Supreme Court Justice Ruth Bader Ginsburg is receiving chemotherapy to treat a recurrence of cancer.

The 87-year-old was first diagnosed with pancreatic cancer in 2009 and announced this week the cancer has returned, this time in her liver.

“Liver metastasis is a common feature of pancreatic adenocarcinoma,” said Dr. Dae Won Kim, a medical oncologist in the Gastrointestinal Oncology Program at Moffitt Cancer Center. “Over 50% of pancreatic patients have metastatic liver disease at the time of diagnosis.”

Kim says treatment depends on the location of the recurrence but is most commonly systematic chemotherapy.

In a statement, Ginsburg says chemotherapy is “yielding positive results” after immunotherapy proved unsuccessful. Pancreatic cancer does not usually respond as well to immunotherapy as other cancer types.

“The tumor microenvironment of pancreatic cancer is highly immunosuppressive and pancreatic cancer is surrounded by thick fibrotic tissue, which inhibits immune cell infiltration,” said Kim. “However, around 1% of pancreatic cancers have specific gene mutations that are very sensitive to immunotherapy.”

Ginsburg has had several bouts with cancer, including radiation therapy for pancreatic cancer in 2019 and surgery to remove lung nodules in 2018. She also had colon cancer in 1999.

Ginsburg will continue to serve on the Supreme Court during her current treatment. “I have often said I would remain a member of the Court as long as I can do the job full steam,” she said. “I remain fully able to do that.”