Porter, I have a little to add to the collective pile of info or thoughts on this. As of tomorrow, I am at 6 weeks post op from a left node resection of two of the segments due to a 5 + cm intrahepatic tumor and a smaller quarter of an inch size one. My surgical margin with no cancer cells was 2.2 cm, really rather large, but I think the surgeon measured the distance from the small tumor to the edge of the big one and tacked on another margin to boot in an attempt to aggressively eliminate any cancer cells that couldn't be seen but might be growing in the same orbit around the bigger tumor. The pathologist found NO other tumors than the two and no microscopic cancer cells either in the surgical margin. I had 6 hilar lymph nodes removed and they were normal. So, I'm left with the only really adverse risk being the multifocal aspect of my cancer...that is....two tumors. Stage T2b . The question in my mind, is, did the big tumor seed...but only one tumor grew because of it (that seems relatively unlikely)..or, is the smaller tumor a product of whatever process caused the first/bigger one. I believe my surgeon felt that the latter is the case, because she didn't want to use the term, "satellite tumor," but instead wanted to call it a "sister tumor". In that case, whatever caused those two to form, may well cause more to form. When I discussed chemo with the Mayo oncologist on Tuesday, he realized that I was pretty informed on treatments , etc about this cancer, so we got into some deeper discussions. He agreed that there is no study shows that the current standard chemo used as first line against bile duct cancer has an effect one way or another to keep new tumors from growing. However, they do know that it has an effect in at least shrinking tumors that can be seen and thus, they speculate that the chemo could potentially kill off microscopic cancer cells left after surgery. He was very much advising I do chemo, but said it was my choice. However, when I went to my surgical followup, the surgeon asked at the end whether anyone had discussed chemo with me. I said yes, and that my husband and I would be discussing it when we got home. Her reply was, "You ARE doing chemo....we don't do the surgery without the chemo." She was that adamant about it. Now, I had already decided I was doing chemo...but I meant that we were going to decide if I'd have a port put in up there or here at home....and if the first treatment would be at Mayo when the port was installed or if it would be here at home, but she didn't know that. She really felt very strongly that to give me the best chance, I should do chemo. I know I have to decide and do this for myself, but this woman took me on as a patient, knowing that I had diabetes and am obese and as such, not the greatest surgical risk for a procedure like a liver resection, but she did it...and I sailed through it and went home in a short 3 days...better than the best she expected...no complications, at least not there (until two weeks ago when I popped stitches on two of the incisions and now am trying to get them to close up). So, I feel like maybe she might take on another patient like me in the future again, based on how well I did....not assuming all diabetic and obese patients will do badly.....and I'd like to be her poster child for her doing this surgery....and then doing the followup chemo and then NOT having any recurrence. I know that it still could come back even with the chemo, ...as my GP said today, cancer is fickle...and esp this one.....but I have as good a chance as any for that curative resection to end this with a cure. I was in tears all day today.....trying to deal with the percentage of this that come back after resection despite chemo, but my mind is made up....I'm (we're) doing chemo. I agree with Mark. I never want to be in the piace where I found myself saying , "What if", if the cancer came back and I hadn't done chemo. I'll be thinking about you as you go through chemo...and will be right behind you several weeks on the same journey. Julie T.
Just for today, I can get through anything. "Never let fear decide your fate." (from the band, Awoination.)