From Peritoneal Metastasis of Colorectal Cancer to Postoperative pCR: Optimism and Resilience Create Miracles | Patient Story

In August 2022, during her summer break, my mother traveled from our hometown in Jingtai County, Gansu, to Dingxi City where I work. She complained of stomach pain, back pain, and poor sleep. We visited a traditional Chinese medicine doctor together. A gastric ultrasound at the TCM hospital showed no abnormalities, and her symptoms improved after taking herbal medicine.

In September, after stopping the herbal medicine, the stomach and back pain returned. My mother called to complain about gaining weight recently, feeling constantly bloated, and noticing her waistline had thickened. Due to the pandemic, we delayed action until November. When the abdominal bloating and pain became severe, she lost her appetite and couldn't lie down to sleep due to back pain. We finally went to the county hospital for a gastroscopy, which indicated atrophic gastritis. Medication did not significantly relieve the bloating. She then visited a small clinic nearby, hoping acupuncture could "release the gas" in her abdomen. The doctor palpated her belly and suggested she get an ultrasound the next day.

The county ultrasound revealed a large amount of ascites, and she was advised to transfer to a higher-level hospital. Imaging at the city hospital faintly showed a mass near the ovaries, recommending a transfer to the provincial hospital.

After urgently arranging nucleic acid tests, an ambulance, and contacting doctors, we finally admitted her to Gansu Provincial Maternity and Child-care Hospital. We ran tumor markers, performed gastroscopy and colonoscopy, and scheduled enhanced CT and MRI scans. The tumor markers came out first: CEA was 157 and CA-125 was 52. Not understanding the report, I naively comforted my family: "Mom gets annual school check-ups, it should be nothing serious." It wasn't until my father called to say the colonoscopy biopsy results were out—pathological diagnosis: (cecum) adenocarcinoma (partially mucinous adenocarcinoma, with signet ring cell carcinoma in some areas)—that I truly grasped the severity. With no time to grieve, my husband and I immediately started figuring out who we knew in Shanghai, Beijing, or Xi'an to take her for treatment.

During this time, my mother called and said, "You don't need to hide it from me. I looked it up on my phone. It's cancer, I can accept it. I just regret that when you have children in the future, I won't be able to help you raise them; your younger sister isn't married yet, and I won't be able to watch her wedding..." Hanging up, I broke down in tears. I cried because even in such a moment, my mother's thoughts were only for her children, and I cried because I hadn't studied medicine and knew nothing. After wiping my tears, I called a friend in Xi'an to ask for help finding a doctor, then checked my alumni directory for medical professionals. My father, sister, and uncle were all trying to find connections. Our thinking was simple then: medical resources in Gansu are average, so we must go to Beijing, Shanghai, Guangzhou, or Xi'an for treatment!

Later, our family reflected on this. In hindsight, the back pain, abdominal bloating, and sudden increase in weight and waist circumference were already warning signs of a serious condition. For gastrointestinal issues, a gastroscopy and colonoscopy should have been done much earlier. Also, a CEA level over 10 should have been taken very seriously.

Fortunately, a close high school friend was studying clinical medicine at Southern Medical University, focusing on the digestive tract. He had his professor carefully review the records and told me: "Standard treatment follows clinical guidelines. Your mother already has distant metastasis from colorectal cancer, so immediate surgery isn't an option. Start with the FOLFOX6 chemotherapy regimen first. Every 3-4 cycles, consult a doctor to evaluate surgical eligibility. Draining the ascites can help relieve her current back pain and sleep issues."

He also recommended genetic testing to see if targeted therapy or immunotherapy was an option. As for the chemotherapy hospital, it could be done locally since chemotherapy is essentially IV infusion; the drugs and dosages are standardized in guidelines, so traveling elsewhere isn't necessary. However, the first surgery is crucial, so that should be done in Beijing, Shanghai, or Guangzhou. He also warned us to verify online information carefully and not be deceived by exaggerated claims of "miracle cancer doctors."

I am deeply grateful to my classmate Ahua (who will be Dr. Wang at the First Affiliated Hospital of Xi'an Jiaotong University in July). During the early days of diagnosis, she patiently answered my questions at any time, explaining treatment approaches and medical terms in simple terms, which helped us embark on a correct and standardized treatment path.

At this point, doctors at Gansu Provincial Maternity and Child-care Hospital organized an MDT (Multidisciplinary Team consultation) and planned cytoreductive surgery for my mother in three days. However, after consulting doctors in Beijing, Shanghai, Nanjing, and Xi'an through various channels, all recommended chemotherapy before surgery. My mother decided to follow the advice from the major medical centers. She personally communicated with the attending physician and successfully persuaded him to start chemotherapy first.

My mother also told the doctor that we had contacted a genetic testing company and asked if a nurse could draw blood for us. The doctor readily agreed. There was a small interlude: upon hearing that our large-panel test for hundreds of genes cost only 20,000 RMB, the doctor specifically listed over ten genes for us to confirm whether to test them, to prevent us from being scammed. In his experience, testing just four or five genes at other companies cost nearly 10,000 RMB. Surgery or chemotherapy? At this first major crossroads on our cancer journey, we chose chemotherapy. Everything that followed proved we made the right choice.

It was also around this time that Ahua shared an article about colorectal cancer forwarded by a hospital colleague, published by a WeChat Official Account called "Panda and Friends." Following the account, I joined the Panda Group. From then on, our medical journey changed dramatically. The Panda Group might have been a lifeline heaven left for us in the shadows. Fortunately, we chose the right path at this fork as well.

The Panda Group contained comprehensive materials on colorectal cancer treatment, from staging, chemotherapy regimens, and side effect management to how to compile medical records and interpret genetic reports. It also had the colorectal cancer treatment guidelines and latest protocols that Ahua had mentioned repeatedly.

The official account featured engaging popular science articles and successful patient stories. The group had volunteer experts answering questions and regular doctor lectures. I diligently absorbed all the knowledge shared and finally gained a comprehensive understanding of our situation.

At diagnosis, my mother had colorectal cancer with ovarian and peritoneal metastasis, accompanied by ascites. The cancer cells included mucinous adenocarcinoma (highly malignant) and signet ring cell carcinoma (the most malignant). It was essentially a "hell mode" start. For advanced colorectal cancer, the standard approach is chemotherapy combined with targeted or immunotherapy, followed by seeking surgical opportunities. However, since ovarian metastases are often less sensitive to chemotherapy, some patients opt for surgical removal of the ovaries first.

Targeted or immunotherapy depends on genetic testing results. If the patient is one of the lucky 5% with special genotypes like dMMR or MSI-H, immunotherapy can be prioritized and usually yields good results. For typical cases, the choice of targeted drugs depends on the primary tumor location and mutations in RAS and BRAF genes.

My mother had no special genotypes and no KRAS, NRAS, or BRAF mutations. Her primary tumor was in the right colon, making her suitable for the targeted drug bevacizumab. Standard chemotherapy plus targeted therapy is covered by medical insurance, so it doesn't cause severe financial strain. Drug side effects can also be managed in various ways. The TV tropes of patients suffering unbearably during chemo or families selling houses and blood for money are false! Genetic testing is a murky industry. For advanced cancer patients needing it, I recommend prioritizing labs at top-tier hospitals in Beijing, Shanghai, or Guangzhou. If using a third-party agency, choose a professional one and compare prices to avoid being overcharged.

The first chemotherapy was done at Gansu Provincial Maternity and Child-care Hospital before the genetic results were out. A PICC line was inserted, and only oxaliplatin was administered. We took capecitabine home for oral use. Pandemic lockdowns were strict in both Baiyin City and Jingtai County. At my strong insistence, my parents took an ambulance to Dingxi City where I work. Unexpectedly, a city-wide lockdown began on the third day. My husband and I made over a hundred calls, pleading and negotiating, to finally secure home nucleic acid testing for them. Just in time for the PICC maintenance day, their red health codes turned green, allowing us to go to the hospital for line flushing.

For the second chemo, pandemic restrictions had just lifted, and hospitals were overcrowded. Through connections, we used FOLFOX plus bevacizumab at Baiyin Second People's Hospital. Unfortunately, the patient in the next bed contracted COVID-19, and my mother caught it on the day of discharge. Fortunately, her symptoms were mild and required almost no medication.

The third chemo coincided with New Year's Day. My father returned to our hometown for errands. Having recovered from and then reinfected with COVID, I accompanied my mother for chemo at the Second Hospital of Lanzhou University. The 5-FU pump indicated an infusion time of 18 hours. I confirmed with the nurse that this was the doctor's order. After discharge, I researched and found it should actually be 48 hours.

The fourth chemo fell during the Spring Festival. We chose Dingxi City People's Hospital for convenience. On New Year's Eve morning, my mother was still in the hospital receiving IV liver-protecting drugs and a traditional Chinese medicine injection, Kushen. In the afternoon, my sister and I prepared a reunion dinner, but my mother had no appetite and barely ate. The next day, after the TCM injection, she developed a red rash. We only then realized she was allergic to Kushen injection. The doctor switched to Yadanzi oil injection. Her liver function indicators kept rising until all TCM injections were stopped, after which they gradually improved.

Learning from the third time, I calculated my mother's chemotherapy dosage based on the group's guidelines and verified it with the doctor. The deputy chief physician in oncology smiled and asked, "Are you a medical student? You're quite professional." I replied, "I'm an accountant. I learned this from the group."

During the holiday, I wasn't idle. Using the recommended doctor list from the Panda Peritoneal Metastasis Group's resource pack, my sister and I compiled a registration memo. It listed doctors, hospitals, booking methods, release times, clinic schedules, and alarm times for booking. We successfully secured an appointment with Professor Cai Guoxiang at Fudan University Shanghai Cancer Center.

After organizing the medical records according to the group's templates and completing the cross-provincial referral paperwork, my parents flew to Shanghai in March. My sister accompanied them for an enhanced CT. Professor Cai recommended trying the most potent three-drug regimen, FOLFOXIRI plus bevacizumab, for two cycles before re-evaluating the response.

The fifth and sixth cycles were at Shanghai Jing'an District Central Hospital, a partner of Fudan Cancer Center. The medical conditions in Shanghai were indeed excellent. The hospital's accommodation and staff attitude were outstanding. The cost for fully imported drugs plus long-acting G-CSF injections was under 2,000 RMB out-of-pocket. My father even suspected the hospital miscalculated when paying.

Between tests, we visited the nutrition department at Fudan Cancer Center. The doctor said there was no need for dietary restrictions. Chicken, duck, fish, shrimp, beef, lamb, pork—eating more meat is good for recovery. Spicy foods and sweets are fine too, as long as there's no gastrointestinal discomfort. There's no need to change decades-old eating habits. To gain weight, nutritional powder supplements can be added. However, alcohol should be avoided, and pickled or raw foods should be minimized.

With the doctor's advice, we stopped restricting her diet. My mother ate whatever she craved: hotpot, BBQ, crayfish—nothing was missed. Her weight successfully increased from under 90 jin (45 kg) after the first cycle to over 100 jin (50 kg). We added nutritional powders daily: Ensure, Speedy, Bebo Rui, Lijian Neng, Dongze Quantai. She never complained about the taste, always saying they were fine. I secretly tasted them; Ensure was okay, but some were truly hard to drink.

Between the two cycles, my parents toured Shanghai, Nanjing, and Yangzhou, enjoying food and sights. From the outside, you couldn't tell my mother was a cancer patient. We also met Sister WL, who was also accompanying her mother for treatment. She thoughtfully brought my mother warmed juice to drink.

After the sixth cycle evaluation, although tumor markers dropped significantly, imaging showed little change in the tumor. The doctor said there was no surgical opportunity yet and suggested returning home to continue chemotherapy. We had sent them to Shanghai full of hope, but the results were disappointing. I felt devastated, but my mother remained strong. She was only sad for half a day before cheerfully comforting us that everything was fine.

The seventh and eighth cycles were at Gansu Provincial People's Hospital. Directors Z and L in the oncology department were patient and responsible. We requested to continue the FOLFOX plus bevacizumab regimen, and both doctors readily agreed. Except for the tight bed availability in oncology, requiring us to stay in random 3- to 6-bed wards, the medical experience was quite good.

During the eighth cycle, due to insufficient antiemetic dosage, my mother vomited severely, experienced rapid heartbeat, and had uncontrollable tremors. She was put on cardiac monitoring. Watching her curled up into a tiny ball, I questioned for the first time whether persisting with chemotherapy was the right decision.

Many people in the Panda Group chatted with me until midnight. Yanyan carefully labeled the meaning and normal ranges of every indicator on the cardiac monitor. Sister Tongxin sent a long comforting message and even a video of her playing the piano. The Panda Group is not just a learning platform, but a place where people embrace and warm each other.

After the eighth cycle came the May Day holiday. My sister held her pre-wedding banquet in our hometown. My mother bought a new dress and attended the ceremony beautifully. Everyone smiled happily in the family photo, but we all feared it might be the last one. Chemotherapy had to continue, but the severe side effects of the eighth cycle left us apprehensive. Her liver function indicators kept rising. Through Haodf, we consulted Professor Xiao Jian, who suggested switching to maintenance therapy with capecitabine plus bevacizumab.

Starting from the ninth cycle, we reduced the medication. My mother felt much better. Although she could barely eat anything besides nutritional powder during hospitalization, she would be full of energy to eat Korean BBQ once discharged.

Simultaneously, we did an imaging evaluation at Gansu Provincial People's Hospital. The report showed the ileocecal tumor was 4.*74.7cm (likely a typo), with slight reduction in omental and ovarian tumors. Director Zhang from oncology repeatedly compared it with the March Shanghai scans and said the chemotherapy effect was decent, at least showing no progression. However, the "70+ cm" intestinal tumor still made my mother restless. Though likely a doctor's typo, we specifically booked an appointment with the imaging department director. After careful review, he confirmed no progression and even refunded our registration fee. The next day, the hospital report corrected the ileocecal tumor size to 4.7*4.7cm.

Waiting for tumor marker results before the tenth cycle was the most agonizing. I worried that single-drug maintenance couldn't suppress tumor progression. After the blood draw, I checked the hospital's official account almost every ten minutes. Around 1 PM, the system showed the report was ready. With trembling hands, I opened it. CEA and CA-125 continued their downward trend. My eyes instantly reddened, and the heavy weight on my heart finally lifted. 

It was time again to consult a doctor for surgical evaluation. Fortunately, I secured an appointment with Professor Chen Gong. With the pandemic severe in Guangzhou, Sister Kong waited at the hospital from morning till night to help me get a proxy consultation with Professor Chen. After reviewing the records and imaging, he said surgery could be considered. The waiting list at Sun Yat-sen University Cancer Center was about a month and a half. He advised us to decide and have his assistant queue us up.

When the surgical opportunity finally arrived, we hesitated. My mother said, "Let's wait a bit longer, until after your sister's wedding in October." So we continued single-drug maintenance.

In August, Professor Chen Gong came to Gansu Provincial Cancer Hospital for support. I took my mother to see him. He carefully reviewed the imaging frame by frame and performed a digital rectal exam. He recommended a laparoscopic exploration first. If the exploration went well, we would convert to open surgery and HIPEC (Hyperthermic Intraperitoneal Chemotherapy). Professor Chen detailed his previous peritoneal surgeries. My mother finally made up her mind: "Let's do the surgery!"

After two cycles of double-drug chemotherapy post-op, my parents rented a homestay in Huiyang. They took a half-hour high-speed train to Shenzhen for chemo and spent the rest of the time recuperating in the gentle southern winter, returning to Gansu only for the Spring Festival. On another New Year's Eve, my husband and brother-in-law took charge of cooking. My mother ate plenty of meat and vegetables. We welcomed the new year amidst fireworks blooming outside the window.

After the Lantern Festival, my mother said she wanted to rest. After consulting relevant professionals, we decided to stop treatment for now. There might be a recurrence in the future, but she has been strong for so long. What's wrong with taking a break? Treatment should fully respect the patient's own choices. I hope I will always remember this.

After stopping treatment, we monitored tumor markers monthly. CEA bounced between 1 and 3. My mother said, "Should we do one more chemo?" I asked, "Do you want to?" She replied, "Not really, but I can endure it." I said, "Let's observe a bit longer and decide next time." She let out a long sigh of relief. "Alright, next time then."

And so it went until April. We returned to Shenzhen for a follow-up PET scan. The diagnostic opinion noted many "considered inflammatory" findings. Thank heaven's grace, the six-month follow-up passed smoothly.

Who knows what the future holds?

At least now, my mother doesn't need chemotherapy. She runs 3-5 km daily, has gained over 10 jin since surgery, occasionally travels to nearby places, and spends most of her time in Dingxi accompanying my grandmother and me. Such days are beautiful enough~

Finally, thank you to all the doctors we met along the way, to our silently supportive family, friends, and colleagues, to the kind strangers we met in Shenzhen, and to the family we found by chance in the Panda Group.

May we all: stay healthy, keep our original aspirations, fear not the road ahead, and may all our hopes come true!