ATLANTA -- Former President Jimmy Carter announced Thursday that his cancer showed up in four small spots on his brain, saying he is "at ease with whatever comes." He began radiation treatment later in the day.
"I'm ready for anything and looking forward to a new adventure," said Carter, appearing upbeat and making jokes as he openly talked about his melanoma during a news conference.
So far, the pain has been "very slight," and Carter said he hasn't felt any weakness or debility. Still, he will dramatically cut back on his work with the Carter Center and will give the treatment regimen his "top priority."
Later Thursday, he had the first of four targeted radiation treatments. He was to receive more injections of a newly approved drug to help his immune system seek out and destroy the cancer cells wherever else they may appear.
Carter, in a dark blazer, red tie and jeans, said that at first he thought the cancer was confined to his liver. He said he thought an operation Aug. 3 had completely removed it, "so I was quite relieved."
But the afternoon after the surgery, an MRI showed it was on his brain.
"I just thought I had a few weeks left, but I was surprisingly at ease. I've had a wonderful life," the 90-year-old Carter said. "I've had thousands of friends, I've had an exciting, adventurous and gratifying existence. So I was surprisingly at ease, much more so than my wife was. But now I feel it's in the hands of God, who I worship, and I'll be prepared for anything that comes."
He didn't give any prognosis but spoke about receiving three months of treatments and cast doubt on the possibility of traveling to Nepal in November to build houses for Habitat for Humanity, a Georgia-based organization he has worked with for decades. He said other family members may have to represent him there.
Carter's health has been closely watched this year. He cut short an election-monitoring trip to Guyana in May. At the time, a spokesman said Carter did not feel well, and Carter himself later said he had had a bad cold.
At the news conference, Carter said it was about that time he found out he had a spot on his liver. He didn't tell his wife, Rosalynn, about it until June 15, and life went on as normal.
"The doctors told me that it was a very slow-growing cancer, apparently it wouldn't make any difference between the middle of July and August, so we scheduled it when I got through with the book tour," Carter said.
He finished a book tour and had the surgery to remove about one-tenth of his liver, which contained a small cancerous mass. He said he healed quickly and was left with "minimal pain."
His father, brother and two sisters died of pancreatic cancer. His mother also had the disease. Carter, who had been tested for pancreatic cancer, said no cancer has been found there so far.
Treatment regimen
The former president didn't discuss his long-term prognosis, but said he will cut back dramatically on his humanitarian work while following the orders of a team that includes the world's best "cancer-treaters."
After Thursday's initial session, his treatment regimen will include three more sessions three weeks apart. The tumors in his brain will be hit by concentrated beams of radiation and he will get more injections of pembrolizumab, better known as Keytruda. The drug, the first in a new class of medications called immunotherapy, has been on the market for only 11 months and was approved by the FDA for melanoma patients earlier this year.
Carter said doctors will continue to scan his body for cancer in an effort to determine where the melanoma originated.
He said he was told that, with melanoma, 98 percent of the time it develops first in the skin. He also said the rest of his body will be scanned repeatedly for months to come and that more cancers may show up elsewhere. The cancer spots on his brain are about 2 millimeters in size.
According to Memorial Sloan Kettering Cancer Center, "one of the most common primary tumors to spread to the brain is malignant melanoma. In nearly 50 percent of people with melanoma that has metastasized, the disease can be found in the brain."
The center added that "the outlook for patients with brain metastases generally depends on the number, size, location, and origin of the primary tumor or tumors."
Carter's team of doctors at Emory Health Care includes Dr. Walter Curran Jr., who runs Emory's Winship Cancer Institute. Treatments for melanoma have improved tremendously in recent years and Carter's prospects are good even at the age of 90, Curran said. But he cautioned against the idea that Carter can be "cured."
"Any treatment can be tough at any age, but ... most people are able to go on with their regular daily life," Curran said. "Side effects include achiness of joints and bones, fatigue and irritation. Side effects from radiation can include headache and nausea. Some patients feel none of those."
When patients have melanoma that has spread, Curran said, "the goal is control and to have a good quality of life."
Dr. Patrick Hwu, a melanoma expert at the University of Texas MD Anderson Cancer Center, said the key immune system cells needed to attack the tumor can get into the brain, so the treatment gives Carter a fighting chance.
"Every patient is going to be different," he said.
For now, Carter noted that his cancer treatment will become his "top priority" and he described a more limited routine going forward.
He plans to host his extended family at Rosalynn's 88th birthday celebration in their hometown of Plains, Ga., on Saturday, and will keep teaching Sunday School at their small church, including this Sunday's class. He said he looks forward to his 91st birthday on Oct. 1 and, as much as he's able, will continue lecturing at Emory, raising money for his center's $600 million foundation, and meeting with experts on guinea worm and other diseases the center is working to eradicate.
Well-wishes
Former presidents George W. Bush and George H. W. Bush both called him Wednesday, Carter said, and he has received well-wishes from President Barack Obama, Bill and Hillary Clinton, and Secretary of State John Kerry.
Later, Obama tweeted: "President Carter is as good a man as they come. Michelle and I are praying for him and Rosalynn. We're all pulling for you, Jimmy."
Carter said he appreciated all the well-wishes. "First time they've called me in a long time," he added, to laughter.
Carter's grandson Jason Carter said he hopes his grandfather spends as much time as possible with Rosalynn -- and gets to go fishing.
"My grandfather is a remarkable person. This is not a eulogy in any way," Jason Carter said. "I don't think anybody who knows him was surprised to see him sitting here ... with this deep and abiding faith and courage and analytical brain and all those other aspects of him that have led him to lead this incredibly giant human life."
The former president opened by thanking his wife of 69 years, who listened quietly in the front row, never reaching for the tissues placed near her chair.
Marrying her was the best thing he's done in his life, Carter said, and his eyes often returned to her during the 45-minute news conference.
Carter was the nation's 39th president, defeating President Gerald Ford in 1976. Several foreign policy crises, in particular the Iran hostage crisis, hurt his bid for re-election and Ronald Reagan swept into the White House.
On Thursday, he said he remains proud of what he accomplished as president, but is more gratified by his humanitarian work since then, which earned him a Nobel Peace Prize in 2002.
Asked to name his biggest regret, he brought up the failed mission to rescue U.S. hostages in Iran.
"I wish I had sent one more helicopter to get the hostages, and we would have rescued them and I would have been re-elected," he said to wide laughter in the room. "But that may have interfered with the foundation of the Carter Center. If I had to choose between four more years and the Carter Center, I think I would choose the Carter Center."
Then again, "it could have been both," he added with a wink, prompting another round of laughs.
He called his work with the Carter Center "personally more gratifying" than his presidency.
He said he and his wife have thought for many years about cutting back their work at the Carter Center, which he established in 1982 to promote health care and democracy.
"We thought about this when I was 80," he said of cutting back at the Carter Center. "We thought about it again when I was 85; we thought about it again when I was 90. So this is a propitious time I think for us to carry out our long-delayed plans."
The center has a $600 million endowment and Carter said he will continue to help raise money as long as he feels up to it.
"I think I have been as blessed as any human being in the world," Carter said. "So I'm thankful and hopeful."
Former presidents have generally chosen to make announcements about their health in writing, as Ronald Reagan did in 1994 when he disclosed that he had Alzheimer's disease. But Carter's appearance Thursday, by turns clinical and homespun, hewed closely to his public identity: an accessible statesman with both a deep command of details and an untroubled grace.
As he addressed dozens of journalists and supporters, Carter appeared to display "a certain vulnerability that we don't often get a glimpse of in our presidents," said Mark Updegrove, the director of the Lyndon Baines Johnson Presidential Library and the author of a 2006 book about modern post-presidencies.
"We've seen presidents reveal their health conditions, as we saw with Reagan's letter, through more indirect means," Updegrove said. "But there is Jimmy Carter in front of the cameras, really in a moment of total honesty, and that just doesn't happen very often for any public servant."
Information provided by Kathleen Foody and Marilynn Marchione of The Associated Press, by Abby Phillip of The Washington Post, and by Alan Blinder and Richard Fausset of The New York Times.
A Section on 08/21/2015