About Prof. Li Jin
Prof. Li Jin is a senior oncologist at Ruijin Hospital, Shanghai Jiao Tong University School of Medicine — one of China's foremost centres for oncology, haematology, and multidisciplinary cancer management. He specialises in the systemic treatment of gastrointestinal and lung cancers, including targeted therapy and immunotherapy, and leads multidisciplinary tumour boards for complex cancer cases. His clinical philosophy holds that the most important decisions in oncology are made not by individual specialists acting in isolation, but by teams of experts deliberating together — integrating every discipline to arrive at a plan no single specialist could have formulated alone.
Case Overview
Ms. Li (pseudonym), a 69-year-old Chinese woman with a history of right breast cancer treated in 1994, presented in early 2023 with rapid weight loss (from over 50 kg to under 45 kg), markedly reduced appetite, and progressive physical deterioration. Investigation confirmed two concurrent primary malignancies: left breast cancer and pancreatic cancer with vascular invasion precluding immediate surgery. CT, MRI, and biopsy established both diagnoses. Ruijin Hospital's multidisciplinary team — medical oncology, breast surgery, pancreatic surgery, and radiology — formulated a sequenced strategy: neoadjuvant chemotherapy targeting the pancreatic cancer first (with expected suppressive effect on breast cancer), pivot to targeted therapy if toxicity became limiting, pancreatic surgery once resectability criteria were met, then definitive breast surgery, radiotherapy, and endocrine therapy. The strategy was executed over approximately 18 months. By August 2024 there was no evidence of pancreatic cancer recurrence; Ms. Li underwent successful modified radical mastectomy, followed by radiotherapy and endocrine therapy. By late October 2024, wound healing was excellent and she was in good overall condition. She reflected: "Ruijin Hospital's treatment not only restored my health — it gave us a profound sense of the professionalism and care of the medical team. The spirit of teamwork at Ruijin Hospital truly saved my life."
Diagnostic Workup
CT and MRI characterised both the left breast mass and the pancreatic tumour, confirmed vascular involvement, assessed regional lymph nodes, and excluded distant metastasis. Core needle biopsies confirmed left breast carcinoma (with receptor and Ki-67 status) and pancreatic adenocarcinoma. Genetic and molecular profiling informed personalised chemotherapy and targeted therapy selection. MDT discussion — medical oncology, breast surgery, pancreatic surgery, and radiology — confirmed the decision to prioritise the pancreatic cancer with neoadjuvant chemotherapy and formulated the sequenced treatment plan.
Prof. Li's pre-treatment assessment: The pancreatic cancer is the primary threat — more aggressive, with vascular involvement, and the condition most likely to determine short-term prognosis. Neoadjuvant chemotherapy targets it directly while also having activity against breast cancer. The key is flexibility: we must be prepared to adapt if the patient's tolerance of chemotherapy is limiting.
Treatment Strategy and Course
Diagnosis: Concurrent Left Breast Cancer and Pancreatic Cancer with Vascular Invasion in a 69-year-old patient with prior right breast cancer history.
- Phase 1 — Neoadjuvant chemotherapy: Personalised regimen selected for dual activity against pancreatic and breast cancer; Ms. Li developed recurrent pancreatitis with severe pain — MDT pivoted to targeted therapy to reduce toxicity while maintaining efficacy
- Phase 2 — Pancreatic surgery with vascular reconstruction: Following successful tumour downstaging, surgery completed with vascular resection and reconstruction; no postoperative complications
- Phase 3 — Modified radical mastectomy (August 2024): No evidence of pancreatic cancer recurrence; mastectomy with complete axillary lymph node clearance; pathology: pT1cN2
- Phase 4 — Radiotherapy and endocrine therapy (late 2024 – ongoing): Radiotherapy completed; endocrine therapy initiated; October 2024 follow-up: wound healing excellent, side effects mild, overall condition good
Prof. Li's clinical reflection: Ms. Li's outcome is the result of a strategy that was right in its priorities, flexible in its execution, and consistent in its multidisciplinary coordination over 18 months. The pivot from chemotherapy to targeted therapy when pancreatitis became limiting was the critical adaptive decision. The teamwork Ms. Li describes is not incidental to her outcome — it is the reason she is alive and well.
Expert Commentary — Prof. Li Jin
1. Concurrent Multiple Primary Malignancies: Prioritisation and Sequenced Management
Concurrent multiple primary malignancies require a treatment strategy that addresses two biologically distinct diseases in a sequence that optimises outcomes for both without compromising the patient's tolerance. The first step is oncological prioritisation: which disease poses the more immediate threat? In Ms. Li's case, the pancreatic cancer with vascular invasion was the more immediately life-threatening disease. The neoadjuvant chemotherapy strategy — targeting the pancreatic cancer as the primary disease while exerting a suppressive effect on the breast cancer — best served both oncological priorities simultaneously.
2. Neoadjuvant Chemotherapy in Borderline Resectable Pancreatic Cancer
Neoadjuvant chemotherapy has become the standard of care for borderline resectable pancreatic cancer. The rationale rests on three principles: tumour downstaging to achieve resectability; selection of patients with favourable tumour biology; and treatment of micrometastatic disease to reduce early systemic recurrence. The decision to proceed to surgery requires careful serial imaging to confirm adequate tumour response, absence of distant metastasis, and adequate patient functional status.
3. The Multidisciplinary Tumour Board in Complex Oncology
The evidence for multidisciplinary tumour board review is substantial: higher rates of guideline-concordant treatment, more frequent use of clinical trials, and improved survival across multiple cancer types. In Ms. Li's case, the tumour board formulated the sequenced strategy, adapted it when chemotherapy toxicity became limiting, and coordinated each phase of treatment. The outcome — a patient alive and well 18 months after the diagnosis of two concurrent primary malignancies — is the product of that multidisciplinary process.
How CMCS Shanghai Coordinated This Case
CMCS Shanghai supported Ms. Li and her family throughout the diagnostic, treatment, and follow-up pathway at Ruijin Hospital, including: priority consultation coordination with Prof. Li Jin's team and the multidisciplinary tumour board; bilingual interpretation across all MDT discussions, treatment planning consultations, and follow-up appointments; bilingual explanation of the sequenced treatment strategy and each adaptive decision; coordination of imaging, biopsy, genetic profiling, and specialist assessments with bilingual results communication; bilingual consent for each treatment phase; and postoperative and post-treatment coordination including pathology results, MDT recommendations, and surveillance scheduling.
For international patients facing complex oncological diagnoses, Prof. Li Jin's team and the Ruijin Hospital multidisciplinary tumour board offer access to one of China's most experienced cancer management programmes. CMCS ensures that expertise is accessible — in the patient's language, with every step coordinated and communicated clearly.
This case report is de-identified and published for educational purposes. All clinical details have been anonymized in accordance with patient privacy standards. CMCS Shanghai is a medical concierge service and does not provide direct medical care.
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