When someone hears the words “Stage 1” or “Stage 4,” a story often begins forming almost immediately.
Stage 1 sounds hopeful.
Stage 4 sounds frightening.
And while there is truth in those reactions, I’ve noticed that many people unknowingly assume something else as well: that stage tells us everything we need to know about what is happening.
But stage is only part of the picture.
What Stage Tells Us
Imagine two cars driving toward a cliff.
One car is ten miles away.
The other car is one mile away.
If I ask which car is more likely to go over the cliff in the next few minutes, the answer seems obvious. The car that is only one mile away is at greater immediate risk.
That distance from the cliff is similar to what stage tells us.
A Stage 1 cancer may be like the car that is ten miles away.
A Stage 4 cancer may be like the car that is one mile away.
Stage helps us understand where we are when we first discover the cancer.
What stage does not tell us is how fast the car is moving.
Some cancers move very slowly.
Some move very quickly.
Some remain relatively stable for years.
Others change dramatically over a short period of time.
In other words, stage tells us where the car is. Biology tells us how fast it is moving.
The challenge is that biology is much harder to measure.
We can often see the size of a tumor. We can determine whether it has reached nearby lymph nodes. We can identify whether it has spread to other organs.
Those things help us determine stage.
But biology asks different questions.
How aggressive is this cancer?
How likely is it to spread?
How sensitive is it to treatment?
How fast is it growing?
What is it likely to do next?
These questions are harder to answer.
Modern medicine has become increasingly sophisticated at studying cancer biology. Genetic testing, molecular profiling, pathology, imaging, and other tools can provide important clues. Yet even with all of these advances, predicting exactly how a particular cancer will behave in a particular person remains surprisingly difficult.
This is why stage matters, but it is also why stage can sometimes be misunderstood.
A Stage 4 cancer is not automatically more aggressive than every Stage 1 cancer.
Sometimes a Stage 4 cancer has simply been discovered later in its journey.
Likewise, some early-stage cancers may appear small and localized while possessing biological characteristics that make them more concerning than their stage alone would suggest.
This is one reason survival statistics can sometimes be confusing.
People often hear that individuals with Stage 1 cancer have higher five-year survival rates than those with Stage 4 cancer.
That is generally true.
But part of that difference comes from the fact that one person entered the story earlier and the other entered the story later.
If two cars are traveling at the same speed, the car that is ten miles from the cliff will naturally have a different outlook than the car that is only one mile away.
The statistics tell us something important.
They just don’t tell us everything.
And perhaps this is the deeper lesson.
When we receive a diagnosis, our minds desperately want certainty.
We want to know what it means.
We want to know what happens next.
We want to know how the story ends.
But medicine often works in probabilities rather than certainties.
Stage provides information.
Biology provides information.
The person’s overall health provides information.
Their response to treatment provides information.
None of these, by themselves, reveal the entire future.
I’ve found that sometimes the most helpful perspective is remembering that stage tells us where the car is today. It does not fully tell us how fast it’s moving, where it will be tomorrow, or how the journey will unfold.
That uncertainty can feel uncomfortable.
Yet it is also where possibility lives.
Because while statistics describe groups, every individual remains their own story.
The Driver Is Still in the Car
There is one more limitation to the car analogy.
Up to this point, we’ve been talking as if the car is simply moving toward the cliff and all we can do is observe its distance and estimate its speed.
But perhaps the biggest limitation is this:
The driver is still in the car.
When people receive a diagnosis, they often begin to feel as though the future has already been written.
The stage becomes the story.
The statistics become the story.
The scan becomes the story.
Yet human beings are more than their scans.
More than their pathology reports.
More than their prognostic estimates.
One of the most fascinating observations from physicians like Bernie Siegel and psychologists like Lawrence LeShan is that some people seemed to change profoundly after a diagnosis.
Not everyone.
Not predictably.
Not in ways that guaranteed a particular outcome.
But often enough to make us pay attention.
Some left relationships that were draining the life out of them.
Some finally pursued work that mattered to them.
Some learned to say no.
Some began expressing emotions they had suppressed for decades.
Some reconnected with family.
Some discovered creativity.
Some deepened their spiritual lives.
Some found purpose, joy, and meaning in ways they had never allowed themselves before.
It was as if the diagnosis forced them to ask a question they had been avoiding for years:
“If I truly understood that life is precious, how would I choose to live?”
From this perspective, healing is not simply about shrinking a tumor.
It is about becoming more fully alive.
This is where the analogy changes.
Perhaps the most important question is not only how far the car is from the cliff.
Or how fast it is moving.
Perhaps the question is whether the driver still has choices.
Can they slow down?
Can they ask for help?
Can they stop organizing their life solely around fear?
Can they begin moving toward what matters most?
Can they stop abandoning themselves?
Can they begin living in a way that feels more aligned, authentic, connected, and alive?
Nutrition may matter.
Sleep may matter.
Movement may matter.
Stress regulation may matter.
Medical treatment may matter.
But so may joy.
So may purpose.
So may love.
So may connection.
So may laughter.
So may the courage to finally become oneself.
None of these guarantee remission.
None of these guarantee survival.
But they may influence the terrain in which healing occurs.
They may influence inflammation, immune function, metabolism, resilience, treatment tolerance, recovery, and quality of life.
And even when they do not change the ultimate outcome, they often change the experience of living.
Yet I also believe there is something deeper here.
Medicine is remarkably good at measuring tumors.
It is far less skilled at measuring hope.
It can measure the size of a lesion.
It cannot easily measure what happens when someone finds a reason to get out of bed in the morning.
It can measure blood work.
It cannot easily measure the effects of feeling loved, supported, connected, purposeful, or fully alive.
That does not mean those things are unimportant.
It may simply mean they are harder to quantify.
The medical literature contains documented cases of remarkable recoveries that are difficult to explain. We call them spontaneous remissions.
Perhaps some are purely biological.
Perhaps some involve mechanisms we do not yet understand.
But they remind us of something important:
There is still mystery in healing.
One of the things I have learned from working with people facing serious illness is that healing and curing are not always the same thing.
Sometimes healing includes remission.
Sometimes healing includes years of unexpected life.
Sometimes healing includes discovering a version of yourself that had been waiting patiently beneath the surface for decades.
Sometimes healing includes finding peace, love, meaning, and connection in the midst of uncertainty.
This is why I believe it is important to respect both realities at the same time.
To respect the data.
And to respect the mystery.
To understand the stage.
And to understand that the stage is not the whole story.
Because statistics describe what has happened to groups of people.
They do not determine what is possible for the person sitting in front of us.
And because the driver is still in the car, the story is still being written.
If this article resonated with you, the companion piece for paid subscribers explores a question many people ask next: “How do I actually do this in my real life?” We’ll walk through practical exercises to help you reconnect with joy, meaning, purpose, and the parts of yourself that may have been pushed aside for years. You’ll find step-by-step guided reflections, real-life examples, in-the-moment scripts, and simple daily practices designed to help you notice where you may be moving away from yourself—and how to begin moving back toward what makes you feel most alive. If you’d like to continue this exploration with us, we’d love to have you join our community of paid subscribers.