08/05/2026
Some days I feel like I practice medicine in an alternate universe.
One world says:
"We removed the tumor."
"We'll watch."
"If it comes back, we'll treat it."
The other world asks:
What if we monitored for microscopic disease?
What if we measured circulating tumor DNA?
What if we looked at circulating tumor cells, immune function, metabolic health, inflammation, and the biologic terrain that allowed cancer to grow in the first place?
What if we intervened before a recurrence became visible on a scan?
I recently cared for a patient who was confidently told after surgery, "I got it all."
Weeks later, imaging suggested otherwise.
When I asked about closer surveillance using emerging technologies, I was told there was "zero evidence" and that we would simply wait until the cancer returned.
Then it did.
And suddenly the conversation became:
"You probably have about a year."
This is exactly what breaks my heart.
Not because every recurrence is preventable…. It absolutely can be…
But because waiting for cancer to declare itself is still considered acceptable in far too many situations, despite the incredible advances happening around us.
We are living in an era of AI, precision genomics, liquid biopsies, immunotherapy, metabolic science, hyperthermia, peptide therapies, immune modulation, and personalized medicine.
Yet too many patients are still being managed with a strategy that amounts to:
Wait until it gets worse.
Patients deserve more than reactive medicine.
They deserve physicians willing to ask harder questions, embrace evolving science, monitor intelligently, and fight for every possible opportunity, not just after a recurrence, but before it becomes one.
That isn't false hope.
That's what progress looks like.
