In spite of his advanced age, Jimmy Carter’s generally good health will be a strong positive in his treatment for cancer, oncology experts said Thursday.
“You never use age as a cutoff,” said Dr. Charles Fuchs, chair of gastrointestinal cancer at Dana-Farber Cancer Institute in Boston. Cancer in older patients is a fast-advancing field, Fuchs said, “and I can assure you that people at Emory and Dana-Farber are working in this area as we speak.”
Fuchs said he has treated several patients this year who are 90 and older.
Someone like Carter “who is very attentive to his health” and has no other diseases would likely tolerate cancer treatment well, Fuchs said.
Aging patients with other conditions, such as diabetes or heart disease, may not be able to tolerate the same kinds of chemotherapy or other treatments that younger people can, according to Dr. Lodovico Balducci, whose team focuses on adult cancers at Moffitt Cancer Center in Tampa, has developed an assessment to help doctors tailor treatment to an older person.
Decisions about treatment should be made on a person’s ability to function rather than a person’s age, he said.
“What I would say is important is that people should not be judged by chronological age,” said Balducci. “Though (Carter) is 90, I would try to do anything possible without hurting him. He has been a president who was always ahead of his time.”
That thinking represents a substantive shift in cancer knowledge and treatment, said Dr. Len Lichtenfeld, deputy medical director of the American Cancer Society.
“When I started my oncology career back in 1970, we didn’t have that option, even for someone who was 70,” said Lichtenfeld.
‘He’s lived through this too many times’
While Carter had not been diagnosed previously with cancer, the disease has stalked his family. Pancreatic cancer claimed the lives of his father and three siblings. It was also found in his mother.
Experts said that it was hard to say whether Carter’s cancer could be pancreatic cancer, too. Typically, cancers that are heritable — that is, those caused by a hereditary gene or missing gene — usually are diagnosed much earlier in life, Fuchs said.
Still, the experience of losing so many loved ones to cancer would likely affect anyone, even if it doesn’t result in a similar diagnosis.
“He’s lived through this too many times,” said Lichtenfeld. “I’m sure he’s given considerable thought to what he would do.”
Dr. George Fisher of the Stanford Cancer Institute, said pancreatic cancer would normally be diagnosed earlier but could still be a possibility.
“Because it’s rare (to be diagnosed later in life) doesn’t mean it can’t happen,” Fisher said. But he also agreed that Carter’s good health “bodes well for him, and I know he’ll get excellent care there in Atlanta.”
Where Carter’s cancer originated is unclear
Additionally, the news that doctors found a malignant tumor in Carter’s liver does not mean that he has liver cancer, the experts said. The liver is a common site to which cancers that originate in other organs may spread, or metastasize, they explained.
Further testing could reveal where Carter’s cancer began. That screening could include additional scans, looking at the tumor cells under a microscope and genetic and genomic testing. It would not be unusual for the process to take two weeks or longer Lichtenfeld said.
Dr. Ronald Busuttil, executive chairman of the Department of Surgery and director of the Dumont-UCLA Transplant and Liver Cancer Centers, said his first impression — from news reports and without access to the former president’s medical records — is that the cancer most likely originated in another organ of Carter’s body and spread to the liver.
That is mainly because primary liver cancer typically occurs in patients with Hepatitis B, Hepatitis C or some type of chronic liver disease.
“That’s how it starts in the majority of cases,” said Busuttil.
Where the cancer started is important, Busuttil said. If, in fact, the primary site was the liver, there are ways to treat that with surgery, transplantation or a procedure called radio-frequency ablation, in which the tumor is eradicated through radio-frequency waves that destroy it.
In some instances, doctors never learn where in the body a cancer actually began. That happens in about 2 to 3 percent of cases, said Fuchs.
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