Next Wednesday, I sit down with my oncologist again.
Not for reassurance. Not for symbolism. For interpretation.
Last Friday — February 6 — I had my CT scan. I didn’t walk into it expecting poetry. I walked into it expecting language. Measurements. Comparisons. Words like stable, increased, nonspecific, follow-up — the vocabulary of a life where progress is counted in millimetres and meaning is decided in committee.
By the time we meet next week, the scan won’t be “new” anymore. It’ll be absorbed into the system. Filed. Compared. Placed against the previous baseline. And then the real question will surface — not “what does the scan say?” but:
What do we do now?
Because the scan is not clean.
The dominant liver lesion — the one that sits at the resection margin and carries most of the weight in this story — has grown. The other liver lesions appear stable. There is no definite extrahepatic disease in the abdomen and pelvis. The chest CT mentions a new 2 mm lung nodule described as nonspecific, something to watch rather than something to fear.
This is not chaos.
But it is not the kind of clarity you hope for when you’re on a trial drug and trying to believe the slope is changing.
So the conversation next Wednesday is going to be about three things:
definitions, velocity, and decision gates.
1. First: What counts as progression?
The first thing I’m going to ask is the most clinical question, because it determines everything downstream:
Does this scan meet the trial definition of progression?
Not “does it look worse?” That question is emotional.
The real question is bureaucratic:
- What lesions are being tracked as “target lesions” under the trial rules?
- What are the official measurements from baseline versus now?
- Has the sum of diameters crossed the threshold that triggers a protocol decision?
Because in trial medicine, you can have worsening biology without being labelled “progression.” And you can also have a single dominant lesion drive the entire classification, even if everything else stays quiet.
I want to know which one this is.
2. Second: Is the drug doing anything — even if it’s not shrinking tumours?
The second question is the one my brain keeps trying to answer on its own:
Is there evidence that the drug is slowing growth even if it isn’t shrinking the dominant lesion?
This is where the difference between standard care and trial care becomes real. Standard chemo is often judged by whether tumours shrink. But many newer therapies — especially targeted agents — can sometimes show benefit by stabilizing disease, slowing velocity, and preventing spread.
So I’ll be asking:
- Are the stable lesions a sign of control?
- Is the dominant lesion behaving differently than the rest — and if so, why?
- Are we seeing mixed responses (one lesion progressing, others stable)?
- Is that a known pattern with this class of drug?
I don’t want false optimism. I want honest framing.
If the drug is failing, I want that said plainly.
If the drug is doing something, even imperfectly, I want that understood precisely.
3. Third: What do we do about a single dominant problem?
This is the practical part.
If one lesion is growing and everything else is holding, the question becomes:
Can we control the one problem without throwing away the whole strategy?
I will ask directly:
- Is there an option for local control of the dominant lesion (ablation, radiation, resection, or other targeted approaches)?
- Would the trial protocol allow local intervention while staying on the drug?
- If local control isn’t possible, what are the next systemic options?
The underlying reality is simple: I’m not interested in either/or thinking unless the system forces it. If there’s a way to keep pressure on the disease without resetting everything, I want to know what it is.
4. Fourth: The lung nodule — signal or noise?
The report notes a new 2 mm lung nodule and calls it nonspecific. That word matters. “Nonspecific” is radiology’s way of saying: we’re not making a claim.
Still, I’ll ask about it, because clarity is calming:
- How common are tiny nodules like this?
- What is the follow-up schedule?
- What would make it concerning versus background noise?
Not because I’m panicking — but because I’m not interested in leaving loose threads untied.
5. Fifth: Timing — what happens next, and when?
Treatment schedules and scan schedules don’t just mark time — they define it. So I’ll ask for a clean timeline:
- When is the next scan?
- What are we expecting to see by then?
- What would trigger a change before that point?
And I’ll ask the question that sits underneath everything:
If the next scan looks the same — dominant lesion up, others stable — do we stay the course or pivot?
I want to know the decision rules before the next emotional event arrives.
This is the phase where the body waits, and the mind negotiates
There is a particular kind of mental fatigue that comes from living inside treatment. Not physical exhaustion — something sharper. The constant interpretation. The constant restraint. The steady effort of not overreacting to data while also refusing to ignore it.
I’ve learned something already in this phase of my treatment:
- Cancer is not just fought in the body.
- It is negotiated in the mind.
And next Wednesday is a negotiation day.
Not because we’re in crisis.
Because the scan is speaking, and it needs to be translated into a plan.
So I’m going in with one goal:
- To leave that appointment with clear definitions,
- a clear timeline, and a
- clear understanding of what is being measured — and
- what decisions those measurements will trigger?
The numbers don’t get to narrate my story on their own.
But I will listen to them.
And I will ask the right questions until the strategy is visible again.