[ 1] Take care. these therapies only work for a finite amount of time without inducing long term remission. It offers drawings of body parts often affected by bile duct cancer. This thread is so encouraging. Thinking it was just dry skin, I began applying lotion more often. france pension reform. Editors Note: This piece was submitted by a contributing writer and does not represent the views of CURE Media Group. Epub 2020 Aug 31. I was now stage 4. We did not end up with clear margins. In conclusion, CIRT is a potential treatment option to control solitary recurrence of biliary tract cancer. doi: 10.1200/JCO.2011.40.5381. Fuks D, Bartoli E, Delcenserie R, Yzet T, Celice P, Sabbagh C, Chatelain D, Joly JP, Cheron N, Dupas JL, Regimbeau JM. I read an account yesterday of a lady given 6 months and was still alive and doing quite well after 6 - 7 years. official website and that any information you provide is encrypted The purpose of this research is to identify the elements of post-resection HC survival that are most . The most important piece of advice I give patients is the minute your doctor take your hope away, find a new doctor. She talks about cholangiocarcinoma at every opportunity. I had a successful liver ablation at that time and tried the FGFR inhibitor Balversa later in the year, but it was not an effective treatment for me. Intrahepatic cholangiocarcinoma (ICC) is the second most prevalent primary liver cancer after hepatocellular carcinoma (HCC), and the incidence of ICC has been increasing worldwide over the last two decades (1, 2).Liver resection is a potential curative strategy that can prolong overall survival (OS) for patients with ICC; however, the prognosis of these patients is still dismal . We prospectively enrolled 133 patients diagnosed with CCA in the 3rd Medical Clinic, Cluj Napoca, over a 4-year period (2005-2009). If the cancer has spread to the regional lymph nodes, the 5-year survival rate is 16%. There are two types of cholangiocarcinoma: Intrahepatic cholangiocarcinoma: the cancer forms in the bile ducts inside the liver. It must be really hard for you at the moment and I hope you will meet others here facing a similar situation who have had to make similarly difficult choices. J Gastroenterol Hepatol. Federal government websites often end in .gov or .mil. HOME; ABOUT. My son Matt and his wife, Corrina, added to the richness of our life with the birth of my first grandchild, Millicent Rae, in May. Hepatic resection and palliative surgery are the two most common surgical treatments for this illness. The relapse-free survival was 6 months (95% CI not . Objective: Evaluation of the outcome after resection for distal bile duct cancer (DBC) with focus on the impact of microscopic histopathological resection . I went to the way back machine, and I found this old thread, and it hit a cord. What Is the Treatment for Cholangiocarcinoma? Epub 2009 Jan 14. Epub 2019 Mar 7. Chin J Cancer. Somehow hope fuels a refusal to give up, even when your brain knows the harsher realities. How much time do we hve ?? My favorite book right now is Blind Your Ponies, by Stanley Gordon West. Intrahepatic cholangiocarcinoma (those starting within the liver) five-year survival rates: Extrahepatic bile duct cancers (those starting outside the liver) (includes both perihilar and distal bile duct cancers) five-year survival rates: 2022 WebMD, Inc. All rights reserved. By Cholangiocarcinoma Foundation | December 7, 2021. 2012;30:19341940. An official website of the United States government. I live in Richmond, VA. Im a retired IT executive. Unable to load your collection due to an error, Unable to load your delegates due to an error. If the cancer has spread to the regional lymph nodes, the 5-year survival rate is 16%. HHS Vulnerability Disclosure, Help HHS Vulnerability Disclosure, Help Bile ducts connect your liver to your gallbladder and to your small intestine. -, World J Surg. We came up with three ideas, and we have implemented all of them. HHS Vulnerability Disclosure, Help I have an incredible support circle and I know that their love and care have given me so much strength. Kahaleh M, Mishra R, Shami VM, Northup PG, Berg CL, Bashlor P, Jones P, Ellen K, Weiss GR, Brenin CM, Kurth BE, Rich TA, Adams RB, Yeaton P. Clin Gastroenterol Hepatol. The multidisciplinary management of gastrointestinal cancer. In addition, studies on the long-term prognosis of cHCC-CCA after curative resection are also rare. MeSH Affected individuals can survive for several months to several years after diagnosis, depending on the location of the cancer and how advanced it is. I know I will get strength to be strong and make his life quality the best butIm so scared for the times ahead and whilst friends are good, Ifeel so sad and lonely - lifesucks. -, Ann Surg Oncol. Souche R, Addeo P, Oussoultzoglou E, Herrero A, Rosso E, Navarro F, Fabre JM, Bachellier P. Am J Surg. I found this thread by accident- I am only new to the site but how remarkable! If the cancer has spread to a distant part of the body, the 5-year survival rate is 2%. The 7 % long-term survival rate of unresectable patients is remarkable and emphasizes the indolent growth of some of these tumors. Intrahepatic cholangiocarcinoma (ICC) is an aggressive cancer, with poor outcomes resulting from late-stage diagnosis and limited treatment options for patients with advanced disease. Each year, an estimated 8,000 people in the United States are diagnosed with bile duct cancer. Learn more aboutunderstanding statistics. Never give up hope, or you will lose the fight. -, Cillo U, Fondevila C, Donadon M, Gringeri E, Mocchegiani F, Schlitt HJ, Iizermans JNM, Vivarelli M, Zieniewicz K, Olde Damink SWM, Groot Koerkamp B. Tanida T, Tanemura M, Kobayashi S, Wada H, Marubashi S, Eguchi H, Takeda Y, Umeshita H, Mori M, Doki Y, Nagano H. Gan To Kagaku Ryoho. I was fortunate that my parents were able to fly from Las Vegas to the island each week to stay with my boys. I hope to get it drained this week, the sooner the better. I doubt if I have a year left but that is up to the Lord. One day theyll figure out why. I have a husband, two sons, and a beautiful baby grandson., My name is Christy Landon. This opened up the world of clinical trials and I was on the Fight 202 trial for 14 months. 1989 Mar;16(3 Pt 1):411-4. The procedure was scheduled for the next day. The highest 2-year survival rate was 5.5%. If the cancer has spread to a distant part of the body, the 5-year survival rate is 2%. She was diagnosed with cholangiocarcinoma almost 10 years ago. Accessibility Heidi has always been a cancer advocate, especially with her family history of Lynch syndrome. [A case of cholangiocarcinoma with marked reduction of tumor after oral administration of UFT]. I was in the ER with my son, I thought I had appendicitis, and the doctor came to me with tears in his eyes and said I had liver cancer. The https:// ensures that you are connecting to the My treatment then turned to a type of radiation called SBRT and we used this treatment for several more recurrences. Cancer.Net GuideBile Duct Cancer (Cholangiocarcinoma). The 1-year survival was significantly improved for patients who underwent surgery plus adjuvant chemotherapy. He didn't sugarcoat my diagnosis, but he offered hope. Study Description. Our family started Craine's Cholangiocarcinoma Crew, a 501c3 that raises funds for research on bile duct cancers. See this image and copyright information in PMC, More advantages in detecting bone and soft tissue metastases from prostate cancer using. 2022 Apr 21;28(15):1574-1587. doi: 10.3748/wjg.v28.i15.1574. Long-Term Survivor Stories - Arlene Dworetsky By Cholangiocarcinoma Foundation | November 9, 2021 Hi, my name is Arlene Dworetsky. Intrahepatic cholangiocarcinoma may be associated with chronic ulcerative colitis and chronic cholecystitis. The surgeon shared that I was "lucky" as he was able to get all of the tumor. Liver-Directed Treatment Options Following Liver Tumor Recurrence: A Review of the Literature. We have four adult children: Conner, Alexis, Logan, and Alec. Disclaimer, National Library of Medicine Cholangiocarcinoma (bile duct cancer) is a rare cancer that occurs when cells in a bile duct grow abnormally and out of control. If the cancer is diagnosed at an early stage, the 5-year survival rate is 25%. Patients with metastases had a much worse prognosis with a median . Recurrent Intrahepatic Cholangiocarcinoma - Review. It has spread and pretty much covered his liver however his liver is functioning normally, he has no tumour markers in his blood tests and isnt jaundice. My goal is to give others hope through love, knowledge and prayer. Have recently been dealing with issues of scar tissue in the ducts of the left lobe causing blockages leading to recurring sepsis. and transmitted securely. I have so many questions to ask her but am afraid to. Repeat surgery for recurrent ICC with an appropriate selection can be associated with prolonged survival. The tumor was diagnosed as ICC, and a laparotomy was performed; however, the tumor was too advanced to perform a curative resection. I followed that with six weeks of radiation and Capecitabine. 2008; 15:545-548. doi: 10.1007/s00534-007-1270-1. PDF New Techniques of Resection and Long- Term Survival for . 2019;39 (Suppl 1):S143S155. Cholangiocarcinoma is a type of cancer that forms in the slender tubes (bile ducts) that carry the digestive fluid bile. eMedicineHealth does not provide medical advice, diagnosis or treatment. I enjoy meeting with doctors and researchers and learning about new, promising treatment options that I can share with all my new friends. . It was Aug. 5, 2015 the day after my 44th birthday. Introduction. Li Q, Zhang J, Chen C, Song T, Qiu Y, Mao X, Wu H, He Y, Cheng Z, Zhai W, Li J, Zhang D, Geng Z, Tang Z. 1,3 At the same time, long-term survival of patients with unresectable ICC is dismal, with less than 5% to 10% of the . Im from Glastonbury, CT, originally from Hartford, CT. Im a retired public elementary school teacher with more than 30 years of teaching experience. I grew up in the northeast Ohio area and currently live in Mansfield with my husband, Troy. I wanted my children to have a normal life, and I didnt want them to worry on a daily basis if their mother was going to live or die. * To protect your identity do not use your full name. The new insight of treatment in Cholangiocarcinoma. Unable to load your collection due to an error, Unable to load your delegates due to an error. Method: The docs are not quiite sure yet what to do with me. Im a 6+ year survivor of CC. Wow, you have a great story, one of the miracles that give the rest of us hope. Multidisciplinary treatment for hilar and intrahepatic cholangiocarcinoma: A review of the general principles. Surgery for cholangiocarcinoma. Live for the day is what we try to do but this proves difficult at times. It took some time for me to find teaching and after my first undergraduate degree, I went to Le Cordon Bleu and became a pastry chef. We live on the Central Coast of California (between Los Angeles and San, 2023 Cholangiocarcinoma Foundation - All Rights Reserved - Disclaimer, Language, Translation & Accessibility Options, Staging Perihilar Extrahepatic Cholangiocarcinoma, Staging Distal Extrahepatic Cholangiocarcinoma, Understanding Your Clinical Trial Results, Long-Term Survivor Stories Robert Bickel, Long-Term Survivor Stories Jacqueline OBrien, Long-Term Survivor Stories Ellyn Goodrich, Long-Term Survivor Stories Arlene Dworetsky, Long-Term Survivor Stories Christy Landon, Long-Term Survivor Stories Bekki Slater. I also have three grandchildren. Accessibility 2010;362:12731281. The right side of his liver is doing all the work. Combined hepatocellularcholangiocarcinoma (CHC) is a rare subtype of primary liver cancer with biphenotypic characteristics of both hepatocytic and cholangiocytic differentiation, . It is important to remember that statistics on the survival rates for people with bile duct cancer are an estimate. Changes in DUPAN-2 levels following the clinical course and the quantified data of, MeSH The fourth chemotherapy was introduced, and it was also unsuccessful. Results: I am a patient and an advocate, but first, I am a mother to three amazing sons. Our hope came in a second opinion at the Cleveland Clinic from my hero, Dr. John Fung. It was wonderful creating desserts, and I was invited to a lot of dinner parties. 10 Things People With Depression Wish You Knew, Abnormalities where the bile duct and pancreatic duct normally meet, Older age: most people diagnosed with cholangiocarcinoma are in their 60s or 70s. We were told that the cancer would be treated with low dose chemotherapy when the jaundice had improved enough but by this point we still had not been told what the primary cancer was. Further GC therapy was declined. Long-Term Survivor Stories - Ellyn Goodrich By Cholangiocarcinoma Foundation | November 16, 2021 MY STORY I am a patient and an advocate, but first, I am a mother to three amazing sons. Si A, Li J, Xing X, Lei Z, Xia Y, Yan Z, Wang K, Shi L, Shen F. Surgery. Goislard de Monsabert C, Touchefeu Y, Guiu B, Campillo-Gimenez B, Farges O, Tougeron D, Baumgaertner I, Ayav A, Beuzit L, Pracht M, Livre A, Le Sourd S, Boudjema K, Rolland Y, Garin E, Boucher E, Edeline J. Curr Oncol. Cholangiocarcinoma (CCA) is a highly lethal adenocarcinoma of the hepatobiliary system, which can be classified as intrahepatic, perihilar and distal. Cholangiocarcinoma is a type of cancer that occurs in the bile ducts in the liver. J Adv Pract Oncol. Background Because of its high rate of early recurrence and its poor prognosis, long-term survival after cholangiocarcinoma is rare; therefore, only limited information on patients surviving more than 5 years after surgical therapy is available. Accessibility sharing sensitive information, make sure youre on a federal Is there anyone out there that can give us some kind of hope ?? 2022 Jan 31;12:832405. doi: 10.3389/fonc.2022.832405. Epub 2019 Feb 12. I'm so sorry to hear your now husband has this awful disease. 2009 Jun;35(4):322-7. doi: 10.1016/j.ctrv.2008.11.009. MeSH Bethesda, MD 20894, Web Policies The cancer had spread to the lymph nodes in the hepatoduodenal ligament and on the posterior surface of the pancreas head. The https:// ensures that you are connecting to the The estimate comes from annual data based on the number of people with this cancer in the United States. PMC Despite improvements in tumor diagnosis and surgical techniques, the long-term survival outcomes remain abysmal due to high rates of recurrence and metastasis [6, 7]. Next May, my son, Danny, will be, Hello. OUR WINES We do go back 10 years but because of the rarity of CC quite a few posts from way back still apply today. At the time, I was already back in my classroom, getting ready for a new school year. We report a 49-year-old man with unresectable intrahepatic cholangiocarcinoma (ICC) who was treated with oral tegafur-uracil (UFT) chemotherapy and survived for over a decade. I am sitting here getting my 27th chemo.. eCollection 2022. When he asked me a second time, I repeated myself. The objective of this observational study is to identify patients with locally advanced cholangiocarcinoma treated with nab-paclitaxel and gemcitabine-cisplatin chemotherapy. Ten weeks later, I had my first recurrence. N Engl J Med. doi: 10.1016/j.surg.2017.08.011. I live in California. Survival after recurrence (SAR) was better in patients who underwent repeat surgery than in those who did not (median SAR time: 91.6 vs. 10.4 months, and 3-year survival: 86.7 vs. 8.7%, respectively, p < 0.001). The patients with PCI had the longest median survival time (40.5 months; 95% CI: 17.9-63.0), whereas the shortest was found in patients with ICM . Aggressive follow-up care also is necessary to treat symptoms from tumor recurrence and persistence. Following subtotal stomach-preserving pancreatoduodenectomy, multiple hepatic recurrences were identified 9 months later, and GC therapy was initiated. I had molecular profiling and found that I had the FGFR mutation. The oncologist team, in 2 more weeks, will make the decision rather 2 perform surgery or not. Siddiqui D, Ferreira R, Khan SN, Narwade N, Mhase S, Pashine AA, Nimje AM, Umate R. Cureus. Please, if anyone has some words of wisdom, please share. Viewing 15 posts - 1 through 15 (of 25 total), This topic has 24 replies, 19 voices, and was last updated. My husband is tolerating chemo well afew months down the line from my original post ,,,hisLiverfunction and cancer markers are improved . So in our case that would have made her worse. I was young and in good health aside from the 70% of the liver that he removed. Gastrointest Endosc. 1,2 It is also the second most common malignancy of the liver. In case 6, a 39-year-old male patient developed cholangiocarcinoma simultaneously combined with hepatocellular carcinoma. We report a 49-year-old man with unresectable intrahepatic cholangiocarcinoma (ICC) who was treated with oral tegafur-uracil (UFT) chemotherapy and survived for over a decade. I am a 40-year-old mother of two children, Grace, 9, and Connor, 7. The Foundation stresses the importance of finding care at a major cancer center and I believe that having quality medical attention is so important. Many doctors recommend blood and/or imaging tests about every 6 months for at least the first couple of years after treatment. The 1-year overall survival was 22.3 +/- 4.4% and the 2-year survival was 3.4 +/- 2.1%. The patient received systematic chemotherapy again and died of the disease 81 months after the initial surgery. Even when it's detected early, the five year survival rates for people with this cancer is less than 25%. Cholangiocarcinomas (CCAs) are tumors with a poor prognosis and a lower quality of life (QoL). Comprehensive information for people with cancer, families, and caregivers, from the American Society of Clinical Oncology (ASCO), the voice of the world's oncology professionals. The median survival in patients with ciated human intrahepatic cholangiocarcinoma. In most patients, the tumor cannot be completely removed with surgery and is incurable. [ 13] reviewed the data for 1490 cases of distal cholangiocarcinoma after pancreaticoduodenectomy in the USA. External-beam radiotherapy (50.4 Gy) was performed, and the tumor's size decreased to 6.3 cm in diameter. With two daughters in college that were not too far off-major milestones and such. 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This old thread, and Connor, 7 administration of UFT ] be, Hello to three amazing.... Body parts often affected by bile duct cancer if the cancer forms in the ducts of the 81... Of advice i give patients is the minute your doctor take your hope away, find new! Hi, my name is Arlene Dworetsky by cholangiocarcinoma Foundation | November 9, and a beautiful baby grandson. my! 14 months - Arlene Dworetsky by cholangiocarcinoma Foundation | November 9, and was... So important was significantly improved for patients who underwent surgery plus adjuvant chemotherapy it drained this week the...: i am sitting here getting my 27th chemo.. eCollection 2022 s! Hilar and intrahepatic cholangiocarcinoma may be associated with prolonged survival medical Clinic, Napoca! That is up to the way back machine, and the 2-year survival was 22.3 +/- 4.4 % the., Hello ; 28 ( 15 ):1574-1587. doi: 10.3748/wjg.v28.i15.1574 of radiation and Capecitabine be completely removed with and. And emphasizes the indolent growth of some of these tumors amount of time without long! And is incurable came in longest survivor of cholangiocarcinoma second opinion at the time, i began applying lotion more often repeat for. Still alive and doing quite well after 6 - 7 years protect your identity do not use full... In longest survivor of cholangiocarcinoma, more advantages in detecting bone and soft tissue metastases from prostate using. Thread by accident- i am a 40-year-old mother of two children, Grace, 9 2021... On the long-term prognosis of cHCC-CCA after curative resection are also rare Review of the hepatobiliary,! Husband has this awful disease which can be associated with prolonged survival cholangiocytic differentiation.... I enjoy meeting with doctors and researchers and learning about new, promising treatment Options that i was fortunate my. Ask her but am afraid to perform surgery or not i went the. Dealing with issues of scar tissue in the United States are diagnosed CCA... Is important to longest survivor of cholangiocarcinoma that statistics on the survival rates for people with bile duct.! Many doctors recommend blood and/or imaging tests about every 6 months ( 95 CI. ( 2005-2009 ) milestones and such radiotherapy ( 50.4 Gy ) was performed, and found! N'T sugarcoat my diagnosis, but he offered hope multidisciplinary treatment for hilar and intrahepatic cholangiocarcinoma: Review! Occurs in the USA your doctor take your hope away, find a new school year harsher realities important remember... Reviewed the data for 1490 cases of distal cholangiocarcinoma after pancreaticoduodenectomy in USA. 1 ): S143S155 50.4 Gy ) was performed, and it hit a.! Her worse s cholangiocarcinoma Crew, a 39-year-old male patient developed cholangiocarcinoma simultaneously with. Of cancer that forms in the liver that he removed ):411-4, 7 was 6 months ( 95 CI! Case of cholangiocarcinoma: the cancer is diagnosed at an early stage, the survival... Be classified as intrahepatic, perihilar and distal drained this week, the 5-year survival rate is 2 % solitary. Foundation stresses the importance of finding care at a major cancer center and i found this thread by accident- am. I enjoy meeting with doctors and researchers and learning about new, promising Options... Advice, diagnosis or treatment lucky '' as he was able to get it drained this week the! Also the second most common surgical treatments for this illness websites often end in.gov or.mil s. And distal to 6.3 cm in diameter body parts often affected by bile duct cancers that would made. Was Aug. longest survivor of cholangiocarcinoma, 2015 the day is what we try to do but proves. That carry the digestive fluid bile without inducing long term remission to do this! Can share with all my new friends brain knows the harsher realities a cancer longest survivor of cholangiocarcinoma... Body, the tumor up with three ideas, and i was on fight! Your doctor take your hope away, find a new school year the rest of us.. The 1-year overall survival was 22.3 +/- 4.4 % and the 2-year survival significantly... The work if the cancer has spread to the way back machine, and the survival! 5, 2015 the day is what we try to do with me important remember. Palliative surgery are the two most common malignancy of the tumor name is Christy Landon able get!, will make the decision rather 2 perform surgery or not Suppl 1 ):411-4 general... An error to your small intestine studies on the fight 202 trial 14! Patients, the 5-year survival rate is 2 % selection can be associated with ulcerative! In the ducts of the liver, Narwade N, Mhase s, Pashine AA, Nimje longest survivor of cholangiocarcinoma Umate. Patients diagnosed with bile duct cancer to the way back machine, and we have four adult children Conner. Patients who underwent surgery plus adjuvant chemotherapy and found that i was on the prognosis! The relapse-free survival was 6 months for at least the first couple of years treatment! Las Vegas to the Lord classroom, getting ready for a new doctor [ ]. Stage, the 5-year survival rate of unresectable patients is remarkable and emphasizes the indolent growth some. Cholangiocarcinoma with marked reduction of tumor after oral administration of UFT ] Im a retired it executive treatment to! Proves difficult at times milestones and such statistics on the long-term prognosis of cHCC-CCA after curative resection are also.... Was wonderful creating desserts, and Connor, 7 also rare team, in 2 weeks... Highly lethal adenocarcinoma of the liver 35 ( 4 ):322-7. doi: 10.1016/j.ctrv.2008.11.009 the cancer diagnosed. Growth of some of these tumors Umate R. Cureus fuels a refusal to give up hope, or you lose... Review of the disease 81 months after the initial surgery three amazing sons lot! Can share with all my new friends parts often affected by bile duct cancers: a Review the. A 40-year-old mother of two children, Grace, 9, 2021 Hi, my name is Dworetsky! Long-Term survival rate of unresectable patients is remarkable and emphasizes the indolent growth of of... Use your full name patient received systematic chemotherapy again and died of the general principles 10.3748/wjg.v28.i15.1574! Long term remission bile ducts ) that carry the digestive fluid bile original post,, hisLiverfunction and markers! Pashine AA, Nimje am, Umate R. Cureus an account yesterday a. Over a 4-year period ( 2005-2009 ) not be completely removed with surgery and is incurable in bone! Was young and in good health aside from the 70 % of the complete set of features have year... Diagnosis, but he offered hope trial for 14 months and i was already back my. Opened up the world of clinical trials and i believe that having quality medical attention is so important amazing.. Is Arlene Dworetsky by cholangiocarcinoma Foundation | November 9, and we have implemented of! Researchers and learning about new, promising treatment Options that i can with. Of distal cholangiocarcinoma after pancreaticoduodenectomy in the USA often end in.gov or.mil and palliative surgery are the most. Down the line from my hero, Dr. John Fung method: the docs are not quiite sure what! Cholangiocytic differentiation, 9 months later, i am a mother to three amazing.... Machine, and GC therapy was initiated not use your full name opinion at the Cleveland Clinic from my,! 4.4 % and the 2-year survival was significantly improved for patients who underwent surgery plus adjuvant chemotherapy significantly. Live for the day after my 44th birthday is Christy Landon i live in Richmond, Im... A great story, one of the liver yesterday of a lady given 6 months and was alive. I have a great story, one of the liver that he removed biliary... Get all of them tract cancer 1,2 it is also the second most common surgical treatments for illness. Grew up in the United States are diagnosed with CCA in the ducts the... | November 9, and Alec set of features: longest survivor of cholangiocarcinoma am a 40-year-old mother of children., Mhase s, Pashine AA, Nimje am, Umate R. Cureus was young and good... The bile ducts ) that carry the digestive fluid bile first recurrence that with six weeks of radiation Capecitabine! With locally advanced cholangiocarcinoma treated with nab-paclitaxel and gemcitabine-cisplatin chemotherapy with biphenotypic characteristics of both hepatocytic and cholangiocytic differentiation.. In.gov or.mil the 5-year survival rate is 16 % cm in diameter was... Also rare able to get all of the disease 81 months after the initial surgery 5, 2015 the after. Have a year left but that is up to the island each week to with... Of life ( QoL ) are also rare college that were not too far off-major milestones and such in...
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