Late-Stage Gastric Cancer at 34: A STEM Professional’s Cancer Journey in Germany: Preparing for the Worst, Living the Most Positive Life

At 36, Mat has a stable job and life in Germany, seen by others as a successful overseas professional. In 2024, this young man who "works out regularly, has rarely had major illnesses, and seldom catches colds" was diagnosed with gastric cancer. After a total gastrectomy, pelvic metastatic lesions were discovered.

His life was sharply divided from that point on. The first half was a steady career, a planned marriage with his girlfriend, and years of companionship with his parents; the second half consists only of chemotherapy, surgeries, shuttling between hospitals, and a life measured in three-month increments.

His story may not feature a miraculous turnaround, but it holds the most authentic struggle, perseverance, and unextinguished will to survive in the face of fate's dead ends. On his cross-border cancer journey between China and Germany, he uses clarity and rationality to confront all the uncertainties in life. On the path of living toward death, every earnestly lived present is the best response to fate.

Author | Chanchan
Editor | Chanchan
Reviewer | Guangguang

「 Part 1: Sudden Drop in Appetite, Gastroscopy Biopsy Confirms Gastric Cancer 」

For the first 34 years of his life, Mat was on a steady upward trajectory. He went to Germany in 2013 and stayed for 13 years, with a stable job, a loving girlfriend, and parents frequently traveling between China and Germany to accompany him. Life was smooth and fulfilling.

He always had great confidence in his physical condition. "Young, works out regularly, rarely has major illnesses, and seldom catches colds" was his self-assessment. However, Germany's vastly different healthcare system also caused him to miss earlier opportunities to detect the problem.

"Most companies in China organize annual check-ups, and even personal check-ups can be done at one-stop centers within a day or two. But Germany is completely different," Mat says.

Germany lacks convenient one-stop check-ups. All tests require a referral from a family doctor first, followed by separate appointments at different clinics: ophthalmology, ENT, gastroenterology... A full-body check-up requires visiting seven or eight different clinics, with appointment wait times often stretching to two or three months. For Mat, who travels frequently for work, this process is nearly impossible. Not just him; most Germans do not have the habit of annual preventive check-ups, usually seeking medical attention only when symptoms appear.

Mat could only take advantage of business trips back to China to get a comprehensive check-up once a year. In the summer of 2024, he already noticed physical abnormalities: his appetite plummeted to less than that of a petite girl, unable to finish one takeout meal over three sittings, and his weight dropped steadily. He was on a business trip in China at the time and originally planned to get a gastroscopy, but due to busy work and a tight schedule, he kept postponing it.

[Mat during this year's Spring Festival]

This postponement lasted until December 2024. Upon returning to China again, his check-up revealed hydronephrosis and a positive H. pylori antibody test. Coupled with a six-month loss of appetite, he finally decided to undergo a gastroscopy.

To avoid troubling colleagues, he opted for a standard (non-sedated) gastroscopy. The awake procedure was uncomfortable, but compared to the physical discomfort, the doctor's reaction alarmed him more. The operating doctor was tense throughout, repeatedly asking him to cooperate and inquiring where his family was. After Mat explained he was alone, the doctor still hesitated and kept asking. At this point, Mat had already prepared for the worst. He tentatively asked, "Is it cancer?" The doctor nodded silently.

At that moment, Mat felt his mind go blank, as if suddenly losing power. He mechanically walked out of the hospital and stood on the streets of Wuxi, the December wind biting his face. "My whole body went numb, and I didn't know how to get back to the hotel."

He needed time. During the days waiting for the biopsy results, Mat worked as usual during the day and lay on the hotel sofa at night, his mind blank. He thought about many things: his parents, his girlfriend, the future they had just planned, and wondered if there might be a reversal.

On Thursday, the biopsy report was completed, confirming gastric cancer. The first person he told was his father. Before the video call, he specifically asked his father to sit down, "I was afraid he might faint." His father, a gastroenterologist, broke down in tears upon hearing the diagnosis, but regained his composure within minutes. Because the son on the other end of the line was not only calmer than him but also comforted him: "No one wants this to happen, but since it has, we must face it."

A CT scan done the same day showed no distant metastasis. The local doctor told him surgery could be scheduled for the next week. But standing at a crossroads in life, Mat had to make a realistic trade-off: his insurance, job, and life center were all in Germany, his parents were waiting for him there, and he had no insurance in China. Alone, he ultimately decided to cut his business trip short and fly back to Germany to begin treatment.

"At that time, I didn't really understand the disease. I just assumed that as a developed country, Germany's medical standards wouldn't be poor." Looking back now, he didn't know what awaited him.

「 Part 2: Returning to Germany for Tests and Consultations, Determining the FLOT Neoadjuvant Chemotherapy Regimen 」

In Mat's description, Germany's healthcare system presents a suffocating level of "rigor."

Before returning to China, he had already contacted his German family doctor and a public hospital, which exceptionally secured an early appointment for him. He landed in Germany on a Sunday, saw his family doctor on Monday, and visited the public hospital on Tuesday. Yet, even with a green channel, he still had to redo the full gastroscopy and CT scans. The gastroscopy was scheduled a week later, the CT two weeks later, coinciding with the Christmas and New Year holidays. Hospital staff were drastically reduced, and all processes were infinitely prolonged.

After the tests, he had to wait for the hospital's tumor board consultation to determine the final treatment plan. This system, equivalent to China's MDT (Multidisciplinary Team), is standard in German public hospitals. Patients don't need to apply; all cancer treatment plans must be collectively discussed and approved by the committee. But behind this rigorous process lies a long wait.

"That period truly felt like days dragging into years, like walking forward in pitch darkness, never knowing what the next step would bring." Recalling this time, Mat says it was the most difficult phase of his entire cancer journey. Doctors in China told him surgery could be scheduled next week, but in Germany, he could only watch time slip away day by day, without any treatment intervention, passively waiting.

He spent every day online, scouring German gastric cancer treatment guidelines and checking hospital rankings for gastric cancer cases. His parents contacted hospitals in China, and the family once debated whether to fly back to China for treatment. After repeated weighing, they decided to stay in Germany.

Christmas and New Year arrived back-to-back, and his birthday fell right in between. His girlfriend traveled from another German city to be with him. On Christmas Eve, he confessed his condition to his girlfriend of seven months. She had already planned their future: when to marry, when to have children. This sudden illness pressed pause on all those plans.

Mat immediately suggested breaking up, "I felt it was unnecessary to hold her back. We've only been together for a short time; she shouldn't have to bear this." She refused, insisting on accompanying him through this hardest path. On his birthday, with his girlfriend by his side and the recent tests completed, the stone in his heart temporarily settled. Amidst the holiday fireworks, he stole a moment of peace.

On December 30, the tumor board completed its consultation. Mat's gastric cancer was staged as T3N0M0, locally advanced. According to German guidelines, neoadjuvant chemotherapy was required first, followed by surgical evaluation. On January 10 of the following year, nearly a month after returning to Germany, he finally began his first chemotherapy cycle, using the European first-line standard regimen for gastric cancer: FLOT (Fluorouracil + Leucovorin + Oxaliplatin + Docetaxel).

「 Part 3: Significant Tumor Shrinkage After Four Chemotherapy Cycles, Switching Hospitals for Total Gastrectomy 」

The chemotherapy results were unexpectedly good.

Mat loves ramen. Before treatment, he could only eat half a bowl; after two cycles, he finished a whole bowl by himself. This tangible improvement brought him "great joy." After four neoadjuvant chemotherapy cycles, the CT showed "significant shrinkage."

However, as early as right after his second neoadjuvant cycle, Mat had already made an important decision: to switch hospitals. The hospital he initially chose ranked fourth in Germany for gastric cancer cases and was close to home. But during treatment, the hospital's rigid processes and the doctors' passive responses completely eroded his trust. "They never plan ahead, taking things one step at a time, completely failing to consider the importance of time from the patient's perspective."

What he found most unacceptable was the doctor's refusal to schedule an early surgical consultation. According to the treatment plan, surgery should be evaluated after four neoadjuvant cycles. The golden window for gastric cancer surgery is 4-6 weeks after chemotherapy ends. Learning from his previous waiting experience, Mat hoped to book the surgeon early to complete pre-op tests and surgery promptly after chemo. But the attending doctor refused his request, scheduling the surgical consultation three weeks after chemo ended.

"A consultation three weeks later, followed by tests and waiting for results, makes it impossible to catch the golden surgical window. I strongly requested an earlier date, but he refused to communicate or explain why." Moreover, in Germany's healthcare system, patients cannot freely choose their attending doctors. So, he decisively left this fourth-ranked hospital and transferred to the top-ranked Charité Hospital in Berlin.

[Pre-operative consultation with the surgeon]

After sending his medical records, Charité quickly connected him with the surgical department. Between his third and fourth chemotherapy cycles, Mat traveled to Berlin, completed a face-to-face consultation with the surgeon, and pre-scheduled the pre-operative gastroscopy, CT, and a laparoscopic exploration that the first hospital had omitted.

[In the ward before surgery]

On March 28, 2025, exactly in the fourth week after his fourth chemotherapy cycle, hitting the golden surgical window, Mat underwent a total gastrectomy at Charité Hospital. The post-operative pathology grade was TRG 1b, meaning over 90% of the cancer cells were inactivated, with less than 10% remaining viable. At that moment, he thought he had finally crossed the hardest hurdle, just one step away from clinical cure.

「 Part 4: Recurrence or Misdiagnosis? Pelvic Metastasis Appears Half a Year Post-Surgery 」

After the total gastrectomy, Mat recovered smoothly. In August 2025, as he was about to complete his post-operative adjuvant chemotherapy, he began planning his return to normal life, preparing to end his long-term sick leave, gradually resume work, and even planned a trip back to China to visit family and friends and handle some affairs.

[In the ICU post-surgery]

What he didn't know was that during this time, a hidden danger present since his initial diagnosis was quietly brewing. During his first check-up in Wuxi, he had already been diagnosed with hydronephrosis, which had never occurred in his kidneys before. His father, a former gastroenterologist, highly suspected it was caused by metastatic lesions compressing the ureter. However, doctors at Charité insisted on "evidence-based medicine": if no clear lesion is visible on the CT, it cannot be deemed metastasis, repeatedly rejecting Mat's requests for a PET-CT.

[Hospital caregiver helping Mat stand post-surgery]

"German doctors only recognize visible evidence. Later, doctors in China told me that without congenital disease, sudden hydronephrosis should first be considered metastasis," Mat says. After multiple failed communications, he had to contact other German hospitals.

Ultimately, only University Hospital Erlangen (UKER) agreed to his PET-CT request. The results indicated a hypermetabolic lesion in the pelvic peritoneum, highly suspicious for metastasis. This meant his gastric cancer had progressed to a late stage, and the hope of soon finishing treatment completely vanished.

At this point, he sent the results to Charité, but the hospital did not accept the metastasis conclusion, requiring a laparoscopic exploration with biopsy to determine the next treatment plan.

This laparoscopic surgery became the final straw that broke his trust in the hospital. The surgery was delayed from noon to evening. The originally scheduled attending doctor went off duty, handing the surgery over to an assistant doctor completely unfamiliar with his case. The assistant only performed a routine abdominal exploration, did not examine the pelvic lesion area, and did not biopsy the suspicious site. The hospital then concluded there was no recurrence...

After the failed laparoscopic exploration, Charité decided to try an endoscopic ultrasound to obtain a biopsy sample, leading to another series of baffling "operations": a nurse wrote the wrong appointment time in an email, causing him to drive 500 kilometers for nothing, later only saying "people make mistakes"; a puncture plan collectively decided by the tumor board was canceled on the spot by the operating doctor, citing unsuitable lesion location; a scheduled endoscopic ultrasound was mistakenly reported by the doctor as a standard colonoscopy, and only when he asked a question right before the anesthesia was administered did he avoid another useless procedure.

[Charité Hospital]

Within just one month, a series of low-level errors, the doctors' refusal to admit mistakes, and the completely unapologetic handling left Mat thoroughly disappointed in this world-renowned hospital. "Foreign hospitals aren't necessarily better. Even top-ranked hospitals have systemic oversights and irresponsible doctors." Mat says.

「 Part 5: Switching Hospitals and Regimens Again for Palliative Chemotherapy: "Preparing for the Worst, Living the Most Positive Life" 」

He chose another strategic transfer. After directly checking out of Charité, he went to University Hospital Erlangen (UKER), which had previously performed his PET-CT, and began a new treatment cycle.

The doctors at UKER gave Mat a completely new treatment plan. Recurrence meant he had developed resistance to the previous regimen, so they switched to a second-line chemotherapy regimen: FOLFIRI (Irinotecan + Leucovorin + Fluorouracil). Simultaneously, the doctors offered advice completely different from other hospitals: considering the risk of disease progression, stop insisting on obtaining a biopsy for pathology, and start chemotherapy directly. On September 11, 2025, he began chemotherapy again.

Unlike the previous curative-intent chemotherapy, late-stage palliative chemotherapy no longer aims to eradicate cancer cells, but to control tumor growth and achieve living with the tumor. "Relying solely on chemotherapy, the probability of completely eliminating the lesion is extremely low. All I can do is try to control it and coexist with it."

[Mat undergoing day chemotherapy]

From September 2025 to February 2026, Mat completed 10 chemotherapy cycles, once every two weeks, without interruption. A follow-up in November 2025 showed that the lesion shrank from an initial 1.3×1 cm to 0.6×0.5 cm, and the metabolic value also dropped significantly. Yet, a string remained tight in his heart. He learned that the median resistance period for the current regimen is four months, and he had already been on it for six.

During this Spring Festival trip back to China, he visited ten domestic medical and surgical oncologists specializing in gastric and colorectal cancers in Beijing and Shanghai. "I'm particularly worried about drug resistance. I also want to know what options remain after resistance, and whether there's still a chance to surgically remove the pelvic lesion."

Most medical oncologists advised against rash surgery, while half of the surgical oncologists thought it could be attempted. Surgery would require a laparotomy, possibly removing part of the rectum and creating a temporary stoma, causing significant trauma. A drop in immunity could also trigger a cancer cell explosion. Yet Mat hasn't completely given up on surgery: "The probability of a cure through chemotherapy alone is too small. I still want to seize the surgical opportunity. I want to live well."

While scheduling intensive consultations, Mat also "handled some affairs." "To put it bluntly, I'm 'arranging my affairs.' I want to complete the things I must handle myself while I still have the strength, so if things take a turn for the worse later, I won't have so many regrets or loose ends."

This coexistence of rational planning and a strong will to survive is exactly his consistent logical framework. He is accustomed to "preparing for the worst, living the most positive life." It's not about being fearless or un-sorrowful, but choosing to move forward despite fear, and transforming sorrow into action.

「 Part 6: Being the "Project Manager" of Cancer, Seeking the Optimal Solution Within Limited Scope 」

Mat describes his approach to cancer: "I treat this matter like a project, and I am the project manager."

Indeed, he studies German gastric cancer guidelines, checks hospital rankings, and emails doctors. He treats the disease like a project: gathering information, analyzing data, formulating strategies, executing, and adjusting.

"I studied STEM, so I'm used to identifying and solving problems," Mat says. He never dwells on "why me," nor does he blame his past self. "The causes of cancer haven't been fully conquered by humanity yet; there's too much luck involved. If you can't figure it out, don't dwell on it. Focus on the present and solve the immediate problem."

"Anyway, it still feels quite fulfilling now," he says. "I really like this feeling of having everything under my own control." In the face of cancer, a sense of control is a luxury, but Mat grasped it. He doesn't deny fear, but refuses to be dominated by it. He strives to understand and deconstruct the disease, making the best possible choices within limited boundaries.

"If Germany's options are exhausted, I might consider returning to China." Mat says. Over a year of cross-border treatment has given him the most authentic understanding of both healthcare systems.

Germany's medical consultation system is rigorous. Although statutory (public) insurance patients cannot freely choose their doctors, making it less flexible than directly booking specific experts in China, hospitals familiarize themselves with patient records in advance. Nearly half complete tumor board multidisciplinary discussions before consultations. Single consultation times often exceed half an hour, allowing ample doctor-patient communication. Hospital hardware and patient meals are also superior. The high-welfare medical system provided a safety net for his treatment, but the processes are cumbersome and wait times are long.

[Diet during hospitalization in Germany]

Meanwhile, China's gastric cancer treatment level has long been at the forefront globally. Doctors have rich clinical experience, and new drugs and clinical trials emerge constantly. Several marketed original drugs and cutting-edge clinical trials targeting CLDN18.2 are already available. However, the doctor-patient ratio is highly skewed, consultation times are tight, and patients must prepare all questions in advance, leaving almost no room for on-the-spot thinking or follow-up, making deep communication with doctors difficult.

「 Part 7: Life "Measured in Three-Month Increments", Living in the Present, Living Toward Death 」

His rationality also extends to intimate relationships. His girlfriend accompanied him through a full year of treatment, from surgery to chemotherapy, from recurrence to seeking medical help, always staying by his side. Yet he still decided that once her overseas assignment ends and she returns to China, they will part ways.

This rationality borders on coldness. But beneath it lies another kind of warmth. "She is a traditional girl who wants marriage, children, and a stable life. I need a check-up every three months, meaning life can only be planned in three-month increments. I can't let her live in this uncertainty with me, nor can I let one family's misfortune become two families' misfortune."

He actively chose to be the "bad guy", to make the "difficult decision". But the "project manager" also has tender moments.

The disease reconstructed Mat's social circle. He says he "doesn't like socializing anymore", feeling strong illness-related stigma and unwilling to discuss his condition with unfamiliar people. Later, Mat joined a "Panda Group" (patient support group). There, he found deeper connections. It's an understanding based on shared circumstances, requiring no explanation or disguise.

Initially, he joined as a novice to learn, later becoming a sharer and helper. "Having been caught in the rain, I now hold an umbrella for others," he says. Half the group's content discusses treatment, the other half shares daily life: what to eat today, what to do tomorrow, interesting events. This "stigma-free" communication makes him feel "like family." "Even though we've never met, I can talk about anything. I even share things in this group that I wouldn't tell my parents."

His relationship with his parents is also subtly changing. They try to treat him like a normal person, while he tries to lighten their burden. His father's biggest regret is not detecting his son's illness earlier as a gastroenterologist. Mat can only repeatedly comfort him, slowly untangling the old man's knot. When his mother shows excessive concern, he directly gives feedback: "Too much concern actually makes me feel worse inside."

[Mother praying for Mat every day]

"Not saying love, but showing it everywhere" is a typical expression of Eastern families. "This period has been the longest continuous time I've spent with my parents since leaving for college at 18," Mat says. "I often tell them that compared to leaving suddenly in an accident, this illness at least gave us buffer time to say goodbye properly and do what needs to be done. Even if we can't make long-term plans, we can measure life in three-month increments and treat every present moment seriously."

「 Part 8: Epilogue, When Conventional Means Are Exhausted 」

The March 2026 follow-up arrived as scheduled. The results were mixed: the good news is that the pelvic lesion is no longer visible on imaging; 10 cycles of FOLFIRI chemotherapy "eliminated" the 1.3 cm metastasis. The bad news is that new peritoneal seeding metastases appeared on the intestinal wall, the tumor is still progressing, and most previous chemotherapy regimens have developed resistance.

"It's like playing whack-a-mole," Mat describes. "You press down on one side, and it pops up on the other." Just as domestic doctors previously advised, German doctors also told him that conventional treatment options are nearly exhausted, and clinical trials must be considered: CLDN18.2-targeted ADC drugs (Antibody-Drug Conjugates), or CAR-T cell therapy.

These are two paths full of unknowns. CLDN18.2 is one of the most prominent new targets in gastric cancer treatment in recent years, with extremely low expression in normal tissues but high expression in about 40% of gastric cancer patients. ADC drugs targeting this have shown good objective response rates in most clinical trials. CAR-T therapy has achieved significant success in hematological malignancies, but its efficacy in solid tumors like gastrointestinal cancers is still under exploration.

But behind these hopes lie the inherent uncertainties of clinical trials: Will eligibility criteria match? Can side effects be tolerated? Will efficacy be replicated? Everything is unknown.

Mat's story is not a typical "cancer warrior" narrative. There are no grand declarations, no miraculous reversals, only an ordinary person's rational response and perseverance in extreme circumstances. In this era full of uncertainty, everyone is ferrying across their own river; disease merely makes this uncertainty sharper and more urgent.

Mat is currently still weighing his clinical trial options. CLDN18.2 ADC and CAR-T represent the most cutting-edge explorations in solid tumor treatment, carrying the hopes of countless late-stage gastric cancer patients. Whichever path he ultimately chooses, this posture of maintaining rationality and actively seeking solutions in the face of despair is itself the most powerful response to the disease.

Mat's river continues to flow. He doesn't know if the next bend will be rapids or shallows. But he has learned to navigate uncertainty, to believe in dawn amidst darkness, and to cherish gatherings amidst farewells. Just as he said: "Prepare for the worst, live the most positive life."

May his experience illuminate a little of the path forward for more patients groping in the dark. The length of life may be unpredictable, but its depth can always be written by oneself.

To protect patient privacy, the name used in this article is a pseudonym.
Images featuring the patient's portrait have been authorized by the patient and may not be used without permission.