Advanced Rare Hepatoid Adenocarcinoma of the Stomach with Liver Metastasis: A Long Healing Journey Spanning 26 Months | Patient Story

「 Part I: Fainting in the Restroom, Initial Diagnosis of Stomach Cancer 」

On October 1, 2023, the highways were filled with the joy of the upcoming holiday. In a corner of a rest stop, Xia Tian and her husband's truck sat amidst the bustle, the fatigue of long-distance driving setting in.

Xia Tian's husband was a long-haul truck driver, constantly traveling across the country, which meant an irregular lifestyle. For the couple, there were no real holidays. After a brief rest at the service area, they had to rush to the next unloading point.

Not long after, her husband stumbled back to the truck, his clothes covered in dust. "He said he fainted while using the restroom." Seeing his pale lips, Xia Tian took him to a county hospital. "The doctor hadn't even run blood tests yet; he just took one look and said it might be anemia. I thought that was impossible—he was so strong."

The normal hemoglobin reference range for adult males is 120-160 g/L. That day, his test results showed a level of only 60 g/L. The doctors told them his condition was critical.

During the National Day holiday, the county hospital lacked specialists. On October 5, Xia Tian rushed her husband to Dezhou People's Hospital. By then, his hemoglobin had dropped to 45 g/L, requiring an emergency blood transfusion. Emergency CT scans revealed a space-occupying lesion at the gastric fundus.

By the third day in the emergency department, the gastroscopy results were still pending. Anxious, Xia Tian approached the department director. After reviewing the scans, he gave a preliminary diagnosis: stomach cancer.

「 Part II: Diagnosis of Rare Hepatoid Adenocarcinoma of the Stomach 」

A year earlier, her husband had undergone a comprehensive check-up. Eleven polyps were removed from his intestines, and his stomach showed erosion and congestion, along with an H. pylori infection. After following a light diet for a month as advised, he returned to his busy routine.

With this diagnosis, Xia Tian learned a secret he had kept for ten months: he had been experiencing black stools but was too afraid of a bad diagnosis to tell her.

At the time, Xia Tian didn't fully understand the disease. "I know others who had stomach cancer and lived a long time after treatment," she thought.

To arrange surgery as soon as possible, Xia Tian traveled between hospitals in Jinan and Dezhou. However, because her husband was diagnosed with a subacute cerebral infarction, doctors recommended resting for three months before reassessment. By chance, she contacted a specialist at a major Jinan hospital and requested a visiting specialist surgery.

The surgery lasted over eight hours, preserving one-third of his stomach. The specialist informed her that 15 lymph nodes were dissected, with only one showing metastasis. The operation was successful.

However, two unfamiliar terms left her uneasy. First, preoperative tests showed an alpha-fetoprotein (AFP) level of over 600 ng/ml. The doctor explained, "Some gastrointestinal tumors naturally cause high AFP levels."

Second, the postoperative pathology confirmed "hepatoid adenocarcinoma of the stomach." "The doctor only mentioned it was very rare," Xia Tian recalled. She later learned that this is a rare gastric cancer subtype, accounting for only 0.3%-1% of cases. It is highly aggressive, prone to early liver metastasis, and carries a very poor prognosis.

「 Part III: Treatment and Metastasis Simultaneously 」

After discharge, his appetite never recovered. His weight plummeted from 110 kg at admission to 85 kg. More critically, his hemoglobin hovered around 70-75 g/L, requiring frequent blood transfusions and IV fluids at the county hospital.

Hearing that Tianjin Medical University Cancer Institute & Hospital was highly regarded, Xia Tian took her husband there. Nearly 40 days post-surgery, he was so weak that two people had to support him from the parking lot to the clinic, and his mental state was at its lowest.

"Seeing our condition, the doctors in Tianjin said the prognosis was poor and the situation severe. They also noted how rare this subtype is," she said.

Returning without a clear plan, her husband was admitted to two more hospitals. Due to his extreme weakness, no doctor would formulate a follow-up treatment plan. By December 2023, seeing no progress, Xia Tian transferred him to a specialized hospital in the provincial capital, where doctors prescribed the SOX regimen.

Shortly after surgery, Xia Tian had her daughter take the scans to a gastroenterology department in Beijing. The doctor there had already recommended the SOX regimen and warned of a "high risk of recurrence." Trusting the major Beijing hospital, Xia Tian followed this advice.

On May 23, 2024, after 12 cycles of chemotherapy, Xia Tian finally breathed a sigh of relief. Many doctors had warned of the poor prognosis, and she hoped chemotherapy would buy him a few more years. Yet, just one month after finishing treatment, a June 26 follow-up CT revealed a 1.7 cm liver lesion. By July 1, enhanced CT and MRI confirmed diffuse multiple liver metastases, and his AFP skyrocketed to 3,000 ng/ml.

Genetic testing and immunohistochemistry results showed: HER2 score 0, CLDN18.2 negative, and CPS < 1. No targeted new drugs were available.

Second-line chemotherapy began hastily, using a regimen of "albumin-bound paclitaxel + fruquintinib capsules." The side effects drove his spirits to rock bottom. On July 19, ten days after the first cycle, he fainted again at a breakfast stall.

"I took one look at his eyelids and knew the anemia had returned. I immediately called 120 to get him to the hospital for a transfusion," she recalled.

His appetite remained poor, consuming only about 250 ml of millet porridge and a small bite of steamed bun daily. Worse, after prolonged transfusions, "some hospitals refused to continue treating us. We've visited nearly every hospital in the county."

During that time, Xia Tian constantly searched online for information on "hepatoid adenocarcinoma of the stomach," hoping to connect with others who shared their experience. Clinical cases of this rare disease are scarce, and online information was highly fragmented. One day, on Toutiao, she read an article by a family member of a patient with the same condition and learned about the "Panda Group."

「 Part IV: Nearly a Year Post-Diagnosis, a Treatment Plan Finally Set 」

After joining the group, Xia Tian immediately added "hepatoid adenocarcinoma of the stomach" to her nickname. After a few days of silence, she finally spoke up. "As soon as I finished, the group admin, Lao Niu, saw my note and said, 'For this disease, you should see Dr. Wang at Peking University Cancer Hospital.'"

By then, her husband had completed two treatments. His AFP had risen to 16,000 ng/ml, and enhanced CT showed the liver lesion had grown to 6 cm. The disease was progressing rapidly. Xia Tian knew they needed to change the treatment plan but had no direction.

After adding Dr. Wang on WeChat, Xia Tian sent all the medical records. "He said the previous regimen was too mild and asked us to come to Beijing for an in-person consultation," she said.

In mid-September, the summer heat still lingered in the wind, mirroring their unresolved anxiety. Xia Tian and her husband brought all their medical files to Beijing. Upon meeting Dr. Wang, she learned her husband not only had hepatoid adenocarcinoma but also signet ring cell carcinoma—both highly aggressive types.

Fortunately, throughout their conversation, the doctor patiently analyzed their situation like a close friend or family member, answering even the most basic questions without hesitation. "Don't worry, we still have options to try," he assured them.

This patience and certainty brought them peace of mind for the first time since the diagnosis. Dr. Wang prescribed a regimen of "interventional therapy (HAIC/TACE) + immunotherapy (sintilimab) + targeted therapy (lenvatinib)," explaining it was a precision strike tailored to the characteristics of liver metastasis from this specific cancer.

It was Xia Tian's first time hearing of HAIC. Dr. Wang added her to a dedicated patient group consisting entirely of individuals with hepatoid adenocarcinoma, allowing her to learn more about the interventional therapy.

Armed with the new plan, they returned to Shandong for the third treatment, only to be refused by the attending physician. Xia Tian processed their discharge that same day. "It's time to leave," she thought, feeling wronged but more determined than ever to seek treatment in Beijing.

「 Part V: "You've Achieved Clinical Cure!" 」

Given the rapid progression of her husband's condition, Xia Tian quickly secured a hospital bed at Beijing 302 Hospital.

A new challenge emerged. Doctors at 302 Hospital believed HAIC was better suited for highly vascular primary liver tumors. For their case of diffuse multiple liver metastases, the tumors lacked sufficient surrounding blood vessels, making HAIC less likely to be effective.

Dr. Wang, however, insisted HAIC was still the best current option. Regarding medication, Dr. Wang recommended 5-FU, while the 302 Hospital doctors suggested substituting it with raltitrexed to reduce the patient's discomfort.

Xia Tian felt lost again. "He gave us a path, but now even that path seems blocked." By then, a week had passed in Beijing, and her husband's AFP had climbed to 26,000 ng/ml.

They couldn't wait any longer. After thorough communication, Dr. Wang advised, "We can try raltitrexed as an alternative to 5-FU. As long as it achieves the therapeutic effect, it's fine."

On September 19, her husband underwent his first HAIC treatment using raltitrexed + oxaliplatin. "About ten hours after the procedure, the catheter was removed, and he could move around," Xia Tian recalled. "He had a fever for seven or eight hours that night, so I used cold compresses and wiped his body to bring it down. By the next morning, his temperature was normal."

On the day treatment ended, he managed to eat one and a half steamed buns. With the help of other supportive medications, a year after diagnosis, his three daily meals finally returned to normal.

Early in treatment, his AFP once spiked above 40,000 ng/ml. A follow-up enhanced MRI showed the liver lesion had grown to 11 cm. In a panic, the doctor explained this was due to tumor necrosis and fusion, not disease progression, and actually indicated a strong treatment response.

After the second treatment, AFP began to steadily drop by over 10,000 each time. The liver lesion also shrank to about 3 cm.

After completing the third and fourth combined HAIC + TACE treatments, AFP finally dropped below 1,000.

During interventional therapy, sintilimab and oral lenvatinib were used concurrently to further target the lesions. On the evening of February 14, 2025, after working overtime to review the latest CT scans, Dr. Wang delivered the long-awaited conclusion: "You've achieved clinical cure!"

The persistently high AFP finally returned to normal levels.

「 Part VI: Being the Strongest Support Behind Her Husband 」

Throughout this 26-month treatment journey, Xia Tian handled everything herself without involving her daughter. She once thought, "Even if it's cancer, how bad could it really get?"

In front of others, Xia Tian never showed her vulnerability, fearing her negative energy would affect those around her. Alone, she could only release stress through tears. "Sometimes I felt there was no worst, only worse," she admitted.

During her husband's first chemotherapy, Xia Tian simultaneously underwent gynecological laparoscopic surgery at a cancer hospital. She was discharged the next day. "I told the doctor I couldn't stay hospitalized; I had a patient to care for," she said. A biopsy later revealed a precancerous lesion.

Due to lack of rest, her body developed abnormalities half a month later, making every follow-up examination extremely painful to this day. Thinking back, she still tears up. "Thankfully, it wasn't cancer. I told myself I must stay well, stay happy, and keep my immunity strong."

While hospitalized at 302 Hospital, Xia Tian suddenly experienced chest pain while out shopping. Sitting on a curb outside a park, tears welled up. "The pressure was immense, but I couldn't let my husband know, or his stress would be even greater." A family member of another patient comforted her and stayed up talking with her until late at night. "Sometimes, you really need someone to pull you through."

Xia Tian's father once comforted her, saying she didn't need to be perfect in everything. "You've already done your absolute best." As a retired teacher, he provided both emotional and financial support. Yet Xia Tian felt some outcomes could only be known by trying. "It was all driven by the will to survive. Initially, I just wanted to prolong his life as much as possible. I never expected that, step by step, we would find a bright path forward."

Currently, her husband continues maintenance therapy with sintilimab. From being told he had "only three to five months left" to receiving a "clinical cure" verdict, Xia Tian and her husband have witnessed the power of medicine and experienced the resilience of life.

"If we had joined the Panda Group earlier, we would have avoided many detours," she said. She is deeply grateful to admin Lao Niu and other group members who reached out during their darkest times. Still, she tries to minimize bothering others. Being older, she forgets things quickly, so she writes everything down in a notebook. "That way, I won't trouble others when I need information."

Now, Xia Tian's greatest wish is to share her experience with more people. "If diagnosed with hepatoid adenocarcinoma of the stomach, you must seek professional, authoritative doctors. Trust science, not folk remedies," she advises. "No matter how hard it gets, as long as you don't give up, leave the rest to the doctors."

「 Part VII: From One in 3.17 Million to the 'Only One' 」

"Truck driver's wife" (Kasao) is a unique concept in China's road freight industry. According to a 2022 report by Minsheng Weekly, there are approximately 3.17 million such women in China. This title, derived from their husbands' profession, falls far short of representing their daily labor value and dedication.

"He just drives; I handle everything else." Once, as one of those 3.17 million, Xia Tian managed all logistics: assisting on trips, daily care, coordinating tasks, and even emergency response. Now, as her husband recovers from his severe illness, she still revolves around him daily. "I cook whatever he wants to eat, and we go wherever he wants to play." Xia Tian has become the "only one" on her husband's cancer journey.

Whether treating illness or living daily life, Xia Tian has always kept the "steering wheel" firmly in her own hands. From a truck cabin of less than 5 square meters, to a hospital ward, and now to a stable home, wherever she is, she anchors the family there.

The truck has changed hands, but Xia Tian dares not ease off the accelerator. She says life's lowest points are also new beginnings. Treating this as a gear shift, she continues to rely on the resilience forged on the highways, shifting gear by gear up life's long slope, driving steadily toward the light.

To protect patient privacy, names used in this article are pseudonyms. Images featuring the patient's portrait have been authorized by the patient and may not be used without permission.