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Did They Know They Had Metastatic Cancer Before Diagnosis?

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Once a person is medically diagnosed with having metastatic cancer (cancer that has spread to other organs), some people accuse that person of lying when the person says they didn’t know they had cancer. Because some cancers might grow for years before spreading to other organs, people think the person with cancer would had to have known they had it.

After more than a decade of living with metastatic lung cancer and serving as a patient research advocate, I have seen plenty evidence this need not be the case. Here are some important factoids about lung cancer that also hold true for other types of cancer:

1. Not all cancers have symptoms while they are growing.
Lung cancer rarely has symptoms until it has spread to other organs. Lungs don’t have nerves to say “ouch!” when a tumor is growing. For this reason, the vast majority of lung cancers were not detected until the cancer had spread elsewhere before the advent of lung cancer screening. But not everyone is eligible for lung cancer screening. Screening is limited to people who are at increased risk of developing cancer and who can benefit from treatment–this is to minimize the risk of overdiagnosing and treating people who don’t need cancer treatment.

2. Not all cancer grows at the same rate.
When I was diagnosed in 2011, I was told my non-small lung cancer did not grow fast and would have taken years to create the 2.5 inch tumor in my lung. I had months of combined chemo and radiation treatments designed to cure me of my cancer. Yet three months after a CT scan said my tumors were almost gone, I had grown a new three-inch tumor at the base of my neck. Some types of cancers are much more aggressive than others.

3. Best practice medical care might not be looking for cancer.
Another friend (age in mid-20s) reported shortness of breath when running. Because they were so young, their doctor took a conservative approach to treatment. My friend was treated for allergies, and then pneumonia. By the time doctors prescribed a CT scan, the lung cancer had spread to several other organs. You can’t find something when you’re not looking for it.

4. Not all cancer is detectable with current technology.
A friend who had lung cancer had a brain scan using magnetic resonance imaging (MRI). The scan showed their brain was clear of cancer. Three weeks later they began leaning slightly to one side while walking. A second brain MRI scan found sizeable tumors in their brain that didn’t show up just a few week earlier. The seeds of those tumors likely existed when they had the first brain scan, but scan technology is not sensitive enough to detect cancer that small.

My take-away message
Don’t assume that someone must have known they had cancer just because it had spread to other organs by the time it was officially diagnosed. Many people honestly had no idea they had cancer before they were diagnosed. I didn’t.

Remembering Mount St. Helens

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45 years ago today, Mount St. Helens erupted.  From my home in Tacoma over 70 miles away, I could hear and feel the blast and see the plume of ash, rock, and hot gases rising into the atmosphere.

Such major blasts of chaotic energy and hot gases produce extensive damage.  The explosion darked the skies for miles, extinguished lives, erased forests, and rearranged the landscape. The melted glacial ice generated a lahar that carried away homes, destroyed highway bridges, and clogged shipping lanes.  The blast left behind tons upon tons of pulverized rock that continue to cause challenges for communities living downstream–such as clogging their drinking water systems.


Mount St. Helens is now one of the most closely monitored volcanos in the world.  Last Saturday at the Cascade Volcano Observatory (CVO) open house I learned about different types of volcanoes, effects of eruptions on living creatures and the earth, how we track and model earthquakes to predict eruptions, understanding lahar flows so we can provide early warnings, and atmospheric influences on that guide ash and volcanic gas distribution. Models for making these predictions depend on data gathered by a variety of sources, such as weather balloons launched by the National Oceanic and Atmospheric Administration (NOAA). We can’t prevent volcanoes from erupting, but we can improve our preparedness and detection abilities so we can help reduce deaths and damage–IF we can learn from history and maintain the will to and funding to do what is necessary.

The posters I’m sharing in this blog were on display at the CVO open house.  CVO is part of the Volcano Hazards Program run the by U.S. Geological Survey (USGS), which is under the U.S. Department of the Interior.  Many USGS scientists and staff have departed in response to government actions of the past few months. In May the federal government has notified USGS researchers and students that their funds could be frozen and staff could be laid off. Other government cutbacks (such as reduced weather balloon launches) reduce USGS ability to monitor volcano activity, not to mention the U.S. Weather Service’s ability to predict tornadoes and other severe weather.

Despite the devastation, signs of life returned to the desolate blast zone within months, but it will never appear as it did before the eruption. If we don’t actively pursue the objective study of our world, we not only limit our learning about the world we live in, we will become less able to predict impending disasters and protect lives. Guess we’ll just have to adapt when natural disasters strike. If we can.