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New, overwhelmed: What's microsatellite stable?

Pancreatic Cancer | Last Active: Aug 27, 2023 | Replies (17)
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@mommacandy

thank you SOOO much for this information...we're getting his care at University of Virginia which is a Cancer Center of Excellence...the surgeon we have an appt with on paper has excellent ratings and people i've talked to around the hospital seem to love him. we'll see 🙂 but i have hope...its almost a 5 hour drive for us but i'd MUCH rather trust them than these local folks...sorry don't have much confidence in our local docs..
i will certainly thank him for you.. he's a British vet (permanent green card holder)who moved to the US 16 yrs ago and worked as a private military contractor for the US after coming here. So he doesn't qualify for a lot of assistance (ie our vet care, disability etc)..he has no family left in England and no family here...he's the last one so my hubby and I and other friends are all he has in the way of "family".
From my understanding, we are meeting with the surgeon first to discuss surgery options, if its an option, whats involved, will it be done first etc and the following week we are meeting with an oncologist to discuss the rest of it... yes its two separate long drives but to wait on a day when we could do both was going to be at least a month out and tbh knowing how aggressive pancreatic cancer can be (my stepmom passed from it less than 3 months after she was diagnosed, it had already spread all over) i'd rather "get the ball rolling than sit around and wait on someone else to do it" so to speak and if it means two long drives so be it.
i DO already know that UVA has something like 11 clinical trials going atm for various pancreatic cancer treatments atm so who knows, he may fall into one of those.. we'll see
thank you so much for taking the time to give me all this info.. its exactly the kind of stuff i need..

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Replies to "thank you SOOO much for this information...we're getting his care at University of Virginia which is..."
markymarkfl | @markymarkfl | Aug 10, 2023

You're very welcome, and I hope it helps lead to a positive outcome.

One thing I meant to elaborate on a little more was the neoadjuvant treatment. There was a study (can't find it & don't remember name) showing patients who got chemo before surgery had better outcomes (don't remember the exact outcome criteria either) than those who got surgery first.

Part of it is based on the likelihood that even without evidence of spread, there is often an undetectable "micro-level" spread already to places that surgery would miss, and that surgery with a tough recovery period would delay the start of "adjuvant" chemo to address it, which lets it spread anyway. Their thought process is that surgery in that case just puts the patient through unnecessary agony on the way to the inevitable. With neoadjuvant chemo, they figure a) it gives drugs a chance to target malignant cells that have spread elsewhere; and b) if they do see a spread while the patient was on chemo, then they conclude it was not controllable before surgery and thus would not have been controllable with basic chemo after the surgery. Sort of a patient-screening process to see who really benefits from surgery.

Another level of screening occurs when they do the actual surgery. While the actual procedure may be done "open" or laparoscopically, they typically do a "diagnostic laparoscopy" at the beginning of the procedure. It just means they make the minimal laparoscopic openings, insert some cameras, and look around. If they see evidence of tumors elsewhere, in too many places or a couple bad places, they close up and abort the bigger surgery.

"TNT" (TOTAL NEOadjuvant Therapy) is the approach of doing all chemo before surgery, and none after, on the presumption that if you got a full dose and could tolerate it, that's the best they could do. It was part of the failure in my case (faster spread after recurrence), which is one reason I'm not a fan.

I've attached a paper, with a quote from page 2, "During the last twenty years, it has been well established that all surgical approaches to pancreatic cancer need to be supplemented by adjuvant therapy."

But there are two 10-minute sides of that debate worth watching here:
https://youtu.be/naQ-HlZbEoI (Dr. Jordan Berlin, Vanderbilt, for TNT)
https://youtu.be/nd1l5-GrdVQ (Dr. Matthew Katz, MD Anderson, for surgery first)

Shared files

s00423-021-02362-y (s00423-021-02362-y.pdf)

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