David Mitchell, a 64-year-old retired structural engineer from Vancouver, had been monitored for hepatitis B-related cirrhosis for over a decade. In mid-2025, routine surveillance found a 3.8 cm lesion in segment VI of his liver.
Diagnosis: hepatocellular carcinoma, stage II (T2N0M0, BCLC stage A).
The problem wasn't the tumor — it was the liver. Child-Pugh class B (7 points): albumin 3.1 g/dL, bilirubin 2.1 mg/dL, INR 1.4, mild ascites. The tumor was operable, but Vancouver General's tumor board estimated a 30% risk of post-hepatectomy liver failure.
The alternative — proton therapy — wasn't available in Canada. Seattle's proton center: $200,000+, out of pocket.
Shanghai's Proton Experience
SSAnkang connected David with the Shanghai Proton and Heavy Ion Center — one of five active proton centers in mainland China, treating HCC since 2014 with published five-year local control rates exceeding 90%.
The Shanghai team proposed 8-fraction hypofractionated proton therapy over two weeks, using pencil-beam scanning with respiratory gating. Side effects: mild fatigue (grade 1) by fraction 4. No nausea. No skin reaction. No decline in liver function.
David and his wife spent afternoons exploring Shanghai's French Concession. "It felt less like cancer treatment and more like an unusual vacation."
The Six-Week Scan
MRI at six weeks post-treatment: the lesion had shrunk from 3.8 cm to 1.2 cm with no arterial enhancement — complete radiologic response. Liver function: fully preserved. Albumin had actually improved to 3.4 g/dL.
Total cost: $52,000. Roughly one-quarter of the US price. At 12-month follow-up, David remained in complete remission.
"They didn't just treat the tumor — they respected the liver I have left."
Patient name changed. Outcomes vary by individual.
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