A 1.7cm Dilemma: Sphincter Preservation or Survival? A Sibling's Year-Long Journey Through Their Mother's Ultra-Low Rectal Cancer Cure | Patient Story

When we were young, our parents were our sky, shielding our family from all storms. Yet, the moment my mother was diagnosed with rectal cancer, I suddenly realized that the home that once sheltered us would now need our protection: our hemiplegic father had relied on her care for years. My older sister, already married with her own family, and I, who had just left the workplace to return to school, became the main force in her fight against cancer.

We decided against a rushed local surgery and chose to seek medical care in the north. My sister and I divided the tasks: she became the steadfast executor, taking our mother for tests, borrowing biopsy slides from hospitals, and running errands to care for her. After surgery, she learned to change the ostomy bag to ease my mother's embarrassment, and repeatedly prepared the family psychologically before follow-ups. I took on the role of the calm decision-maker, bearing the pressure of every choice. My graduate studies and internship had to yield to my mother's treatment. I painstakingly deciphered once-distant medical terms and complex treatment protocols.

I had long wanted to write about this experience but hesitated: on one hand, I feared an unexpected recurrence at the one-year post-op checkup would turn this record into a false joy; on the other, I wondered about the purpose of writing it down. Until a few days ago, after turning 29, I suddenly understood: just as I always take photos when going out, I simply want to preserve this moment. In the days ahead, whether to remember "we survived so much together" or to offer a reference to others in similar situations, this record will have found its meaning.

These imprints may carry regrets, but they are full of genuine strength. They are not for "false joy," but to cherish the times we fought with all our might to protect each other.

Author丨Zhong Lala
Editor丨Zhong Lala, Xian Ning
Reviewer丨Guang Guang

「 Part I: Local Medical Care: Trapped in the Sphincter Preservation Dilemma 」

My mother's rectal cancer had early warning signs: in 2018, a benign polyp was removed at a private clinic, but she was never told to follow up regularly. She often ate leftovers, combined with a heavy-oil diet from our hometown. Even when feeling unwell, she chose to endure it silently, not wanting to trouble her children. These factors may have all laid the groundwork for her illness.

In October 2023, when my mother was hospitalized for a lacunar infarction, she first mentioned rectal bleeding. However, due to the acute stroke phase, a colonoscopy couldn't be performed. A fecal occult blood test showed no abnormalities, so the symptom was temporarily set aside.

In 2024, after participating in low-cost moxibustion in our residential community, her anal tenesmus worsened and rectal bleeding recurred. A doctor recommended a colonoscopy for a clear diagnosis. After an anoscopy at a private hospital, the doctor subtly hinted that she needed a comprehensive checkup at a major hospital.

With anxious hearts, my sister and aunt took my mother to the Ningxia Autonomous Region People's Hospital. Given her history of lacunar infarction, diabetes, and previously recorded atrial fibrillation, she was still taking rivaroxaban, so the colonoscopy had to be postponed. An initial fecal occult blood test again showed no abnormalities. It wasn't until a comprehensive examination that the "CA?" on the colonoscopy report weighed heavily on my sister and me.

Clinging to a sliver of hope, I tried to comfort myself with "tumor markers are within normal range" and "does the question mark mean it's not confirmed cancer yet?" to mask my fear. However, after online consultations with several experts on JD Health, they all advised immediate specialist care. Based on the existing results, rectal cancer was virtually certain.

When the final pathology report came back as moderately differentiated adenocarcinoma, I panicked instantly. On one side was my impending graduate school semester; on the other, my mother needing care, and my father, who had been hemiplegic for years and relied on her.

I had to accept this cruel reality. Before this, I knew nothing about surgery, naively thinking "just cut out the bad thing," and assumed chemotherapy and radiation would be as agonizing as on TV, with hair loss and pale faces. The local district hospital doctor noted the tumor was small with no metastasis and recommended prompt surgery, which they could perform.

After repeated discussions with my sister, we made our first decision: stay in Ningxia and find an experienced gastrointestinal surgeon. After several referrals, we consulted two deputy chief and chief physicians. After reviewing the results, both recommended prompt surgery but delivered hard-to-accept news: due to the tumor's extremely low position, sphincter preservation was highly unlikely.

If the cancer diagnosis was a heavy blow, the "no sphincter preservation" conclusion multiplied the pain exponentially. After much thought, my sister and I decided to hide the truth from our mother for now. When taking her to see doctors, we made her wait outside, telling her it was just a benign polyp that would be removed.

That Friday, upon discharge from the district hospital, we successfully obtained an admission slip from the provincial affiliated hospital, scheduled for the following Monday. That same day, after consulting relatives, my sister learned of a relative who had effectively extended survival with liver cancer treatment at Beijing Cancer Hospital. She tentatively suggested, "Should we go to Beijing for a second opinion?"

Initially, I thought surgery was inevitable regardless of location. Seeking care in Beijing meant difficult appointments, long waits, and rumors of red envelopes, which seemed too exhausting. Moreover, with my mother's hypertension, diabetes, and lacunar infarction, a comprehensive provincial hospital seemed safer for managing her comorbidities. Her previous coronary CTA and stroke treatments were there, making records easily accessible and care more continuous. I strongly preferred staying local.

"Fear stems from a lack of understanding." This rings especially true. Back then, I had never heard of "neoadjuvant therapy" or "staging assessment." My only goal was "cut out the tumor." If the doctor said surgery was possible, I saw it as the most direct solution, already planning post-op care without considering "can we preserve the sphincter?" or "what's the recurrence risk?" My sister's careful suggestion to go to Beijing, saying "we can't be careless with a major illness; even if it means an extra trip, we can't leave regrets," finally pulled us out of local limitations and opened our eyes to more standardized, comprehensive treatment options.

「 Part II: Consultation at Beijing Cancer Hospital: Clear Diagnosis and Standardized Treatment 」

The day after the pathology report, I accidentally found a crucial patient support group on Xiaohongshu called "Panda and Friends." Initially worried it might be a scam selling "miracle drugs," I joined cautiously. To my surprise, the group announcements were packed with professional knowledge, from staging to medical tips. Seeing usernames prefixed with "T X N X M X" left me confused.

As the primary decision-maker for my mother's treatment, I feared my wrong choices would cause her unnecessary suffering. After briefly studying the group's resources, I asked questions. The mentors quickly advised: if possible, seek treatment out of town, and recommended several authoritative doctors. It was then I first learned about "neoadjuvant therapy." Professional treatment requires multidisciplinary evaluation, not just surgery. For mid-to-late stage rectal cancer, preoperative chemoradiotherapy can shrink the tumor, downstage it, create better surgical conditions, and even increase the chance of sphincter preservation.

Combining this with my sister's relatives' advice, I also consulted a chief physician at Sun Yat-sen University Cancer Center online, who confirmed that neoadjuvant therapy might offer greater benefits. Ultimately, we decided to travel north for treatment, not giving up any hope of sphincter preservation. The Panda group mentors kindly provided a checklist for out-of-town medical visits, emphasizing pathology slides. I forwarded this to my sister and remotely guided her preparations.

Using my accumulated leave, I flew from Shenzhen to Beijing. My mother and sister traveled from Yinchuan. We converged in three places, officially starting our journey north. We chose Beijing Cancer Hospital partly because I could secure an appointment, and partly due to its good reputation, excellent patient education, and positive patient reviews. On the day of the visit, although my mother waited outside the clinic, seeing the oncology hospital's sign likely made her suspect something.

After reviewing our local reports, the doctor performed a digital rectal exam and ordered a series of necessary tests to clarify the disease stage.

The green channel for the first visit at Beijing Cancer Hospital exceeded expectations. We consulted on Tuesday and had a contrast-enhanced MRI by Friday. Director Wang even joked if we had connections, given how fast it was. The detailed report provided the first clear diagnosis: T3aN2a rectal cancer, tumor distal margin 17mm from the anal verge, 41% circumferential involvement, 23mm in length, with 5 lymph node metastases.

After the results came out, we returned to the clinic. The doctor proposed a treatment plan: 22 sessions of radiotherapy combined with capecitabine chemotherapy, followed by surgical evaluation.

Throughout the radiotherapy, my third aunt accompanied her. My father needed care due to hemiplegia, my sister had a nephew preparing for the college entrance exam, and I even considered taking a leave of absence. My third aunt stepped up, leaving her small shop to accompany my mother north.

They rented a shared homestay near the hospital and stayed for the entire radiotherapy cycle. My third aunt, nearing seventy, never complained about the hardship. She constantly varied my mother's high-protein meals to help her endure treatment and prevent drops in white blood cells and platelets. Thanks to her care, my mother's blood counts remained normal throughout, though she developed a slight aversion to meat, especially beef.

In the later stages of radiotherapy, my mother experienced anal tenesmus, burning sensations, and small blisters—common radiation side effects. After consulting the group mentors, I used Honggudou suppositories and urea cream, which relieved her discomfort.

Radiotherapy coincided with the National Day holiday. After fewer than 10 sessions, my mother felt relatively well. I flew from Guangzhou to Beijing to take her and my third aunt sightseeing. I wanted to ease her anxiety and treatment stress, and give my hardworking aunt a break to see a city she'd never visited.

Looking back, it was quite bold to take two women in their sixties and seventies on a "power walk" through Beijing. I slowed the pace, visiting only one or two sites daily with ample rest. We visited Tiananmen Square, the Chairman Mao Memorial Hall, and the Great Hall of the People, strolled through Tsinghua University, took a cable car up the Great Wall, and ended at a high-tech Haidilao. The moderate outing didn't tire them; instead, it significantly boosted my mother's spirits.

During treatment, we always wanted it to "end quickly" and "get better soon," often overlooking small beauties. Though my mother joked she'd "never come to Beijing again," that short trip interspersed with radiotherapy became a rare, anxiety-free memory on our grueling cancer journey.

After a two-week rest post-radiotherapy, my mother had a port implanted locally. The Beijing doctor arranged the first dual-drug chemotherapy (capecitabine + oxaliplatin). However, on the evening of the treatment day, while at the train station returning home, my mother suddenly experienced chest tightness, cold sweats, and shortness of breath, reporting extreme discomfort. After evaluation, the doctor switched to single-drug chemotherapy (capecitabine).

During chemotherapy, another aunt took her in for care. Even single-drug chemo affected her greatly. Every call revealed her fatigue and poor appetite. I constantly encouraged her to eat protein-rich foods, take protein powder, and use tamarind to stimulate appetite as suggested by volunteers. Fortunately, her blood counts stayed normal. I only breathed a sigh of relief when they remained normal two weeks after stopping the medication.

「 Part III: The Difficult Choice: Sphincter Preservation or Survival 」

After completing four cycles of oral chemotherapy, follow-up results showed circumferential involvement reduced to 33% and length to 16mm. The tumor had shrunk.

I immediately took my mother to Director Wang for preoperative assessment. During the consultation, the doctor clearly stated: due to the tumor's extremely low position, the chance of sphincter preservation was minimal. Unwilling to give up, my sister and I consulted Director Wu, who replied: "Save her life first."

We came to Beijing hoping to preserve the sphincter, made so many efforts, and saw good results, only to face this outcome. It was hard to accept. Though my mother joked "no anus, no point," her disappointment was obvious.

Director Wu smoothly issued an admission slip. However, with my mother's hypertension, diabetes, and lacunar infarction, a detailed anesthesia assessment was mandatory before surgery. To avoid delays, Director Wu suggested going to a partner hospital for this assessment, which would be more efficient. After contacting them, we learned the assessment could be done concurrently with admission, and costs would be reimbursed normally, easing our financial burden.

During pre-op checks at the partner hospital, the coordinating doctor discussed scheduling: surgery could be arranged within one or two weeks there, but returning to the main Beijing Cancer Hospital campus would take over a month. We verified local insurance policies and confirmed identical reimbursement rates. Wanting earlier surgery for peace of mind, and given the partner hospital's decent environment, we decided to proceed there.

Looking back, this decision was quite risky. With my mother's complex comorbidities, intraoperative emergencies were possible. The partner hospital's medical resources and emergency capabilities couldn't match the main campus in the city center. We were quite nervous at the time.

「 Part IV: Successful Surgery, Mother Became a "Rose Person" 」

Right after the 2025 New Year holiday, my mother entered the operating room as scheduled. For over three hours, my sister and I sat anxiously in the hallway, worrying about the surgery's success and whether she could adapt to life with an ostomy. When the doctor finally said, "The surgery was very successful," our suspended hearts finally settled.

The postoperative pathology was excellent: the tumor was completely removed with no new metastases, bringing immense relief. Yet, seeing the stoma on my mother's abdomen filled us with deep regret—she had become a "rose person" (ostomate). No one can truly empathize with this regret. All my sister and I could do was accompany her through the adaptation process.

Since the surgery, my sister has become an "expert" at changing the ostomy bag. She closely observed the nurse's first demonstration, memorizing every step. The second time, though slower, she was methodical and calm. Later, for follow-ups, my mother visited ostomy clinics at 301 Hospital, Beijing Cancer Hospital, and local hospitals, but she always said no one changed it as comfortably as my sister.

As for me, trying to record a video for my sister during the first nurse demonstration triggered a vasovagal response. I felt nauseous, dizzy, and broke into a cold sweat, taking a long time to recover.

Now, my sister changes the bag effortlessly. We've been searching for cost-effective ostomy products. The local malignant disease outpatient reimbursement has a 3,500 RMB limit. A single pack of 10 Coloplast two-piece bags nearly exhausts it before reimbursement, forcing us to budget carefully.

I remember the first time changing my mother's bag, a careful nurse comforted her: "Auntie, don't worry. With proper care, an ostomy won't affect normal life. Eat and drink as usual, no psychological burden." Fellow patients also helped greatly. Roommates shared care tips, showed their bags, and assured her, "With good care, there's no odor and normal life continues."

Looking back, though we couldn't preserve the sphincter, saving my mother's life so she could stay with us is the greatest fortune. Regrets exist, but life moves forward. Seeing her now cook, shop, stroll, and even play mahjong, adapting to life with an ostomy, I know all our efforts were worthwhile. This regret will gradually be healed by time and companionship. All we can do is cherish the present and accompany her through every day ahead.

「 Part V: A Twisting but Ultimately Bright Follow-up Journey 」

Postoperative follow-ups were full of twists: the third scan showed abnormal inguinal lymph nodes, but a biopsy confirmed inflammation, bringing relief. The fourth CT showed enlarged lymph nodes again, requiring close monitoring and offline film review, alongside worries about CT radiation.

Finally, the one-year post-op follow-up arrived. During my internship, I received a text notification from Beijing Cancer Hospital. My heart tightened with fear of recurrence. I took a deep breath, opened the app, and stared at the screen until the words "basically unchanged from before" appeared, slowly calming my nerves.

Though the results were good, I felt uneasy without the director's verbal confirmation. Coincidentally on a business trip to Jinan, I invited my mother and third aunt to relax. For days, I avoided mentioning the follow-up, taking them to Daming Lake, Baotu Spring, and trying local snacks. My mother was in high spirits, praising the clear spring water and fragrant braised pork, and still jokes about the two pieces of sweet and sour carp I didn't let her pack.

After the consultation, the director confirmed her excellent recovery. We finally breathed a sigh of relief. A year of hardship and anxiety had finally yielded a perfect reward.

「 Part VI: Heartfelt Sharing Beyond Treatment 」

After a year of fighting cancer, I want to share these heartfelt words. With the one-year follow-up successfully completed, my mother now lives normally, shopping, cooking, and chatting with neighbors. Seeing her condition fills me with emotion.

This year's journey was bumpy. We stumbled, panicked, but also gained hope and growth. After this visit, relatives now ask me for hospital/doctor recommendations and help booking appointments when going to Beijing. Their attitude toward serious illness has changed: major diseases often require thorough examinations for accurate diagnosis and standardized treatment. Thus, I want to share these reflections to help others.

1. Don't Delay Intestinal Abnormalities; Gastroscopy/Colonoscopy is a "Life-Saving Mirror"

I sincerely remind everyone: if you experience rectal bleeding, abdominal pain, anal tenesmus, or changes in bowel habits, don't ignore them or self-diagnose as "hemorrhoids" or "internal heat." Seek a hospital for a colonoscopy immediately. Especially for those over 40, regular screening is recommended even without symptoms. Many intestinal diseases show no early signs; colonoscopy is the most effective way to detect them.

2. Follow Standardized Treatment; Don't Be Misled by "Shortcuts"

If test results are poor, consult multiple hospitals, especially specialized oncology centers, and follow multidisciplinary treatment guidelines. Don't blindly trust "quick surgery" or "skip chemo/radiation" advice, nor be scared by stereotypes. With modern medicine, side effects are mostly manageable. Standardized treatment maximizes efficacy and minimizes recurrence risk.

3. Arrange Insurance in Advance; Provide Security for Your Family

This year's treatment costs were manageable thanks to insurance and a pre-purchased cancer policy, but upfront exams, travel, and accommodation were still significant. Without that policy, savings might have been strained. If financially able, arrange basic commercial insurance like cancer or critical illness coverage for yourself and family. Resident or flexible employment medical insurance is the baseline; enroll on time. These seem unnecessary until a major illness strikes, then they ease financial pressure, allowing you to focus on the best treatment without worrying about costs.

4. Believe in the Power of Effort; Don't Overlook Surrounding Support

On this journey, I often felt anxious: which treatment plan? Will follow-ups show problems? Can I balance studies and caregiving? But whenever I felt overwhelmed, family companionship, patient group advice, and doctors' encouragement gave me strength.

When feeling low, don't endure it alone. Believe in the meaning of effort—taking every exam seriously and following every treatment step fights for life. Also, don't overlook support: family's partnership, friends' care, and patients' shared experiences are sources of courage. No matter how hard, never give up, and hope will appear.

This year taught me that life is unpredictable, but we can prepare and face it positively. May everyone value health and respect life. May every cancer-fighting family avoid detours and find warmth and strength in adversity.

「 Part VII: Gratitude 」

First, I thank my sister. She worked the hardest this year. Running her own shop is exhausting and caused occupational ailments, yet she managed her family well, brought our parents to live with her, and tirelessly accompanied my mother through treatment this year.

Thank you to my aunts for their meticulous care of my mother's daily life during treatment.

Thank you to neighbors in our hometown and current city for helping care for my hemiplegic father and offering my mother encouragement and comfort.

Thank you to friends on WeChat Moments for proactively sharing practical information when I sought treatment advice.

Sincere thanks to the doctors in the Third Gastrointestinal Surgery Department at Beijing Cancer Hospital for providing standardized guideline-based treatment with excellent results. Thanks to the oncology medical staff for their gentle attitude and care, helping my mother complete neoadjuvant therapy smoothly. Thanks to the partner hospital staff for their patient and meticulous care, ensuring a smooth discharge. Wishing all medical staff smooth work and good health.

Finally, thank you to the volunteer mentors and group members of "Panda and Friends" for providing professional medical advice and warm emotional support when I was lost and emotionally overwhelmed.

It is this gathered strength that became our solid backing in defeating cancer.

Wishing us all peace and health.

To protect patient privacy, names in this article are pseudonyms. Images containing patient portraits are used with authorization and may not be used without permission.