New, overwhelmed: What's microsatellite stable?

Caregivers can suffer from the demands of caregiving. Hope you will find ways to take good care of yourself too.

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)

I wish I had seen Dr Matthew Katz’s video 17 months ago. I may have presented it to our oncologist at top cancer center to go on the table immediately after diagnosis (with somatic mutation after presenting with high bilirubin levels.)
He quickly developed pancreatitis so the stent was needed, but it delayed treatment when it became obstructed twice and he had to be hospitalized. These delays may have contributed to the ineffectiveness of the neoadjuvant Folfirinox. What has Katz been presenting lately?

Sigh...atm its feeling like the world is revolving around him...i've basically "took care of him" if you will since his amputation in 2019...i'm the one who recognizes the symptoms of when he's starting "down the rabbit hole" as he calls it...can get him to respond when he's "in iraq", have made sure he gets to doctors, grocery store, etc even making sure he has a roof over his head..he lives in a VERY rural area off grid with his 8 cats and chickens ...except for the past 6 weeks if he's not in a hospital, he's at my house for the most part...he lives about hour and half north of me..(long story on how he ended up there but basically that or on the streets) and so about every 3-4 days i'm traveling to feed his cats, change litter boxes, refill water and pet them for a bit...occasionally i'll stay overnight there just so they'll have some company for a while...they REALLY miss him... anyways thats another story for another time as well...but tbh i'd rather he didn't come to this board,,,i know that sounds selfish of me but its how i feel atm.. I'm just REALLY grateful i have a super understanding husband 😀

You are an amazing person. He is blessed to have your beautiful loving heart.
There are many angles to this disease. It is not a death sentence! (Any more than we all have one-I don’t think any of us are getting out alive!)
Remind him that everyone has something. Encourage him to eat well, get outside as much as possible, and try to stay active. But most of all, take good care of yourself. You are one in a million.