When Bob invited me to chair this panel I thanked him for the nicely focused topic. We only have about three days worth of discussion on this, so we will have to get going fairly quickly to cover it. Clearly there is so much that we could discuss in terms of why treatments fail. I had to go along and try to look at some focused areas, and perhaps some areas that are a little bit unconventional, but I think what would be a good idea to start off just in very, very broad terms, making just a couple of moments of introduction because we have three basic treatment modalities that we use right now in the treatment of colon and rectal cancer. The first and still the primary is surgical management, and it is perhaps easiest to figure out why surgery fails.
Surgery fails because there is inadequate definition of the tumor extent.
The surgeon thought the disease was one place, and it was someplace else. He didn't get it out. It can fail because you know where it is but because of technical limitations you cannot get it out and the presence of metastases is kind of the same thing. There is more disease than you realized is there, and I think it is fairly straightforward. It is not always clear what to do about these things, but at least in a very broad sense we understand.