Uncertainty is a central theme in the cancer survivorship and coping literature. Existing research on cancer-related uncertainty has primarily documented the adverse effects of existential uncertainty on survivors' well-being and located uncertainty within the stress and coping paradigm. Using in-depth qualitative interviews, the authors explores the paradoxical meanings and impact of uncertainty in the lives of long-term survivors of childhood cancer. The findings suggest that although uncertainty can be a source of distress, it can also be a catalyst for growth, a deepened appreciation for life, greater awareness of life purpose, development of confidence and resilience, and optimism. The results suggest that uncertainty is a dialectic phenomenon located within larger contexts of both stress and coping, and psychospiritual growth.