Multiple Metastases Three Years Post-Surgery: A Late-Stage Gastric Cancer Patient's Turnaround from Despair | Patient Story

In December 2020, Mr. Li underwent stomach surgery. According to the postoperative pathology staging, it was an extremely early stage. "I thought once it was cut out, I'd be fine," Mr. Li recalls now. Consequently, he neglected regular follow-up visits. Later, feeling well, he even stopped getting gastroscopies. By the third year post-surgery, when his body finally "felt off," a check-up revealed cancer cells had spread throughout his abdominal cavity with multiple metastases. In China, the five-year survival rate for postoperative gastric cancer patients is closely tied to regular follow-ups, yet adherence remains a challenge. Patients often let their guard down during recovery, equating "asymptomatic" with "disease-free."

Author | Ma Lingshu & Xiao Han
Editor | Xian Ning
Reviewer | Xiao Han

「 I. The "Fluke Trap" After Early Gastric Cancer Surgery 」

Mr. Li has always been quiet about his health and rarely communicated with his family.

Before his illness, he didn't smoke or drink, had no underlying conditions, and was generally in stable health for his age, aside from occasional stomachaches.

In its early stages, illness often feels unreal, especially when the body hasn't yet protested strongly. For someone in his fifties, occasional stomach discomfort is common. It wasn't until a physical exam revealed a stomach tumor.

Initially, he didn't take it seriously and didn't even tell his family right away. "But they found out anyway and were terrified, insisting I get surgery."

In December 2020, Mr. Li underwent laparoscopic radical distal gastrectomy at Weihai Municipal Hospital. The surgery was successful. Postoperative pathology showed: moderately differentiated adenocarcinoma of the gastric antrum with superficial elevation, partially mucinous adenocarcinoma, tumor size 1.5×1.2×0.3 cm, invading the submucosa, with no clear vascular tumor thrombi or nerve invasion, and no lymph node metastasis. Pathological stage: pT1bN0M0, Stage I. With the successful surgery and good recovery, his eating, sleeping, and energy levels gradually returned to normal. Mr. Li felt his body was almost as if he had never been sick.

For the first six months post-surgery, Mr. Li went to the hospital on time for blood tests and ultrasounds. But as every result came back normal, he began to feel hospital visits were a waste of time. "Two hours waiting, five minutes with the doctor, and they always said everything was fine." Starting in the second year, he delayed his biannual check-ups to once a year, and eventually stopped going altogether. "Back then, I could eat, sleep, and work. How could I possibly be sick?"

This false sense of security from "feeling fine" made Mr. Li lower his guard and abandon regular postoperative follow-ups.

Medically, early-stage gastric cancer still carries a risk of recurrence after surgery. Regular follow-up is key to early detection and improving treatment success. Yet in reality, patients like Mr. Li are not uncommon. By the time symptoms appear, the disease has often progressed.

「 II. From "Extremely Early" to "Extremely Late" 」

In early 2024, Mr. Li experienced systemic fatigue and coughing. It was only upon hospital examination that he realized the severity of the problem. This time, it was no longer early stage.

Chest, abdominal, and pelvic CT scans indicated: multiple lymph node metastases in bilateral supraclavicular, mediastinal, abdominal, and retroperitoneal regions; multiple lung metastases; suspected metastases in the pancreatic head and left adrenal gland, accompanied by biliary dilation. The tumor burden was massive. Without timely treatment, his survival time would likely be very short.

Gastroscopy biopsy pathology showed: remnant stomach adenocarcinoma, moderately to poorly differentiated. Immunohistochemistry and FISH testing confirmed: HER2 positive, PD-L1 low expression, Claudin18.2 and TROP-2 high expression.

HER2 positivity means the cancer cells highly express a protein called HER2, which accelerates tumor growth and metastasis. Fortunately, several targeted drugs can inhibit HER2 expression and induce cancer cell apoptosis, offering more treatment options for HER2-positive gastric cancer patients.

But Mr. Li knew none of this specialized oncology knowledge. On the day he received the report, he sat alone on a hospital corridor bench, staring at the dense text on the paper, his mind completely blank. He didn't dare call his wife, afraid he would break down crying the moment he spoke.

Just three years later, the disease silently returned. His physical condition plummeted, and his weight dropped from 175 jin (87.5 kg) to 120 jin (60 kg). "I was so weak I couldn't stand, let alone walk."

After being hospitalized, the discomfort became unbearable. After much deliberation, he decided, "I still need chemotherapy."

Fortunately, his attending physician mentioned a new drug currently in a clinical trial. It would be added to standard treatment, so the efficacy would not be inferior, and all trial medications and related tests would be free. The doctor objectively explained the protocol, potential benefits, and risks without overpromising, simply saying, "You can give it a try."

For Mr. Li, the suffering from recurrence was agonizing, pushing him to quickly find an effective treatment. Meanwhile, friends and family often said, "Cancer is incurable; spending money is a waste." This mindset actually became an advantage for him. "I didn't really have high hopes. Cancer isn't that easy to cure. I just felt trying is better than not trying," he said. He trusted his doctor's judgment and was willing to grasp this last straw.

「 III. A Turn for the Better: Treatment Progress Came Faster Than Expected 」

On March 8, 2024, Mr. Li began the trial. The final treatment regimen was: Zenocutuzumab (HER2 bispecific targeted therapy) + Tislelizumab (immunotherapy) + CAPOX (capecitabine + oxaliplatin), for 6 cycles.

Mr. Li said the initial days of treatment were truly tough. When side effects hit, "I vomited everything I ate or drank, even water. I was so weak I had no strength at all and needed a wheelchair to go anywhere." But after pushing through the initial adverse reactions, he forced himself to walk a few laps in his neighborhood daily, and gradually felt better.

The treatment breakthrough came faster than expected. After just 2 cycles, a follow-up on April 22 showed a partial response (PR) on imaging. The tumor lesions shrank, and metastases were controlled. After completing 6 cycles, the doctor discontinued oxaliplatin and switched him to maintenance therapy with capecitabine, tislelizumab, and zenocutuzumab. Previously elevated tumor markers CEA and CA19-9 dropped to normal levels and remained stable long-term.

After over a year of maintenance therapy, follow-up PET-CT and CT scans showed continuous lesion regression. Eventually, no tumor was visible on imaging, achieving a clinical complete response (cCR). The duration of tumor control (progression-free survival) has now exceeded 22 months.

For a patient with stage IVB metastatic gastric cancer, this is a remarkable outcome, shattering the common belief that late-stage gastric cancer is "untreatable." It gave Mr. Li and his family immense confidence and strengthened his resolve to continue treatment.

Throughout the entire treatment, Mr. Li's mindset remained simple: "I just follow the doctor's plan, without overthinking or guessing." His complete trust in the medical team shielded him from anxiety caused by information overload and allowed him to cooperate with treatment more steadily.

The changes were gradual but profound. Mr. Li's weight rebounded to around 165 jin (82.5 kg), close to his pre-illness level. "Now I'm almost like a normal person. I eat well, sleep soundly, and my energy is back," he said. Aside from returning to the hospital every 20 days or so for maintenance therapy, his daily life is largely unaffected.

「 IV. Crossing the Life-and-Death Threshold, Life Returns to Normal 」

Having gone through this ordeal, Mr. Li has developed a simple yet practical philosophy on seeking medical care, treating illness, and living life. As his body slowly recovered and life returned to normal, he resumed his exercise routine. Now, he wakes up at 6 a.m. daily and walks 4 to 5 kilometers along the coast.

Breathing in the salty, humid sea breeze of Weihai, he feels the very essence of life filling his lungs. Returning home, his wife has already prepared millet porridge, served with pickled vegetables and a boiled egg. "I used to think this life was mundane. Now, I feel that living another day like this is a gift."

Mr. Li still often reflects: "Thank goodness I tried it back then. I never imagined this drug could cure me. Many people told me there was no point in treating it anymore, that it would just cost money and cause suffering. But looking back, you still have to treat it when you should."

During a follow-up, Mr. Li heard his doctor say that the efficacy of his treatment regimen has been validated and incorporated into clinical guidelines. Mr. Li didn't quite understand what a "guideline" meant. The doctor explained that among patients in the same clinical trial, over half are still living normally two years later, proving the regimen's effectiveness.

So, while every hurdle is hard to cross, every hurdle can be crossed. By not ignoring early signals and not giving up hope in late stages, Mr. Li continues to move forward. More hope is also on the way.

Summary by Director Li Ruilin, Department of Oncology III, Weihai Municipal Hospital:

Our team participated in and witnessed Mr. Li's entire treatment journey. Seeing him overcome each hurdle step by step fills me with genuine joy for him.

First, this story serves as a reminder to all gastric cancer patients: even after early-stage surgery, you must adhere to standardized follow-ups and never let your guard down.

Facing late-stage metastasis, Mr. Li joined a clinical trial and received a regimen of zenocutuzumab combined with tislelizumab and chemotherapy. Encouragingly, he responded exceptionally well. The tumors shrank significantly, eventually reaching a state where no lesions were visible on imaging—a rare and highly inspiring outcome for late-stage gastric cancer.

With the emergence of new drugs and regimens, late-stage gastric cancer is gradually shifting from "helpless" to "an opportunity for long-term control and high-quality survival." The efficacy of zenocutuzumab-related research has been validated and included in guideline recommendations, opening a new door of hope for more HER2-positive gastric cancer patients.

I also want to share this with everyone: do not ignore early signals, do not abandon hope in late stages. With doctor-patient unity and scientific treatment, you will surely overcome the hurdles and return to a healthy life.

To protect patient privacy, names used in this article are pseudonyms.

Images featuring the patient's portrait have been authorized by the patient. Unauthorized use is prohibited.

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