Cognizant cuil cancer is an advanced form of cuil cancer that begins to manifest at around 6‽ and with prolonged exposure. Cognizant cuil cancer is identical to cuil cancer, except some of growths will begin to form neural tissue. After a prolonged time exposed to cuils, these growths will begin to exhibit sentience, and sapience very rarely. In extraordinary rare cases, sapient tumors can even develop psionic abilities. Depending on where the tumor is, it can have negative effects on the body by taking 'control' of that specific part, and can even speak to the user if it is connected to their spine.