Stage 3: Trying to decide whether to do radiation or surgery

Many people have a misconception and lack of understanding of cancer statistics. The figure you quote of 1.5 years survival after surgery is a median value. It applies to no one individual. It looks at a patient cohort and is based on a percentage of all those in the cohort. One has just as good a chance of falling to the left of the median, on the median or to the right of the median which represents statistical outliers-those that exceed the median value. As a cancer researcher, I understood this and saw no reason why I could not be one of those “statistical outliers”. So after I had the Whipple, I advocated for more aggressive therapy and also took advantage of what precision medicine and targeted therapy had to offer. As a result, I became a “statistical outlier” many times over at 10 1/4 years overall survival and 6.5 years NED of progression free survival.

A very elegant essay was written in the mid 1980’s by Harvard University Computational Biologist Dr. Stephen Jay Gould. It is written to help the lay person understand cancer statistics. I highly recommend it to patients and caregivers alike-

The Median Isn’t the Message
https://people.umass.edu/biep540w/pdf/Stephen%20Jay%20Gould.pdf

Thank you. Were you stage 3 with vein intrusion?

My surgical team thought I was stage III when the resection was done. One week later a CT was done (2 weeks post initial diagnostic scan) and the radiologist noted suspicious areas resembling metastatic disease to the liver but far too small to biopsy for confirmation. It was 8 weeks post surgery when I started my first chemo regimen (Gemzar) which was determined after three months did not work at all. So now I had six sizable tumors in three out of four lobes of the liver. A biopsy confirmed they originated from the primary tumor. That is how I had the Whipple as It was not realized initially I was stage IV. Despite it all, I became a 10 year survivor in June and have been NED over 6.5 years.

I’m stage 3 with extensive vein/artery encasement. I visit Mayo every two months to restage and see if i may qualify for surgery yet. Even if I do qualify though I am considering how my quality of life would change. I have responded well to chemo (Folfirinox with the OX just removed) so I am optimistic about my chances without surgery.

@mamarina, I believe you have met with your surgeon in the meantime. May I ask what you have decided for treatment - radiation or surgery?

Radiation. He was very honest with me after 4 conversations. My surgery would have been extremely difficult and most likely aborted but that would have required patching everything up they cut thru and doing gastric bypass
He said everyone is different of course but with my situation the surgery might only gain me another year.if all went well They would attempt surgery if I was 100% ok with pain of surgery , complications , long recovery and possibly loss of life sooner.
he said the radiation even tho new may gleen me same or longer without all above ..
but I do have some reservation should I have taken risk. To be one of the 6% of stage 3 that might make it long term