Cancer does not arrive with poetry. It arrives in scans, numbers, and cold diagnostic language. That is where I am now — entering a new phase not defined by panic or chaos, but by clarity, territory, and strategy.
The results from my November 6 oncology appointment didn’t shock me. They confirmed the battlefield. The PET scan showed hypermetabolic activity in both lobes of the liver, matching the MRI findings. The cancer is active, but it is confined to the liver: no lungs, no bones, no peritoneal spread. The war is intense, but it has not expanded. That distinction matters more than most people realize.
Liver-Only Metastases: What It Means and Why It Matters
“Liver-only” sounds deceptively gentle. It is not. But it is manageable. When recurrence stays confined to a single organ, you retain access to pathways that disappear the moment cancer spreads beyond it:
• Localized surgical options
• Ablation or re-resection if chemo response is strong
• Curated clinical trials
• Aggressive systemic treatments with clear targets
The oncologist didn’t rewrite the plan. They validated it. FOLFIRI + Bevacizumab remains the mainstream next step, with clinical trial inclusion in play. Nothing is emotional; everything is tactical.
This is not a retreat. It is pivot.
The PET Scan as a Map of the War
PET scans don’t tell stories; they draw maps. They outline where the enemy lives and where it doesn’t. Liver recurrence means the battle is structural, confined, and direct.
There is a lesion in the caudate lobe labelled “suspicious” — not as a sentence, but as an assignment. Surveillance. Follow-up. Attention. In oncology, suspicious does not mean fear; it means focus.
Why My Physical Condition Matters
Numbers are never the whole picture. Performance status is the wild card.
I am not sedentary.
I am not folding into bed.
I am not someone who lets their body soften while their cancer sharpens.
I walk 15–30k steps daily.
I train.
I fast.
I push.
Physicians don’t look at me and see fragility. They see capacity — someone who can tolerate what most people cannot. That matters. That extends treatment windows. It keeps intervention options open longer than they usually are. Cancer respects momentum, even if it does not fear it.
Cancer Isn’t a Line — It’s a Negotiation
People unfamiliar with oncology imagine recovery as a staircase:
diagnosis → treatment → remission.
Cancer isn’t a staircase. It is a negotiation — relentless, mathematical, and brutally honest.
Every scan asks the same question:
Who are you today?
Not who you were before the first chemo cycle.
Not who you were before recurrence.
Not who you were when the original tumour was removed.
You look at the bloodwork.
You look at the metastases.
You look at the body that still carries you through Toronto streets before sunrise, step after step, and you answer:
I am not finished.
The Psychology of Containment
The key insight of this oncology update is not that the disease exists — it is where the disease exists.
No extra-hepatic spread means you are not fighting chaos.
You are fighting geography.
Stable or slightly improved outlook.
Multiple treatment pathways remain open.
Future interventions remain viable if chemo performs as expected.
The PET didn’t close doors.
It clarified which ones to walk through.
Chapter Four Is Not a Tragedy — It Is a Strategy
There is a photograph I carry in my head — not taken with a camera but etched into memory. A wet Toronto street before dawn, sodium lamps glowing like small moons, the pavement reflecting last night’s rain. The city is indifferent yet receptive. Every step forward echoes, and the silence answers:
You are still moving.
That is what this stage of cancer feels like. Not triumphant. Not cinematic. Just deliberate motion.
Chapter Four is not a collapse.
It is the first real offensive.
The enemy is visible.
The territory is defined.
The path is narrow, but navigable.
Cancer does not need to fear me.
It only needs to lose.