Observations from the grey zone: things I carry with me as a cancer patient

In short: As a cancer patient, you end up reading a lot. Some of what you read is solid science. Another part is the grey zone: observations from individual doctors, stories from other patients, mechanisms demonstrated in mice but unproven in humans. This article is about that second category. I’m not asking you to believe anything that follows – I’m just showing you six ideas that have stuck with me, with links, so you can see I didn’t invent them, and with an honest label on each one: how much is science and how much is story.

Why I’m writing about unproven things

The rule I set for myself: every observation below gets a label. Demonstrated mechanism means there are published studies showing how it could happen – usually in animals. Anecdotal means stories: real, but not filtered through a study. None of them is a treatment recommendation. All of them, however, are good questions to ask your doctor.

Some of these ideas I came across on X, from Dr. Jason Williams , an American interventional radiologist who runs a private oncology clinic in Mexico and wrote a book about immunotherapy injected directly into the tumor . To be upfront with you from the start: his clinic’s results come from conference presentations and his own materials, not from independently replicated randomized trials. That doesn’t automatically make him wrong – but it makes him a source of hypotheses, not certainties. That’s exactly how I read him.

1. Surgery heals the wound – and may wake up sleeping cells

The idea that has stuck with me the most: after an operation, the body launches a massive regeneration program – growth factors, inflammation, “rebuild here”. Except that signal doesn’t distinguish between healthy tissue and any cancer cells still left in the body. It feeds them all.

The label: mechanism demonstrated in animals; the magnitude in humans – unproven.

The solid part: in 2018, MIT researchers showed in mice that a simple surgical wound – completely unrelated to the tumor – was enough for dormant metastases, held in check by the immune system, to start growing (the full study ). In humans, researchers like Retsky and Demicheli noticed long ago that relapses after breast cancer surgery cluster suspiciously in the first 8-18 months – a pattern that fits the idea of awakening, not slow, uniform growth.

The honest part: when the obvious solution was tested – an anti-inflammatory given around the time of surgery – the randomized trial came out negative . So the mechanism is real, but no one has yet demonstrated in humans either how big the effect is or how to prevent it. My conclusion as a patient is not “avoid operations” – surgery cures people every day. It’s just this: the period around an operation is a vulnerable window, and it deserves to be treated as one.

2. The pulled tooth, the broken arm, and the cancer that comes back

I’ve heard, anecdotally, several stories with the same pattern: a patient stable for years on treatment has a tooth pulled, gets a dental implant, breaks a bone, or goes through some other seemingly unrelated insult – and shortly afterward the cancer comes back, aggressively.

The label: anecdotal in humans; plausible mechanism, demonstrated in animals.

There is no study linking dental extractions to relapse in humans. There is, however, a mechanism published in Science in 2018: inflammation – anywhere in the body – recruits a type of immune cell that throws out sticky webs of DNA, and those webs can wake up dormant cancer cells . Blocking them, in mice, kept the cells asleep. The important detail: in these experiments the awakening didn’t come from an operation, but from a bacterial infection and from cigarette smoke – that is, from pure inflammation. Which suggests that the key word isn’t surgery or the tooth, but any major insult that triggers massive repair and systemic inflammation: a fracture, serious trauma, a nasty infection. Same category, same signal. A 2025 study added another piece: inflammation changes the state of dormant cells and pushes them toward awakening. Even more uncomfortably, a recent lung cancer study suggests that, through the same inflammatory mechanism, even chemotherapy can wake up dormant cells – one more reason why the question “how much and when” is just as important as “which treatment”.

The tooth stories remain stories. But the mechanism that could explain them exists, in black and white.

3. The advice I received myself: postpone what isn’t vital

This one isn’t something I read on the internet – it’s my own experience. I had a non-cancerous medical problem, a bothersome one, for which an operation was being discussed. My doctor in Turkey told me simply: as long as the disease is under control, we do no intervention that isn’t absolutely necessary. He didn’t lecture me about dormant cells. But placed next to observations 1 and 2, his recommendation makes sense.

The label: prudent clinical practice; there is no official guideline requiring it.

No oncology guideline says “postpone non-essential operations”. What the literature on the perioperative period does say is that the days around any operation are a window of immunological vulnerability – and medicine’s answer is to optimize that window, not to avoid surgery. My patient’s translation: an elective procedure, in a cancer patient, is not an administrative decision. It’s a decision to discuss with your oncologist, with a risk and a benefit laid out on the table.

4. Does a biopsy spread cells? Yes, rarely – and there are techniques that reduce the risk

This is the observation I dug into the deepest, because it concerns me directly: my diagnosis started with biopsies. The fear circulates widely among patients: “don’t let them stick a needle in you, it spreads the cancer”.

The label: a real, documented phenomenon, but rare – and the consensus is clear that the diagnostic benefit dominates.

The actual numbers: for lung biopsies, needle-tract seeding is on the order of 1 in several thousand . For the liver, with older techniques, around 2-3% – and with the modern coaxial technique, close to zero . Without a biopsy there is no molecular diagnosis, and without a molecular diagnosis I would never have received the pill that melted my tumors. Refusing a biopsy is, statistically, a far more dangerous decision than the biopsy itself.

But – and this is what I find genuinely useful – modern interventional radiology treats this risk as a real one and designs around it. What a patient can ask before a biopsy:

• Do you use the coaxial technique? (a single outer sheath through which all samples pass, so the needle doesn’t re-touch fresh tissue on the way out)
• Do you seal the tract on withdrawal? (cauterization or a hemostatic plug, described here )
• Could a liquid biopsy – a blood sample – answer the same question? Guidelines for advanced lung cancer increasingly accept it as a first step; be careful though, a negative blood result rules out nothing – it sends you back to tissue.
• Are you taking enough samples in a single pass for complete genomic testing? One good biopsy now is safer than two thin ones a month apart.

5. If the needle is already in the tumor, why does it come out empty?

The idea from Dr. Williams that intrigued me the most: at the moment of a biopsy, the needle is already in the tumor. His argument : why use that pass only to take material out, when you could, in the same gesture, also inject something – immunotherapy, an immune stimulant – directly into the lesion?

The label: the field is legitimate; the practice of “treating at every biopsy” is experimental.

The solid context: intratumoral therapy – injecting treatment directly into the tumor – is a real field, with an FDA-approved drug for melanoma since 2015 and a serious review in Radiology in 2024. The logic is beautiful: you turn the tumor itself into a vaccine, with much smaller systemic doses. A phase 1 study in metastatic prostate cancer , which combines partially freezing the tumor with a locally injected immune cocktail, reported unusually good responses and received fast-track status from the FDA.

The counterweight, just as real: the largest randomized test of an immune stimulant injected into the tumor, in melanoma, failed clearly . And the old version of the idea – chemotherapy injected directly into the tumor to bypass systemic toxicity – worked exactly as promised on toxicity (no kidney, nerve, or hearing damage), but it didn’t prolong life and never became standard. Its accepted relatives do exist, though: chemoembolization for liver tumors, where the drug is delivered through the tumor’s artery, is standard treatment .

So: an idea with a foundation, now being tested in real trials – but if a private clinic is selling it to you today as a proven treatment, that’s a different conversation.

6. Do everything that can be done BEFORE you start treatment

The last observation is again from my own experience, and it’s the one I wish I had read somewhere at diagnosis. In my case, radiotherapy on the spinal lesion was done right away, before I started the targeted pill. It seemed like a scheduling detail. It wasn’t: many local treatments require temporarily interrupting systemic treatment. Done at the start, the radiotherapy cost me nothing. Done later, it would have meant days without the pill that keeps my disease under control – exactly what I lived through last month, when a second course of radiotherapy required a treatment pause.

The label: logistics and clinical common sense; not controversial, just rarely said explicitly to the patient.

The formulation I’ve arrived at: at the beginning of treatment there is a window that never comes back – the diagnosis is complete, systemic treatment hasn’t started yet, and any local procedure, tissue collection, or necessary intervention can be done without stopping anything. The good question for your medical team, in the first week: “What else would be worth doing NOW, while I haven’t started yet?”

What remains of all this

Rereading the list, I see a common thread: the body reacts to any insult – an operation, a needle, a fracture, an infection, inflammation – with a powerful repair program, and that program doesn’t know whose side it’s on. Nothing here translates into “refuse procedures”. It translates into better questions: is it necessary now? is there a gentler technique? what do we do with the window at the beginning?

I’m not a doctor. I’m a patient who reads a lot and who prefers to also know what’s in the grey zone, with the labels applied honestly. If one of these observations sparks a good conversation with your doctor, this article has done its job.