Diagnosed with a Giant Cholangiocarcinoma at 26: Radical Resection After Extreme Tumor Shrinkage, I Now Want to Live in the Moment | Patient Story

At 26, an age meant for believing in life's infinite possibilities, Ran Jiang's vibrant youth was abruptly paused by a diagnosis of intrahepatic cholangiocarcinoma.

Cholangiocarcinoma is a highly aggressive cancer with an insidious onset. Once diagnosed, it is often at an advanced stage, making treatment difficult and prognosis poor. At diagnosis, she faced massive tumors measuring 13 cm at the hepatic hilum and 8 cm within the liver, carrying a constant risk of rupture and bleeding.

Author | Chan Chan
Editor | Chan Chan
Reviewer | Guang Guang

「 I. Sudden Diarrhea and Abnormal Shoulder Pain: Diagnosed with Intrahepatic Cholangiocarcinoma at 26 」

In late February in Tianjin, the sea breeze carried a damp chill. 26-year-old Ran Jiang went to the hospital due to sudden diarrhea and unusual right shoulder pain. She never imagined it wasn't just ordinary gastrointestinal discomfort, but an urgent alarm from her body. The abnormal shadow in the liver area on the ultrasound immediately made the doctor's tone grave: "Go get an enhanced CT right away. There's a problem with your liver."

[ Enhanced CT Report ]

"I just had a check-up last November, how could there be a major issue?" Holding onto this hope, she completed the enhanced CT, only to be told a harsh reality: a massive tumor measuring 8.7×5.8 cm in the liver and 10.2×9.4×9.2 cm at the hepatic hilum, already at risk of rupture.

On February 27, she was urgently admitted for a biopsy. Upon learning of her hospitalization, her mother, back in Sichuan, immediately entrusted Ran Jiang's younger sister to her grandparents and rushed to Tianjin without delay.

On March 6, the pathology results came out, and the doctor called her mother in for a private talk. Ran Jiang was on the phone with her boyfriend, sharing her anxiety, when her mother pushed the door open in tears. One look at her red eyes, and Ran Jiang instantly understood everything. "I didn't cry or break down. My first reaction was to comfort her," Ran Jiang recalled. At that time, the biopsy indicated: poorly to moderately differentiated adenocarcinoma, likely of biliary origin, with low immune expression, belonging to a highly aggressive type.

[ Pathology Biopsy Results ]

After the diagnosis, her mother took leave to become a "24-hour caregiver," and her father rushed from Guangzhou overnight. The family, originally scattered across three cities, suddenly reunited around the hospital ward.

Later, Ran Jiang often pondered why she got sick. She had no underlying conditions or hepatitis B history. At just 26, why intrahepatic cholangiocarcinoma (ICC)? After much thought, she could only attribute it to genetics, as the tumor indeed tested positive for a driver gene mutation (FGFR2 fusion mutation). She even joked with a touch of bitter self-mockery: "I guess it's because I've always been too timid, lacking the courage to take risks in life. Heaven probably thought my 'gallbladder' (courage) was useless and took it back." Fortunately, the FGFR2 fusion mutation is a relatively rare target in cholangiocarcinoma, meaning targeted therapies are available.

「 II. First Treatment: Hepatic Arterial Infusion Chemotherapy (HAIC) + Five-Drug Combination 」

The initial treatment was exceptionally difficult. Seeking professional help, Ran Jiang took her reports to the Tianjin Medical University Cancer Institute & Hospital (TMUCIH) Airport Campus. The enhanced CT showed that the larger tumor had grown to 13.4×13.7×9.2 cm. Director Li from the Hepatobiliary and Pancreatic Oncology Department proposed a "fully stacked" regimen: Hepatic Arterial Infusion Chemotherapy (HAIC), combined with chemotherapy, immunotherapy, and targeted therapy, specifically the FOLFOX regimen (oxaliplatin + leucovorin + fluorouracil), tislelizumab, and pemigatinib.

[ TMUCIH Examination Report ]

On March 17, Ran Jiang prepared for her first HAIC treatment at TMUCIH. As the nurse inserted the catheter, the glint of the metal needle caught her eye, and for the first time since her diagnosis, she cried. "That was the moment I truly realized I had cancer. This was a reality I had to face."

[ Port-a-cath on Ran Jiang's neck ]

During treatment, an arterial catheter was inserted at the groin directly to the lesion. Over 24 hours of continuous infusion meant she could only lie flat, relying on her mother to help her urinate. Even turning over was a luxury. "It felt like being nailed to the bed, watching time crawl by. Contrast allergy caused facial swelling and shortness of breath, severe abdominal bloating and cramps kept me up all night, and I felt completely weak for three days post-op. The antiemetics also caused severe constipation," she recalled. The pain felt as vivid as yesterday.

The treatment brought not only physical pain but also mental torment. There was no clear endpoint to the regimen; doctors only said, "We'll see as we go." The targeted drug alone cost over 40,000 RMB per dose, forcing her ordinary-worker parents to scramble for medical bills. Her roommate was on systemic chemotherapy, so why was her regimen different...

「 III. Urgent "Escape": Changing the Treatment Plan 」

On April 1, April Fools' Day, Ran Jiang had a bed reserved for her second HAIC. Her best friend sent a message: "Do you know the Panda Group? They say it can help you avoid some detours." This seemingly casual recommendation became a crucial turning point in her cancer journey.

On April 5, she added Lynn, the group admin, on WeChat. Lynn's first message sent a chill down her spine: "Your current regimen isn't right. Run!"

The targeted drug cost 40,000 RMB monthly, plus other medications, draining both her body and her family's finances. Lynn immediately contacted a liver transplant specialist at Tianjin First Central Hospital. Even though it was Saturday, the doctor came to review her scans and concluded: "The tumor is too large and invading blood vessels. Surgery isn't an option right now. I recommend finding an internal medicine specialist to optimize the treatment plan."

After multiple consultations and Lynn's advice, Ran Jiang visited Director Wang in the Oncology Department at the Second Hospital of Tianjin Medical University. This internal medicine expert, known for his "genius" in molecular targeted therapy, reviewed her file and bluntly said, "The regimen is too aggressive." A new plan was quickly set: systemic chemotherapy with oxaliplatin + gemcitabine combined with the FGFR2 targeted drug (pemigatinib), dropping immunotherapy to maintain efficacy while reducing the physical burden.

Her family questioned this plan: "The cancer hospital is specialized, this hospital is less famous, and can someone you met online be trusted?" But armed with knowledge from the group and her own aversion to interventional therapy, Ran Jiang made a bold decision against her family's wishes: cancel the scheduled HAIC and switch to Director Wang. "The internal medicine approach fits my condition better." More importantly, she finally felt she wasn't being "bombarded" by drugs, but actually receiving "treatment."

She arranged her hospitalization first, then informed her father, who had returned to Guangzhou to work. He initially strongly opposed it over the phone, but after she presented the new plan and explained the difference between internal and surgical treatments, he silently relented.

「 IV. Six Cycles of Systemic IV Chemotherapy After Transfer: Efficacy and Side Effects Emerge Together 」

Treatment after the transfer quickly showed results, but side effects followed. After the first systemic chemotherapy, hair loss, constipation, intestinal spasms, and numbness in her hands and feet set in. "Chemo requires antiemetics, which cause constipation for three to four days. The targeted drug then triggers diarrhea. My stomach felt hard and bloated, curling up in bed in pain for three to four hours each time," she recalled.

Her mother became her strongest pillar. She prepared nutritious meals daily and gently comforted her when she felt ashamed about bedridden bowel movements: "I'm your mom, what's there to be ashamed of?" Her boyfriend silently stayed by her side during low moments. "His parents even came to Tianjin to visit me. The two mothers cried together in the hallway. I only found out later; they never put any pressure on me." These warm moments fueled her fight against the side effects.

[ Ran Jiang preparing for chemotherapy in the ward ]

After the fourth systemic IV chemotherapy, she experienced severe bone marrow suppression, with platelets dropping to 62, requiring expensive platelet-boosting drugs. During the fifth cycle, white and red blood cells dropped significantly, and platelets fell further to 36, prompting doctors to reduce the gemcitabine dosage.

Yet, every follow-up brought good news: CA199 dropped from 128 to normal, and the tumor shrank from 13 cm to 5 cm, indicating clear chemotherapy benefits and effective tumor control. During treatment, learning of her financial strain, the doctor also recommended she join a clinical trial for the targeted drug.

During chemotherapy, Ran Jiang bought a wig and dressed up carefully. "Even with no eyebrows or eyelashes, wearing a wig and makeup, I still look beautiful," she said. She shared her daily chemo life online, and her genuine feelings and positive attitude attracted many young patients.

「 V. Taking a Gamble on a Chance for Radical Surgery 」

In early July, after completing her fifth systemic IV chemotherapy, Ran Jiang decided to evaluate for surgery.

"After the second systemic IV chemo, the tumor had already shrunk to 5 cm. Sister Lynn helped me consult Director Wang at the Hepatobiliary Surgery Department of the Cancer Hospital Chinese Academy of Medical Sciences (Langfang Campus). Considering the high risk, he suggested a few more treatments before re-evaluation."

Ran Jiang recalled that after three more treatments, Lynn secured an extra appointment slot, allowing her to finally see Director Wang. This time, Director Wang told her: Surgery is possible, but the hilar tumor had compressed the stomach wall and pancreas, possibly requiring multi-organ resection. The tumor also invaded the hepatic artery, carrying risks of massive intraoperative bleeding and incomplete resection.

Two paths lay before her: continue chemotherapy and wait for a better window, but her body's tolerance was nearing its limit, with potential drug resistance risks; or undergo surgery immediately, accepting the worst-case scenario but holding onto hope for a cure.

"I never expected to face such a choice in my twenties. I had insomnia for two hours before deciding. Suddenly, it felt unreal. I wasn't heavily burdened or particularly sad, just lost. I'll just go for it, hoping for a little luck. Maybe the tumor will suddenly make way for the blood vessels during surgery," Ran Jiang said.

[ Ran Jiang named her plush toy "Definitely Win" ]

Surgery was scheduled for late August. While waiting, as a precaution, she underwent one more systemic IV chemotherapy.

On August 26, the surgery proceeded as scheduled, going much smoother than expected. Four hours later, Director Wang stepped out and said, "It went very well. R0 resection (meaning the tumor was completely removed during surgery, with no cancer cells found at the margins under a microscope, representing the ideal state of radical resection)," her waiting family wept with joy.

Postoperative pathology showed 90% necrosis of the intrahepatic lesion, with only 2 lymph nodes involved. The chemotherapy effect far exceeded expectations.

[ Postoperative with drainage tubes ]

After surgery, Ran Jiang had three drainage tubes, experiencing persistent diarrhea and ascites leakage. She was discharged on the ninth day after all tubes were removed. "On the twelfth day post-op, I could finally turn over on my own. On the thirtieth day, I passed a formed stool. That joy was even stronger than getting a good scan report," Ran Jiang wrote, her words brimming with the joy of rebirth.

[ Ran Jiang after surgery ]

「 VI. A "Slowed Down" Life is More Precious 」

For follow-up treatment, three doctors offered different plans: oral pemigatinib for 6 months; oral tegafur or capecitabine plus pemigatinib with MRD monitoring; or stop treatment, follow up every two months, and take pemigatinib if tumor markers rise.

After careful consideration, Ran Jiang chose maintenance therapy with oral pemigatinib + tegafur, along with regular MRD testing.

[ Postoperative follow-up results ]

On October 9, her first postoperative follow-up showed everything was normal, and recent MRD testing was also negative (MRD testing detects molecular residual disease; a negative result suggests the patient may have achieved a potential cure).

"Although I'm still troubled by old intestinal discomfort after taking the medication, and the future remains uncertain, I will not go gentle into that good night." Ran Jiang said she used to always rush through life. Now she understands that cooking a simple home meal and being surrounded by family love... is the greatest happiness. She wants to take better care of herself, honoring her younger self who was always reserved and timid yet stubbornly resilient.

Before getting sick, she was busy working and rushing through deadlines, often celebrating her birthday with a hastily bought cake. The illness unexpectedly pressed the "slow motion" button on her life. She spent eight months living closely with her mother after a long separation. Her father, a typical "Chinese dad"—silent, frugal, and inexpressive—started making playful jokes, laughing that they both went bald. She turned 27 during her illness, receiving blessings and red envelopes from the whole family... Ran Jiang, who had grown distant from her parents in adulthood, reconnected deeply with them through the bonds of illness, learning to openly say "I love you."

[ In her "slowed down" life, Ran Jiang started doing puzzles, cooking, baking... ]

"I am so lucky to have met the enthusiastic Panda Group members and the kind Sister Lynn. Especially Sister Lynn, who guided me throughout the process, consulting many industry experts and seniors at every critical treatment node for me; and meeting professional, responsible doctors who, upon learning of my financial strain, recommended me for a targeted drug clinical trial," Ran Jiang said.

Now, on Xiaohongshu, she continues to share her treatment journey and answer fellow patients' questions. She hopes her story will show more young patients that life is not easy to live once, to believe in their own strength, and never doubt the determination and possibility of survival.

"Focus on what you can control, and don't borrow trouble from the future." She shares this motto with everyone.

The story is written, but life continues. As the Winter Solstice approaches, Ran Jiang sent a message to her family group chat: "Remember to eat tangyuan. May we be together and whole."

To protect patient privacy, names in the article are pseudonyms.
Images featuring the patient's portrait are used with her authorization and may not be used without permission.

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