A Window ‘tween Scans

I am having an epiphany, or maybe a rapid evolution in my journey.

Not the kind that arrives with certainty. The kind that arrives with a question, or five.

What if the most important part of cancer surveillance is not only what we can see, but what we can learn before we can see it?

After chemotherapy ended in February 2025, I had my first CT scan. There was a 4mm spot in my lung. Small. Watchable. The kind of thing that can be described carefully, cautiously, almost quietly. Maybe a common infection I was told.

Three months later, it was 8mm. My alarms went to DEFCON 1.

Three months after that, it was 18mm. DEFCON 3.

That is the part I keep returning to. My 1st PSCC staging was Stage 3! Feels like that!

I feel things returning—not with anger. Not exactly. More with the strange clarity that comes after I have lived through something once and I began to understand where the hidden doors were. The things no one tells you, things not neatly on a list or pamphlet.

But I will tell you, I will tell you my experience so you can ask better questions.

At 8mm, could we have done more? Could I have done more?

Could we have biopsied it?

Could we have used that biopsy tissue—or tissue already stored from my original cancer—to build a tumor-informed Signatera Assay?

Could a blood test have given us an earlier signal?

Could it have bought time?

These are not easy questions. They are not accusations. They are patient questions. Survivor questions. Advocacy questions.

Circulating tumor DNA, or ctDNA, is one of the most powerful ideas I have encountered in modern cancer care. I find the concept poetic: a tumor can leave traces of itself in the blood before it is large enough to command attention on a scan. It’s saying “HEY, I’M HERE!”

A CT scan asks, “What can we see?”

A ct DNA assay asks, “Is there evidence the cancer is speaking?”

That difference matters.

Signatera is a tumor-informed assay. It is built around the genetic fingerprint of a person’s own cancer. Once the assay is designed, it can be followed over time with blood draws. It does not replace scans. It does not replace pathology. It is not magic. A negative result does not promise that cancer is gone forever. NOTE: I have been reviewing false-positives and false-negatives for Signatera assays (in non-PSCC cancers).

But a positive result can be a signal flare. My first Signatera signal flare is in the air now.

And in cancer, time is not an abstract thing.

Time can mean a smaller tumor because we are finding it sooner.

Time can mean more treatment options. And a better outcome.

Time can mean the difference between watching and acting.

What I am learning in 2026 is that survivorship cannot be passive. It cannot only mean waiting for the next scan and hoping the images are clear and kind.

Survivorship also means asking whether we are using every reasonable tool available—especially when the cancer is rare, aggressive, or poorly studied.

PSCC patients do not have the luxury of massive data sets.

We do not always have clear road maps.

That makes better surveillance more important, not less.

I keep thinking about the space between 4mm and 18mm. The space between “too small to know” (aka indeterminate) and “large enough to prove.” The space where I had to sit with uncertainty while my biology kept moving.

That space deserves more attention.

Maybe the answer is not always biopsy. Maybe sometimes the nodule or node is too small, too risky, or too hard to reach. Maybe the tissue is insufficient. Maybe the assay cannot be built. Maybe the ct DNA is negative even when disease is present.

All of that can true.

But the questions still matter.

At 8mm, when a lung nodule has doubled after treatment for PSCC, should we be asking only, “When is the next scan?”

Or should we also be asking: Can we get tissue?

Can we build a ct DNA assay?

Can we monitor every eight weeks instead of twelve weeks?

Can we detect molecular recurrence before radiographic recurrence? And why did we conduct a Tempus Assay last year and not a complimentary Signatera Assay?

Can we move sooner, while the window is still open? You’ll see me more informed and advocating with data to support my case.

I do not want to turn my story into hindsight alone.

I want to turn it into a better question for the next patient, whether PSCC-positive or positive for any other rare cancer.

We are living in the midst of powerful prognostic tools. Tools that can sometimes hear cancer before imaging can see it. And if those tools exist, patients deserve to know when they might help, when they might not, and why they are or are not being used. That’s my initial two cents on the ethical side of this—at least for highly informed patients that grok their own situations.

My journey in 2026 is not only about treatment.

It is about learning how to ask sharper questions.

It is about not confusing caution with inaction.

It is about looking at the liminal space between scans and saying: Something may be happening here.

Let’s listen earlier.