{"id":265,"date":"2026-01-09T11:54:59","date_gmt":"2026-01-09T11:54:59","guid":{"rendered":"https:\/\/paul.macpherson.photography\/TMI\/?p=265"},"modified":"2026-01-09T12:54:15","modified_gmt":"2026-01-09T12:54:15","slug":"when-the-curve-changes-direction","status":"publish","type":"post","link":"https:\/\/paul.macpherson.photography\/TMI\/when-the-curve-changes-direction\/","title":{"rendered":"When the Curve Changes Direction"},"content":{"rendered":"\n

The number arrived quietly in my inbox this morning while I slept.<\/p>\n\n\n\n

3:16 a.m. \u2014 No phone call. No preamble. Just a lab result waiting to be opened.<\/p>\n\n\n\n

CEA: 57.9.<\/strong><\/p>\n\n\n\n

\n

What is CEA?<\/strong>
CEA (Carcinoembryonic Antigen) is a protein that can be released into the bloodstream by certain cancers, including colorectal cancer. It\u2019s not used to diagnose cancer on its own, but it can be useful for tracking trends over time.

Why it matters here:<\/strong>
For patients with metastatic colorectal cancer, changes in CEA can offer an early signal of how the disease is behaving\u2014especially when interpreted alongside imaging and clinical findings. The direction of the curve matters more than any single number.<\/p>\n<\/blockquote>\n\n\n\n

For the first time in months, the curve bent the other way.<\/p>\n\n\n\n

I\u2019ve written before about learning to read numbers without panic<\/a><\/strong>\u2014about understanding that early treatment often looks like noise before it looks like signal. That was the posture I carried into this result as well. I wasn\u2019t looking for a miracle. I was looking for direction.<\/p>\n\n\n\n

And direction is what this offered.<\/p>\n\n\n\n

Context Matters More Than the Number<\/h2>\n\n\n\n
\"\"
CEA Levels – table<\/figcaption><\/figure>\n\n\n\n

On its own, a single CEA value doesn\u2019t mean much. I\u2019ve said that repeatedly, because it\u2019s true. Tumour markers lag. They fluctuate. They rise during inflammation and stress. Early cycles of treatment often make them worse before they make them better.<\/p>\n\n\n\n

But numbers don\u2019t live alone. They live inside patterns.<\/p>\n\n\n\n

Before treatment, my CEA was rising steadily. Not explosively, but unmistakably. That rise continued through the early days of the trial\u2014exactly as expected. Then, sometime between the second and third infusions, the slope slowed. And now, for the first time, it reversed.<\/p>\n\n\n\n

This isn\u2019t proof. It isn\u2019t a verdict. But it is<\/strong> a signal.<\/p>\n\n\n\n

And it arrived at the precise moment when a signal becomes meaningful: just ahead of imaging and biopsy, designed to answer the real question\u2014is this drug doing anything at all?<\/strong><\/p>\n\n\n\n

\"CEA
CEA Levels – graph<\/figcaption><\/figure>\n\n\n\n

Holding Steady Long Enough for Change to Appear<\/h2>\n\n\n\n

Much of this phase has been about staying inside the window.<\/p>\n\n\n\n

That\u2019s what the quiet check-ins<\/a><\/strong> were about. That\u2019s what reading lab abnormalities without spiralling was about. That\u2019s what tolerating infusions, managing fatigue, eating with intent, and keeping my body moving have all been in service of.<\/p>\n\n\n\n

You don\u2019t get to evaluate effectiveness if you don\u2019t remain eligible.<\/p>\n\n\n\n

So far, I\u2019ve stayed eligible.<\/p>\n\n\n\n

Clinically, I\u2019m still ECOG 0. My labs\u2014while dotted with \u201cabnormal\u201d flags\u2014tell a coherent story when read properly. Platelet dynamics adjusting. LDH reflecting metabolic activity. Calcium drifting slightly with hydration and fasting. PT\/INR shifting in a liver that has already given up a significant portion of itself and is still doing the work asked of it.<\/p>\n\n\n\n

None of those numbers has demanded intervention. They\u2019ve demanded interpretation.<\/p>\n\n\n\n

That discipline\u2014learning what to watch and what to let pass\u2014has been the real work of this chapter of my life, chapter 4 <\/a><\/strong>as I like to refer to it.<\/p>\n\n\n\n

Why This Drop Matters Emotionally (Even If It Doesn\u2019t Decide Anything)<\/h2>\n\n\n\n

I\u2019ve written about purpose as a survival variable<\/a><\/strong>, and I stand by that framing. But purpose doesn\u2019t eliminate uncertainty. It gives you something to stand on while uncertainty does its thing.<\/p>\n\n\n\n

This CEA result didn\u2019t change the plan. January 12 still matters. Imaging and biopsy will still decide whether I stay on this trial. Infusions continue as scheduled. The cadence holds.<\/p>\n\n\n\n

But psychologically, this matters.<\/p>\n\n\n\n

Not because it promises success\u2014but because it suggests that the effort, the patience, the waiting, and the discipline might be interacting with something real on the other side.<\/p>\n\n\n\n

When you live inside treatment, you don\u2019t get many moments like that.<\/p>\n\n\n\n

The Space Between Numbers and Proof<\/h2>\n\n\n\n

This is still the space between.<\/p>\n\n\n\n

The space I\u2019ve been writing about since before the first infusion<\/a><\/strong>. The space where nothing is declared and everything is observed. Where you resist the urge to narrate outcomes prematurely.<\/p>\n\n\n\n

The numbers have slowed before. This time, they turned.<\/p>\n\n\n\n

That doesn\u2019t end the story. It sharpens it.<\/p>\n\n\n\n

For now, I keep doing exactly what I\u2019ve been doing:<\/p>\n\n\n\n