The motto for president Jimmy Carter’s Carter Center is: “Waging Peace. Fighting Disease. Building Hope.” Those words now apply to the former president, who is 90 years old and waging war against the cancer that has spread from his liver to other parts of his body.

Former president Jimmy Carter announced on August 3 he was having surgery to remove a small mass from his liver. Nine days later, the Carter Center released this terse statement: “Recent liver surgery revealed that I have cancer that now is in other parts of my body.”

The cancer has now spread to his brain. On August 19 Carter announced that his doctors had found four spots of melanoma on his brain, and that radiation would begin immediately.

“I’m perfectly at ease with whatever comes. I’m ready for anything,” he said in Atlanta this week. “I’m looking forward to a new adventure.”

Finding a cancer unexpectedly during surgery is unusual, because imaging today usually provides the surgeon with a precise, advanced roadmap to what is going on inside the body. Nevertheless, some cancers do not show up well on imaging and so are only found at the time of surgery.

As more patients live into their 90s, they may in fact outlive cancers discovered late in life.

Carter comes from a family with a history of pancreatic cancer. His father, his brother and both his sisters died of pancreatic cancer, and his mother was stricken with the disease as well. Knowing this, Carter has from all accounts tried to lead a clean life: He was regularly seen jogging while president, is a non-smoker and has CT scans twice a year and MRIs to guard against the emergence of cancer in his pancreas.

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That clean life is one of the reasons a man with a family history like his has lived to age 90. Information on the cancer that has been discovered in his body is scarce, but some experts believe Carter has stage IV cancer, which is usually incurable, especially for a man in his 90s.

As more and more Americans live well into their 80s, 90s and beyond, and as medical diagnostic technology continues to advance, patients and doctors will increasingly be confronted with the question of not just how, but whether, to treat cancers discovered very late in life. The variables include the type and stage of cancer, as well as the patient’s overall health. More aggressive treatments, such as chemotherapy and radiation, which would be recommended for younger patients don’t necessarily make sense for people of an advanced age.

Chemo and radiation don’t necessarily make sense for a patient of a very advanced age.

With information about the Carter case as scarce as it is, Dr. William Grossman, a professor of medicine at the University of California, San Francisco, did not have an opinion on Jimmy Carter’s course of action. But he did say he had seen remarkable recoveries in patients of advanced age, including his own mother, who developed breast cancer at age 95.

“(The cancer) was successfully cured with surgery,” Dr. Grossman said. “She recovered rapidly and went on to have five more excellent, independent years before dying of a stroke just six weeks shy of her 100th birthday.”

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Modern geriatric oncologists classify their patients as “fit,” “vulnerable,” or “frail” and that has a lot to do with their treatment. According to Dr. Grossman, “If chances for a cure are poor (e.g., with pancreatic cancer) and the treatment (major league chemotherapy) still has a lot of side effects, it is wise to have a frank discussion and make sure the patient knows about the positive aspects of modern home hospice.”

Cancer is tough, but so is Carter. He survived Annapolis, submarines and a turbulent presidency that was marred by the Iranian hostage crisis. Good wishes for him came from both Democrats and Republicans, with President Obama telling him, “We are rooting for you,” and Jeb Bush saying, “(We) will be praying for him and his family.”

Carter is to be congratulated for his longevity: At 90, he has well outpaced the current male life expectancy of roughly 75 years of age. It is actually the flip number of the male life expectancy of 57 in 1924, the year Carter was born. 

This article has been updated.