President Carter Has Cancer

Jimmy Carter is 90 years old and is still going strong, leading international initiatives through his Carter Center.  He's been a strong voice for world peace and a tireless advocate for Habitat For Humanity, among other charities and NGOs. It pains me then to hear that this true example of an American statesman, having served his country for more than 40 years, is now facing the specter of cancer.

"Recent liver surgery revealed that I have cancer that now is in other parts of my body," Carter said in the statement released by the Carter Center. "I will be rearranging my schedule as necessary so I can undergo treatment by physicians at Emory Healthcare."

The statement makes clear that Carter's cancer is widely spread but not where it originated, or even if that is known at this point. The liver is often a place where cancer spreads and less commonly is the primary source of it. The statement said further information will be provided when more facts are known, "possibly next week."

Carter announced on Aug. 3 that he had surgery to remove a small mass from his liver.

Good wishes poured in on social media after Carter's announcement, while President Barack Obama said he and first lady Michelle Obama wish Carter a fast and full recovery.

"Jimmy, you're as resilient as they come, and along with the rest of America, we are rooting for you," Obama said in a statement.

Jimmy Carter has the resume of ten lesser people combined, a Nobel Peace Prize, countless hours as America's global diplomat emeritus, and a new memoir.  Now he faces this challenge.

"Our thoughts and prayers go out to President Carter," said Dr. Len Lichtenfeld, deputy chief medical officer of the American Cancer Society.

"There's a lot we don't know," but the first task likely will be determining where the cancer originated, as that can help determine what treatment he may be eligible for, Lichtenfeld said. Sometimes the primary site can't be determined, so genetic analysis of the tumor might be done to see what mutations are driving it and what drugs might target those mutations.

"Given the president's age, any treatments, their potential and their impacts, will undoubtedly be discussed carefully with him and his family," he added.

Age by itself does not preclude successful cancer treatment, said Dr. Lodovico Balducci, a specialist on treating cancer in the elderly at the Moffitt Cancer Center in Tampa. Much depends on the patient's "biological" age versus his actual years, he said.

"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, Balducci said. "If he tolerated liver surgery I imagine he has a relatively good tolerance" to other treatments that might be tried. For example, Moffitt has developed a scoring system to estimate how well an older person would tolerate chemotherapy, and the risk of serious side effects.

The first task is to determine if the cancer is curable, "which is unlikely with metastatic cancer," or if it is possible to meaningfully prolong the life through further surgery or other treatments, Balducci said. "Cancer in a 90-year-old is a serious problem, but that does not mean a 90-year-old cannot benefit from treatment."

Here's wishing Jimmy well.