Conservative talk radio giant Rush Limbaugh told his listeners Monday that the advanced lung cancer he announced this year is terminal.

Limbaugh, whose program is nationally syndicated, said he received lung scans last week that showed “some progression of the cancer” after it was previously reduced to a manageable level.

He described his illness as a roller coaster with many ups and downs.

“You measure a happy life against whatever medication it takes. And at some point you decide, you know, this medication may be working, but I hate the way I feel every day,” Limbaugh, 69, said on the air. “I’m not there yet. But it is part and parcel of this. It’s tough to realize that the days where I do not think I’m under a death sentence are over.”

“We all know that we’re going to die at some point,” he added, “but when you have a terminal disease diagnosis that has a time frame to it, then that puts a different psychological and even physical awareness to it.”

Limbaugh announced his cancer in February with few details other than that he had been diagnosed by two doctors after experiencing shortness of breath on his birthday, Jan. 12. He said at the time that he would soon begin treatment.

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He has mostly declined to speak at length about his illness, citing his privacy, a desire to leave enough time for the content of his show and an aversion to seeming as if he thinks he’s the only person experiencing hardships. During a rare update in May, Limbaugh said the wave of treatment he was undergoing had been hard on him. He said he had not left the house in a week and felt “virtually worthless.” Still, he said he was doing “extremely well, all things considered.”

“Every day I wake up and the first thing I do is thank God that I did,” Limbaugh said.

About 600 radio stations carry Limbaugh’s program, which since 1988 has influenced mainstream Republican thought and attracted a loyal following of listeners who call themselves “Dittoheads” to express their agreement with him. His program often criticizes feminists – whom he has called “feminazis” – environmentalists, the media and Democrats.

Limbaugh’s show, featuring political commentary and satire, was at one point the United States’s top-rated radio program. He has been inducted into the Radio Hall of Fame and the National Association of Broadcasters Hall of Fame, and he received the Presidential Medal of Freedom days after announcing his cancer diagnosis.

Limbaugh is also one of the most polarizing figures in radio and has racked up controversies, including promoting the false “birther” theory that former president Barack Obama was not born in the United States.

In 2003, ESPN removed Limbaugh as a football commentator after he said Donovan McNabb, an African American quarterback for the Philadelphia Eagles, got more credit than warranted because “the media has been very desirous that a Black quarterback can do well.”

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Advertisers briefly boycotted Limbaugh’s program in 2012 after he called Georgetown University law student Sandra Fluke a “slut” and a “prostitute” for pushing for mandatory insurance coverage of contraceptives. Limbaugh ultimately apologized for his remarks.

The announcement that Limbaugh’s cancer had worsened prompted both expressions of prayer for him and angry denials of sympathy, painting a real-time picture of his divisiveness.

“I’ll say it again, Rush Limbaugh is a sexist, misogynistic, racist, hateful, bigoted conspiracy theorist trash bin with a repugnant radio program who is by far the most undeserving Medal of Freedom recipient in US history,” wrote singer-songwriter Ricky Davila on Twitter. “He gets no sympathy from me because he has cancer. Nope.”

Liberal writer Bob Geiger tweeted: “I am attempting to compose a thoughtful, sensitive tweet that wishes Rush Limbaugh well despite what a hideous, racist, bilious, hate-monger he is… I’ll let you know when I manage to do that.”

“My sister, who never smoked, died of lung cancer. It is a horrible way to go,” wrote conservative writer and editor Rob Dreher. “You wdn’t wish it on your worst enemy. Even if you don’t like Rush Limbaugh, please pray for him, or wish him well. He is going to pass through a terrible trial, one that we should all hope to be spared”

“I can separate my political issues with Rush, which are deep and real, from my sadness that anyone and their family is going through cancer… it costs us nothing to have compassion,” political commentator and television host S.E. Cupp tweeted. “Even when they don’t. Be better.”

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The Washington Post’s Paul Farhi contributed to this report.