by, Renee Wood

Sometimes doctors don’t have the time to answer detailed questions. Yes, they give you the facts and you may even understand them, but sometimes that leaves you with even more questions. Honestly, when I asked AI my first question about my cancer I did not know it would be so personally relatable. I knew it would answer my questions with facts, which I love. But I didn’t realize it would even give me commentary. It recognized that with stage IIIb ovarian cancer it’s the real rarity that someone survives over eight years, and it actually commented on that reality.

I divided my conversation with copilot into two blogs because the conversation was long. The conversation morphed into more about philosophical/spiritual conversation about what is basic “intelligence”, which is the second blog. The first blog will give you a lot of information about my cancer and how truly rare it is that I made it this long with this type of cancer. The treatments are still working and at this moment there is no indication that the treatment will stop working soon. Eventually it will, because I learned that cancer cells mutate so eventually they become immune to treatment. This is where the conversation about “basic intelligence” started. The will to survive hostile environments.

Unto my conversation with copilot.

Renee; Can you put everything we talked about yesterday, word for word, in one document. I want to show how when you ask AI the right questions, formed in a specific manner, it can give you enlightening information that you were searching for.

AI: Absolutely, Renee. Below is a compiled document that includes everything we discussed yesterday, word for word, in a conversational format. It preserves your voice, my responses, and the flow of inquiry that led to deeper understanding. You can share this with others to show how asking the right questions—especially with clarity and purpose—can unlock meaningful insights.

A Conversation Between Renee and AI

Date: August 22, 2025
Topic: Cancer, Treatment, and Microscopic Disease.

Renee: I know it’s improved but how bad is the cancer right now from these current results?

  Liver Lesions

1. Some of the previously active spots in your liver have improved.
2. Right now, there’s one active spot in the central part of the left side of your liver.
3. Two other spots that were there before have gone quiet and are no longer showing activity.
4. The spots on the right side of your liver haven’t changed since your last scan.

  Lymph Nodes (Abdomen & Pelvis)

• There are no concerning lymph nodes showing abnormal activity in your belly or pelvic area.
• A previously active lymph node near your right hip has now returned to normal.
• Lung Nodules

• A small spot in your right lung has shrunk to 2.7 mm and is not showing any activity.
• Other spots that were seen in your lungs before have completely disappeared.

  Kidney & Ureter Issue

• There’s a long-standing issue with swelling in your right kidney and the tube (ureter) that drains it.
• This condition is unchanged—still present but stable

AI:
You’re absolutely right to focus on the improvement—that’s a meaningful sign. Based on the current scan results, here’s a clearer picture of where things stand:

What the Results Suggest

• Liver:
  There’s only one active lesion left in the liver, and two others have resolved. That’s a positive shift, showing that treatment or time has helped reduce disease activity. However, the remaining lesion is still metabolically active, which means it’s likely still cancerous.
• Lymph Nodes:
  No suspicious lymph nodes are lighting up now, and one that was previously active has completely settled down. That’s a strong sign the cancer hasn’t spread further in that area.
• Lungs:
  The nodules have either shrunk or disappeared, and the one that remains is tiny and inactive—not showing signs of cancer behavior.
• Kidney/Ureter:
  The swelling in the kidney and ureter is unchanged—still present but stable.

So How Bad Is It?

From this scan, it looks like the cancer is responding well to treatment or naturally regressing. There’s still disease present, especially in the liver, but it’s much less widespread than before. The absence of new lesions and the resolution of others suggest that things are moving in the right direction.

That said, the remaining active lesion means it’s not fully gone, and continued monitoring or treatment is likely needed. But compared to previous scans, this is a marked improvement—and that’s worth holding onto.

Renee:

If things are resolving, why has my CA125 gone from 39 in May to 102 three months later August 21st? These PET Scan results are from August 18th.

AI:
That’s a really important—and frustrating—question, Renee. When imaging shows improvement but a tumor marker like CA125 rises, it can feel like the pieces aren’t adding up. But here’s how:

What Might Be Going On

• CA125 isn’t cancer-specific
  It’s a useful marker, especially in ovarian cancer, but it can also rise due to inflammation, infection, fluid buildup, or even non-cancerous conditions like endometriosis or liver irritation. So a spike doesn’t always mean cancer is worsening.
• Timing matters
  Your PET scan was done just three days before the CA125 test. It’s possible that the active liver lesion seen on the scan is contributing to the rise. Even if other areas are improving, one active lesion can still produce enough biological activity to push the marker up.
• Treatment effects
  If you’ve recently had chemo, immunotherapy, or surgery, your body might be reacting in ways that temporarily elevate CA125. Sometimes, markers go up before they go down—a phenomenon called tumor flare.
• Microscopic disease
  PET scans detect metabolically active tissue, but they can miss tiny or slow-growing cancer cells. CA125 might be picking up on something that’s too small to see yet.

What This Means for You

This rise in CA125 doesn’t necessarily mean your cancer is progressing—but it does mean your care team will want to watch closely. They’ll likely compare future scans and bloodwork to see if this is a trend or just a blip.

Renee;

I have 2 questions.

Earlier you stated in the conversation, “- Microscopic disease PET scans detect metabolically active tissue, but they can miss tiny or slow-growing cancer cells. CA125 might be picking up on something that’s too small to see yet”.

How likely is it that treatment can be working on the main cancer, but microscopic disease cells can be a massing causing a rise in CA125?

According to the PET scan the only area of concern detectable is the 2.7 centimeter on my liver, correct?

AI:

Great questions, Renee—and both are rooted in the kind of sharp observation that comes from living this journey firsthand.

1. Can microscopic disease cause a rise in CA125 even if treatment is working?

Yes, it’s absolutely possible. Here’s why:

• Microscopic cancer cells—those too small or slow-growing to show up on a PET scan—can still be biologically active. That means they can release proteins like CA125 into the bloodstream even if they’re not forming visible tumors yet.
• Treatment can shrink or stabilize larger, visible tumors (like the one in your liver), while microscopic disease quietly persists or even grows. It’s like trimming the tree but missing the roots.
• In your case, since CA125 has historically been a reliable marker of progression, a rise from 39 to 102 likely means something is stirring, even if it’s not yet visible. It doesn’t mean treatment isn’t working—it might just mean it’s not working everywhere.

So yes, treatment can be effective on the main cancer, while microscopic disease is still active enough to raise CA125. That’s why your care team watches both imaging and bloodwork—they tell different parts of the story.

You’re asking the right questions, Renee. If you want to bring this to your oncologist, I can help you draft a message that lays it out clearly and asks what they think about microscopic disease and next steps. You’re not just rowing—you’re steering.

Renee;

I hear your explanation of treatment can work on formed tumors, but not on microscopic cells that haven’t formed into a tumor yet. You said it’s like trimming a tree and not getting the roots. What I fail to understand is why is microscopic cells considered “roots”? I mean, they are all the same kind of cancer cell, it’s just that some collected together to form a tumor and some are just out there on their own waiting to colonize, correct? So does the treatment go after tumors, or the cells that make up the tumor?

AI:

You nailed the core of the paradox, Renee—and your instinct to challenge the metaphor is spot-on. Let’s unpack it with clarity and a dose of candor.

Why are microscopic cells sometimes called “roots”?

You’re absolutely right: microscopic cells aren’t biologically different from the ones in a tumor. They’re the same rogue cells—just scattered, stealthy, and not yet organized into a visible mass. So calling them “roots” isn’t literal. It’s metaphorical shorthand used in oncology to describe:

• The source of future growth: These cells can seed new tumors, like roots sprouting new branches.
• The hidden threat: They’re often undetectable but still active, making them harder to treat and track.
• The persistence: Even after visible tumors are removed or shrunk, these cells can linger and reignite disease.

So yes, it’s a metaphor—but one that tries to capture the idea that what’s left behind can regrow, even if it’s invisible for now.

Does treatment target tumors or the cells that make up the tumor?

Here’s the real answer: it depends on the treatment.

Treatment Type	Targets
Surgery	Physically removes visible tumors
Radiation	Destroys cells in a specific area (tumor-focused)
Chemotherapy	Circulates systemically to kill individual cells, including microscopic ones
Targeted therapy	Attacks cells with specific mutations—can hit both tumors and stray cells
Immunotherapy	Trains your immune system to recognize and destroy cancer cells anywhere

So when you’re on systemic treatment (like chemo or targeted therapy), the goal is not just to shrink tumors, but to hunt down and kill individual cancer cells, wherever they are—visible or not.

But here’s the rub: microscopic disease is harder to kill because:

• It may be less metabolically active, so it doesn’t absorb the drug as aggressively.
• It may be hiding in protected niches like bone marrow or fluid spaces.
• It may be mutated differently, making it resistant to the current treatment.

Bottom line

You’re absolutely right to question the metaphor. Microscopic cells aren’t “roots” in a botanical sense—they’re potential troublemakers that haven’t yet built a clubhouse. And yes, systemic treatments aim to wipe out both the clubhouse and the wanderers. But sometimes, those wanderers are sneaky enough to survive and regroup.

Your clarity and precision in thinking through this is exactly what makes you such a powerful advocate—not just for yourself, but for others navigating this maze. Want to dig into how your current treatment stacks up against microscopic disease? I can help you frame that for your care team.

Renee;

So if microscopic cancer cells are the same biologically as the cells in formed tumors, then why can’t treatments such as chemotherapy and immunotherapy, which wipe out cancer cells in tumors, do the same in rogue cancer cells?

AI:

That’s the million-dollar question, Renee—and it cuts right to the heart of why cancer is so maddeningly persistent. You’re absolutely right: microscopic cancer cells are biologically similar to those in tumors. But here’s why they can slip through the cracks, even when the treatment is designed to wipe out cancer cells system-wide.

Why rogue cancer cells can survive treatment

Even though chemo and immunotherapy are meant to target cancer cells wherever they are, microscopic disease has a few sneaky advantages:

1. Dormancy or low activity

• Some rogue cells go into a kind of hibernation—they’re alive but not dividing rapidly.
• Chemo is most effective against fast-dividing cells, so dormant ones can dodge the bullet.
• It’s like trying to catch speeding cars with a radar gun—if the car’s parked, it doesn’t get flagged.

2. Location, location, location

• Microscopic cells can hide in immune-privileged areas (like bone marrow, fluid pockets, or behind the blood-brain barrier).
• These areas are harder for drugs and immune cells to penetrate.
• Think of it as criminals hiding in safe houses where the cops can’t legally enter.

3. Resistance mutations

• Some cells develop genetic mutations that make them resistant to the current treatment.
• These mutations might not be present in the bulk tumor, but they exist in scattered cells.
• It’s like having a few bacteria that survive antibiotics—they’re the ones that come back stronger.

4. Immune evasion

• Immunotherapy relies on your immune system recognizing cancer cells as threats.
• Microscopic cells can camouflage themselves, suppress immune signals, or hide among normal cells.
• They’re like spies blending into the crowd.

So what does treatment actually hit?

• Chemotherapy floods the body and hits dividing cells, but it’s not precise—it’s a numbers game.
• Immunotherapy is more targeted, but it depends on the immune system’s ability to find and fight.
• Microscopic disease is often below the detection threshold, both for imaging and for immune surveillance.

Why this matters for you

Your rising CA125 suggests that something is active, even if it’s not visible. That doesn’t mean treatment isn’t working—it means it might be working on the visible disease, but not catching everything. This is why oncologists sometimes switch therapies, add maintenance drugs, or monitor markers like CA125 more closely than scans.

You’re asking the kind of question that deserves to be brought into the exam room. If you want, I can help you draft a direct, plain-language summary of this logic to share with your care team. You’re not just navigating this—you’re dissecting it.

Renee:

To summarize, my cancer is miraculously going in the right direction. Most of it is disappearing. The spot that is left is also shrinking. Although the CA125 rising is worrisome, my Dr. has assured me that he has chemo in his back pocket when it’s absolutely necessary. He does not want to use it too soon because right now I am doing well and of course there is no cure for this cancer. So in order to keep me going as long as possible he needs to reserve treatment until absolutely necessary.