WASHINGTON – Supreme Court Associate Justice Ruth Bader Ginsburg announced Friday she is battling cancer again, just days after she was hospitalized for a possible infection.

The 87-year-old Ginsburg, a four-time cancer survivor who announced in January that she was cancer-free, said a periodic scan and a biopsy revealed lesions on her liver, but chemotherapy treatment that began in May is “yielding positive results.” Her most recent scan last week showed “significant reduction” of the lesions, the justice said in a brief statement.

“I am tolerating chemotherapy well and am encouraged by the success of my current treatment,” Ginsburg said. “I will continue bi-weekly chemotherapy to keep my cancer at bay, and am able to maintain an active daily routine. Throughout, I have kept up with opinion writing and all other court work.”

This is Ginsburg’s fifth bout with cancer, following colon cancer in 1999, pancreatic cancer in 2009, lung cancer in 2018 and more pancreatic cancer last year. Still, she said she would stay on the court “as long as I can do the job full steam,” a phrase she has used many times in the past.

For years, Ginsburg’s health has been a concern for Democrats who worry that the high court’s 5-4 conservative majority could be expanded if she were to leave the bench before the November presidential election. Even if Democrats sweep to victories, Republicans will control the Senate at least until Jan. 3, and President Donald Trump will be in office at least until Jan. 20.

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Ginsburg said her recent hospitalizations to remove gall stones and treat an infection were unrelated to her cancer. 

Ginsburg was taken to Johns Hopkins Hospital in Baltimore earlier this week after she experienced fever and chills. She was treated for a possible infection and underwent an endoscopic procedure to clean out a bile duct stent that was inserted last August.

She had been hospitalized in May following an infection caused by a benign gallbladder condition, the Supreme Court said. 

‘Speaks to her willpower’

An oncologist, who has not treated the jurist, suggested that the lesions on Ginsburg’s liver could be a recurrence of pancreatic cancer. “I believe it is metastatic pancreatic cancer,” Dr. Wasif M. Saif, of the Northwell Health Cancer Institute, told USA TODAY, citing the type of chemotherapy Ginsburg is receiving. He added: “It seems like her cancer is back in the liver. The good news is that she seems to be responding.”

The doctor also praised Ginsburg’s longevity, more than a decade after she was first diagnosed with pancreatic cancer. “She was diagnosed with this cancer in 2009. And now today, it is 2020. This gives us hope with patients that some people can do better. It also speaks to her willpower,” Saif said.

And Saif opined that Ginsburg should be able to continue to work. He said patients receiving chemotherapy every two weeks, rather than every week, tend to handle side effects more easily. “I think she is one of those people who are super human. I think definitely, her commitment to what she is doing and her willpower is so strong that I will not be surprised if she continues to work during this time.”

Leader of the liberals 

Ginsburg, the second-longest-serving justice on the bench, was nominated by President Bill Clinton in 1993. She is the leader of the court’s liberal wing, which includes Associate Justices Stephen Breyer, Sonia Sotomayor and Elena Kagan.

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That group is outnumbered by five conservative justices, led by Chief Justice John Roberts, who has become the center of the court. To his right are Associate Justices Clarence Thomas, Samuel Alito, Neil Gorsuch and Brett Kavanaugh.

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Should a vacancy occur on the court while Trump and Republicans remain in power, the leading candidates likely are federal appeals court judges Amul Thapar of Kentucky and Amy Coney Barrett of Indiana.

Known fondly to her vast network of supporters as simply “RBG” or the “Notorious RBG,” Ginsburg emerged from three weeks of radiation treatment for pancreatic cancer last fall by traveling the nation giving speeches, staging conversations and accepting awards and honorary degrees. 

“As cancer survivors know, that dread disease is a challenge, and it helps to know that people are rooting for you. Now, it’s not universal,” she quipped in September at the famed 92nd Street Y in New York City. She vowed to stay on the job “as long as I’m healthy and mentally agile.”

Ginsburg must remain on the nation’s highest court at least until January to avoid giving Trump and a Republican-controlled Senate the opportunity to replace her. Such a  scenario could give conservatives a 6-3 hold on the high court – solidifying their majority, perhaps for decades to come.

Ginsburg’s predicament is similar to that faced by the court’s last civil rights pioneer, Associate Justice Thurgood Marshall, in 1991. With his health declining as he approached his 83rd birthday, he retired during the third year of Republican George H.W. Bush’s presidency. 

Marshall ultimately lived four days into the administration of Democratic President Bill Clinton. But by then his seat was held by Thomas, now the court’s longest-serving and most conservative justice.

Rarely misses court

Ginsburg has shown no similar signs of “coming apart,” as Marshall described himself in a calamitous 1991 press conference, though she did miss the first oral arguments of her career early in 2019 while recovering from lung cancer surgery. In May, she participated in oral arguments by telephone from the hospital.

Before her fourth cancer was diagnosed, Ginsburg had said she hoped to stay on the bench for at least five more years, noting that the late Associate Justice John Paul Stevens served until age 90. Stevens died a year ago at 99.

The second pancreatic cancer was concerning because it is the deadliest kind, with an average five-year survival rate of 9%, lowest of all cancers. But Ginsburg has lived 11 years since her first bout.

The justice’s first major health scare was colon cancer in 1999. Chemotherapy and radiation left her depleted, so her late husband Martin convinced her to get a personal trainer. She has worked out twice a week ever since.

Her first bout with pancreatic cancer in 2009 was caught early following a routine blood test, and she made a full recovery. She received a stent in a heart procedure in 2014. In November 2018, she fell in her Supreme Court chambers and fractured three ribs, forcing her to miss Kavanaugh’s investiture ceremony. The fall proved fortuitous, because it enabled doctors to find and remove two malignant nodules from her left lung.

By then, her supporters were increasingly rattled. Twitter was flooded with good wishes as well as medical offers. 

“Ruth Bader Ginsberg (sic) can have my ribs,” actress and #MeToo activist Alyssa Milano tweeted at he time. “And my kidneys and a lung. And anything else she needs.”

If Ginsburg were to leave the court this year, it would mirror the situation in 2016, when Associate Justice Antonin Scalia’s death set in motion a drama that consumed all three branches of government throughout the presidential campaign.

President Barack Obama offered up a compromise candidate, 63-year-old Merrick Garland, chief judge of the U.S. Court of Appeals for the District of Columbia Circuit. Senate Majority Leader Mitch McConnell, R-Ky., refused even to hold a hearing. The court muddled through the second half of its term and most of its next one with eight justices, until Gorsuch was confirmed in April of 2017.

With that history in mind, Democrats and liberals have said any vacancy on the left side of the court should remain open through the November election. But with the White House and Senate in GOP hands, McConnell has vowed to “leave no vacancy behind.”

This article originally appeared on USA TODAY: Supreme Court Justice Ruth Bader Ginsburg battling cancer again

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