Ideas in this flowchart

• Role of chemotherapy in stage III and metastatic disease
• In stage III disease
• Adjuvant chemotherapy targets microscopic residual disease
• Surgery has no instrument to remove microscopic residual disease
• Clinical evidence shows that chemotherapy reduces recurrence risk
• Chemotherapy achieves a recurrence-risk reduction that resection alone cannot achieve
• In metastatic disease
• The treatment goal changes to control
• Control involves slowing progression and managing symptoms