't know for certain."
But he added that determining where the cancer originated and genetic analyses of the tumor can help determine what treatment or drugs might be beneficial.
"In similar situations a patient undergoes a series of tests to uncover the cancer's origin, and sometimes that still doesn’t indicate where it came from. Doctors can also perform genetic analysis, which may help the care team make further treatment decisions," he explained.
"The president has a family history of pancreatic cancer. We cannot say whether that history has any bearing on his current circumstances. Going forward, the president and his family will weigh their medical decisions on what treatments to pursue. Our thoughts and prayers are with them as they begin their journey that has been shared with so many others facing cancer."
Robert Mayer, M.D., a gastrointestinal cancer specialist at the Dana Farber Cancer Institute, told NBC News
that Carter’s age makes it unlikely that he would be able to tolerate the kind of aggressive treatment that could be beneficial for cancer patients in their 60s or 70s.
"This is a 90-year-old gentlemen with apparent widespread disease. The goals of treatment would be his comfort," Dr. Mayer said. “If chemo is considered it would need to take into account his age."
Lodovico Balducci, M.D., a specialist on treating cancer in the elderly at the Moffitt Cancer Center in Tampa, told Newsday
that age alone does not preclude successful cancer treatment.
"A man 90 years old normally would have a life expectancy of two or three years, but Jimmy Carter is probably much younger than that" in terms of his function, Dr. Balducci said. "If he tolerated liver surgery, I imagine he has a relatively good tolerance" to other treatments that might be tried.
Cancer treatment facilities, including Moffitt, have developed scoring systems to gauge how well an older person would tolerate chemotherapy.
Carter was the nation's 39th president. He founded the Carter Center in Atlanta in 1982, after leaving the White House in 1981, to promote healthcare, democracy and other issues globally.
Carter, the second-oldest living president, has maintained an active public life in recent years, promoting the center’s causes. He also recently released a new autobiography, "A Full Life," and has been traveling around the country to promote it.
But last May, Carter had to cut short a trip to Guyana last May, to observe elections, for undisclosed health reasons that fueled concerns about his condition.
Carter’s brother Billy and sisters Ruth and Gloria all died of pancreatic cancer, along with his father, James Earl Carter Sr. His mother Bessie Lillian Gordy Carter died of breast cancer that had spread to the pancreas.
While pancreatic cancer survival rates have been improving in recent years, the disease is still considered largely incurable. According to the American Cancer Society, for all stages of pancreatic cancer combined, the one-year relative survival rate is 20 percent, and the five-year rate is 6 percent.
ACS statistics also indicate:
- About 48,960 people (24,840 men and 24,120 women) will be diagnosed with pancreatic cancer this year.
- About 40,560 people (20,710 men and 19,850 women) will die of pancreatic cancer.
- Pancreatic cancer accounts for about 3 percent of all cancers in the U.S., and 7 percent of cancer deaths.
The average lifetime risk of developing pancreatic cancer is about 1 in 67 (1.5 percent). But a person’s risk can be raised by a number of factors, including family history, experts note.
Carter told The New York Times
that he had CT scans and MRIs of his pancreas twice a year.
Last week, family and friends wished Carter well after the Carter Center disclosed he had undergone elective surgery to “remove a small mass in his liver.”
Jill Stuckey, a close friend of Jimmy and his wife Rosalynn, told the Atlanta Journal-Constitution
that said those who know him have been “praying ever since we found out about the small mass on his liver.”
“He’s done everything right. He exercises, he eats right, that’s how he’s gotten to be 90 and [still] going to different continents,” said Stuckey. She added that while there’s a history of cancer in Carter’s family, “If anyone can beat it, it’s Jimmy Carter.”
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