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With regards to stage four cancer, there are actually some situations where we will perform surgery, even upfront for these tumors. Some situations would mean a symptomatic tumor, including obstruction or blockage or bleeding. If the patient is having obstructive symptoms, which would mean abdominal swelling, bloating, no bowel movements, throwing up, then we would really need to consider upfront surgery. Another thing would be bleeding to the point that the patient is symptomatic or anemic or your blood count is too low. We would need to consider surgery before giving any chemotherapy. These are certain situations. Other situations where we may operate on a stage four patient would include an isolated metastatic disease or a resectable metastatic disease. In this situation, we may be able to team up with a liver surgeon and perform a colon resection and a liver procedure either at the same time or at different times, likely with chemotherapy either surrounding or before or after.
