The other area, now, that's evolving quite quickly is the use of chemotherapy in patients who already have metastatic disease. In these patients, what you're trying to do is to reduce the metastatic disease, palliate them, make them live longer, decrease the symptoms due to the cancer.
More recently, we've become very interested as we have newer agents that are more effective in reducing the disease to the point where it might be surgically resected. Where a surgeon may be able to take cancer out of the liver and render the patient free of disease.
DAVID R. MARKS, MD: So is there any guideline as to what stage of disease the person has to be in to have chemo?
JOHN MacDONALD, MD: If you look at what's generally accepted in adjuvant therapy, everybody agrees that in Stage III disease, and that means the colon's been resected, and when the pathologist looks at it, the lymph nodes show some evidence of metastatic disease, there's no question that those patients benefit from the use of chemotherapy after resection. It decreases the likelihood that they're going to recur, and improves their overall survival.
The other group are patients with what's called Stage IV disease, which is metastatic disease. Again, you're treating them to reduce the disease, reduce the symptoms. And, potentially, with some patients, with a fraction of those patients, to eventually be able to surgically resect all the disease they have.
DAVID R. MARKS, MD: From a surgeon's perspective, what role does chemotherapy play in your management?
