Editor's Note: As we step further into the 21st century, the field of medicine has undergone tremendous changes. Among the many advancements, a generation of compassionate and skilled doctors has emerged, dedicated to the wellbeing of their patients and their nation. The phrase "a doctor's heart is like a parent's" perfectly captures this essence. In the Oncology Frontier series "In Conversation," we reflect on the past with renowned doctors, exploring the highs and lows of their medical journeys. In this edition, we are honored to have Dr. Jie Chen from Fudan University Shanghai Cancer Center share her story. Over the past 30 years, she has remained dedicated to her mission. With five major career transitions, she has continually embraced challenges, breaking new ground where none existed. In the virtually untouched field of neuroendocrine tumors (NEN) in China, she laid the foundation for the discipline and paved the way for future advancements.

Chapter One: A Path Begins—From Teaching to Medicine

Oncology Frontier: Coming from a family of educators, why did you choose medicine over teaching?

Dr. Jie Chen: My family has been in the teaching profession for three generations, from my great-grandfather to my father. However, my uncle entered West China Medical University, which started our family’s journey into medicine and greatly influenced me. I vividly rememtber my grandmother often taking me to a traditional Chinese medicine pharmacy as a child. Above the door hung a plaque reading “Suspending the Bronze Gourd to Save the World” (a phrase symbolizing selfless medical service). Curious, I asked her what it meant, and she told me stories about Hua Tuo and Bian Que—legendary Chinese physicians who saved lives. From then on, I realized that being a doctor was not only meaningful but also a noble profession. When it came time to choose my college major in 1989, these factors guided me to apply solely to medical schools. Luckily, I followed in my uncle’s footsteps and was accepted into West China Medical University 30 years after he did.

Chapter Two: Crossing Disciplines, Never Changing the Goal

Oncology Frontier: You have been described as the “king of cross-discipline” in medicine, transitioning between scientific research, gastroenterology, gastrointestinal oncology, and neuroendocrine tumors (NEN). These decisions must have been difficult. What motivated you to keep crossing disciplines, and how did they connect?

Dr. Jie Chen: I began studying medicine at 16, and now, at 51, reflecting on my path, I realize that I have always moved toward what interested me. While it may seem that I changed directions several times, each step laid a foundation for what came next.

Studying clinical medicine at West China Medical University for five years was my entry into the medical field. After graduating in 1994, I worked as an internal medicine resident at Sichuan Provincial People’s Hospital for three years, where I gained critical clinical experience. This internal medicine background is crucial in my current work with NENs, which require a strong foundation in internal medicine. I still remember my teachers at West China taking a large group of doctors on rounds. Their gravitas made me admire them deeply. I thought, “I want to become a great doctor too,” solving cases like Sherlock Holmes, diagnosing and treating patients based on subtle clues. This brought back my childhood dream of being a doctor.

In 1997, when I applied for graduate school, I chose to leave Sichuan and see the world outside the basin. During the era when everyone was heading to the southeastern coastal areas for opportunities, I too went to the forefront of reform, enrolling in Sun Yat-sen University to study gastroenterology. There, I was fortunate to meet my mentor, Professor Minhu Chen, who was one of the youngest full professors and PhD supervisors at the time. During my five-year master’s-PhD program, I spent two years at the Prince of Wales Hospital in Hong Kong, studying under Professor Joseph Sung, a renowned collaborator. Under their strict guidance, I developed a solid foundation in scientific research. As a doctor, it’s not enough to merely follow textbooks or guidelines; you must also understand the underlying mechanisms of diseases. During my graduate studies, I researched the immune mechanisms of Helicobacter pylori vaccines, spending countless hours reading and conducting basic research. Though this seemed unrelated to cancer at the time, the training I received in immunology has greatly enhanced my understanding of cancer immunotherapy today.

Those five years of foundational research in bacteria and vaccine immunology laid the groundwork for my scientific career. However, I still wanted to be a “great doctor.” In 2002, I pursued a postdoctoral fellowship at the University of Magdeburg in Germany under the guidance of renowned gastroenterologist Professor Peter Malfertheiner. When it came time to choose my postdoctoral research direction, I had two options: one group focused on the then-popular topic of Helicobacter pylori research, and the other, a “very small group,” studied gastrointestinal cancer. Anticipating the rising incidence of gastrointestinal tumors, I chose the smaller group and began my journey into oncology, embracing this new field from scratch. After two years of working tirelessly in Germany, I built a solid foundation in gastrointestinal cancer research, though I had yet to gain clinical experience. Today, that foundation applies directly to my work in NEN research.

When I returned to China in 2004, I continued my work as a gastroenterologist at the First Affiliated Hospital of Sun Yat-sen University, focusing on gastrointestinal cancers. However, the treatment of advanced gastrointestinal cancers was typically handled by other departments, such as surgery or oncology, leaving a gap between my clinical work and research. In 2009, a turning point came when my respiratory colleagues began studying late-stage lung cancer treatment at Sun Yat-sen Cancer Center. My mentor, Professor Minhu Chen, suggested I study the comprehensive treatment of gastrointestinal cancer. During my six-month stint at the cancer hospital, I gained valuable insights and formed lifelong friendships, ultimately entering clinical oncology.

As you asked, it may seem like I kept changing directions before delving into NENs, but each step built the foundation for the next. To become a “great doctor,” you must evaluate your interests and identify gaps in your expertise at each juncture. For me, the goal of becoming a doctor who can truly make a difference never changed.

Oncology Frontier: What was the biggest challenge in these transitions?

Dr. Jie Chen: Reflecting on the past, apart from my 13 years in NEN research, I essentially started over every five years. After graduating from West China Medical University, I started clinical work from scratch as a resident at Sichuan Provincial People’s Hospital. I then ventured into research during graduate school, where I candidly told my professor, “I can write patient histories, but I can’t handle test tubes.” My immunology research was a fresh start, as was my postdoc in gastrointestinal cancer in Germany, and then, I had to learn clinical oncology from the ground up at Sun Yat-sen Cancer Hospital. On my first day, Professor Yuhong Li asked me to write a case report on colon cancer. When I saw “FOLFOX regimen” written in the medical record, I asked, “What is FOLFOX?” She stared at me in disbelief and asked, “Do you really know nothing about it?” I admitted, “I really know nothing.” So, the greatest challenge has always been starting from zero each time.

Oncology Frontier: Did that ever affect your confidence?

Dr. Jie Chen: I’m fascinated by the unknown. I believe that living a life of endless repetition is meaningless. There are so many unknowns in the world, all worth exploring. So, I never worried too much about failure—it’s just part of my personality, I suppose. Even as a child, I dreamed of reading countless books and traveling far, much like the legendary explorer Xu Xiake. When many of my peers chose to study in the U.S., I set a goal of traveling across Europe by the time I was 30, so I went to Germany. In short, my goal has always been to become a “great doctor.” Along the way, I’ve often taken the road less traveled, and I’ve never looked back.

Chapter Three: Passion Breeds Success

Oncology Frontier: Many medical students wonder how to make the most of their opportunities as they enter the workforce. What advice would you give them?

Dr. Jie Chen: I didn’t have any pre-existing advantages. When the time came, I just looked for opportunities. I now teach students at a university hospital, giving lectures and mentoring my own students. Many students lack clear goals when they start. Some weren’t even passionate about medicine, having been pushed into it by their families. My advice is to at least choose a specialty you enjoy. If family pressure forced you into the field, then work on cultivating an interest and finding a goal along the way. I often tell my students, “Even if you become a community doctor, aim to be the one everyone trusts most. If you work in a county hospital, strive to be the doctor everyone in the county speaks of. No matter the level or field, if you have a goal and pursue excellence, you’ll always stand out.”

Oncology Frontier: In the early stages, when you were starting from scratch in basic research and working with animals and cells, did you ever feel isolated?

Dr. Jie Chen: During my time in basic research, I worked with over 1,000 lab mice. I’d arrive at the lab by 6:00 AM, and sometimes I wouldn’t leave until 2:00 AM after finishing my experiments. Day after day, I was immersed in research. Though it seemed far from the work of a “great doctor,” I was constantly exploring the unknown. Basic research is incredibly interesting. What’s the mechanism behind a disease? How do the physiology, pathology, and pharmacology we learn in textbooks translate into real-life treatments? The joy of basic research lies in discovering the unknown, not in gaining recognition. Even now, when my daughter was choosing her high school courses, I recommended physics, chemistry, and biology because I believe they help you understand the fundamental building blocks of the world.

Chapter Four: Pioneering and Leading the Field

Oncology Frontier: When you first entered the field of NEN treatment, there were no guidelines or consensus in China. How did you get involved?

Dr. Jie Chen: Neuroendocrine tumors have been recognized and studied for over a century. In 1907, the German pathologist Oberndofer first identified them during an autopsy and coined the term “carcinoid.” In 1969, biochemists discovered that these tumors could take up precursors of amines and secrete peptides and amine hormones, leading to their biochemical classification as APUD tumors. However, their incidence was low, and their nomenclature confusing. For a long time, there were no treatments available, so they were largely overlooked. In 2010, with the advent of targeted therapies, interest in these tumors surged. The WHO revisited their pathological characteristics and unified their nomenclature as “neuroendocrine tumors.” That’s when domestic experts began paying attention to this tumor type.

My entry into the NEN field was quite coincidental. After returning from Sun Yat-sen Cancer Hospital, I shifted my focus to gastrointestinal cancer treatment. Since about 70% of NENs occur in the digestive system, I began to focus on this area. In July 2010, my mentor, Professor Minhu Chen, suggested I focus on neuroendocrine tumors. He said, “Nobody seems to be paying attention to this disease. Could you perhaps take an interest in it? While you’re treating gastrointestinal cancers daily, can you really compete with the cancer hospital doctors? Where is your academic direction? If our hospital and doctors at our level don’t understand this disease, then it’s an empty field worth exploring.” His words were a revelation, and at crucial moments in my life, he always provided valuable guidance. He said, “I expect that in five years, you’ll become one of the leading experts in NENs in the digestive field. You need to walk a path that no one else is walking; perhaps you’ll find something unique.” So, I dug into this field, and here I am 13 years later.

At that time, there were no mature guidelines in China or abroad. In 2004, nine European experts who had been studying NENs for years founded the European Neuroendocrine Tumor Society (ENETS) and began drafting the first guidelines. Seven years later, I went to the UK to study NENs under two of these pioneers, giving me a high starting point. In 2011, ENETS held its first advisory board meeting in the UK, and I was the only Asian doctor invited as an observer, where I connected with the most prominent experts in the field. In 2015, when ENETS established its second advisory board, I was honored to join as a member, becoming part of the most authoritative academic organization in this field.

Oncology Frontier: From 2010, when the field of NENs in China was nearly empty, to today, what progress have we made?

Dr. Jie Chen: In July 2010, when my mentor asked me to pioneer the NEN field, we published a review and a research paper in the Chinese Journal of Digestive Diseases by the end of the year, systematically introducing Chinese doctors to the latest developments in NEN treatment. The early days were extremely tough, as I barely saw any patients for months. How can a doctor work without patients? My first graduate student and I dug through 15 years of pathology records at the First Affiliated Hospital of Sun Yat-sen University and found 87 cases of NENs. We re-diagnosed them according to the 2010 WHO standards, built a database, and tracked down surviving patients. That’s how we published our first study and found our first batch of patients.

I also told all my colleagues that I was focusing on this rare tumor and asked them to refer any patients they found to me. One night, around 11:00 PM, the chief of the hepatobiliary surgery department called me about a young pancreatic tumor patient whose tumor was inoperable. The pathology results showed it was an NEN, and he asked if I wanted to take over. I rushed to the hospital, explained to the patient that I specialized in NENs, and transferred him to my department. The patient was thrilled to have a specialist, and we managed to extend his life by four years. In those early days, I found patients one by one, using every case to better understand the guidelines and literature. For the first 1,000 NEN patients I treated, I kept detailed records of their treatment, noting down every step in ten large notebooks. Visiting doctors often ask how I manage to remember every detail of my patients’ treatments. It’s because I took detailed notes on every patient. When you’ve treated 100, 1,000, or 10,000 patients, you naturally become more confident and skilled. To this day, I have treated over 10,000 NEN patients, and I still find this tumor’s biological behavior fascinating. As a doctor focused on this disease, I feel that the journey of exploration is endless.

Chapter Five: Balance Between Work and Life

Oncology Frontier: One year, ASCO’s theme was “Learning from Patients.” What have you learned about patient management?

Dr. Jie Chen: In 2012, when online hospitals were just emerging, I set up an online clinic on Haodf.com. Now, ten years later, I manage over 10,000 NEN patients through this platform. I dedicate two hours every day to addressing their issues, many of which involve nuanced details you can’t find in textbooks. When it comes to treatment, the devil is truly in the details.

Oncology Frontier: We’ve heard that you only sleep five hours a day. How do you maintain a good state of mind despite your busy schedule?

Dr. Jie Chen: I think it comes down to two things: maintaining curiosity and having a passion for learning. Our energy is limited, so I focus on doing things I truly enjoy, which prevents burnout. If you approach every task as something you “have to” do, it becomes burdensome. But if your work brings you joy, you’ll be willing to put in the effort. For example, sometimes I’ll solve a problem at 2:00 or 3:00 AM, and in that quiet, uninterrupted environment, I feel fulfilled and satisfied.

Oncology Frontier: Many of your peers and students describe you as always “on-call.” Do you have any hobbies?

Dr. Jie Chen: Traveling and reading. My WeChat tagline is “Read thousands of books, travel thousands of miles,” and that has always been my lifestyle. Before the pandemic, despite my busy schedule, I always found time to travel. I’d take trips during winter and summer vacations, and every year in April or May, I’d gather a few close friends and visit off-the-beaten-path destinations. I even have a checklist of places I’ve yet to explore. I remember that when I was studying in the UK, I managed to write over 20 travel diaries in between my travels.

Chapter Six: Staying True to the Mission

Oncology Frontier: Whether it’s work or life, you seem to pursue everything with full commitment.

Dr. Jie Chen: I like to fully commit to whatever I’m doing. If I’m not going to do something well, I’d rather not do it at all. I think I’m suited to a very specialized path, not as a generalist. All my past experiences have laid the foundation for my expertise in NENs, and they’ve come together to make me an expert in this field. From the day I applied to medical school until now, my mission of serving others as a doctor has never wavered. When I was young, I had fleeting dreams of being a Chinese teacher or novelist because I loved literature. But those fantasies have long faded. Maybe after I retire, I’ll write a memoir.

Oncology Frontier: Looking back at your journey—overcoming hardships and always moving forward—how would you describe it in one sentence?

Dr. Jie Chen: “Stay true to your mission, and you will reach your destination.”

Postscript Reporter’s Note: My conversation with Professor Chen eased my long-standing anxiety. She seems like someone who never experiences mental exhaustion. She dedicates all her time and energy to the work and things she loves. Whether it’s exploring the cutting edge of her field or tending to the orchids on her windowsill, she approaches everything with the same devotion. As a doctor who has started over every five years, her 30-year journey in medicine has reshaped my understanding of the profession. She is someone who balances work and family life seamlessly. As a mother, she prioritizes nurturing her daughter, planning a trip to Kenya to teach her about animal migration. In my eyes, she is undefeatable, always focused on unexplored territories and the vast, uncharted horizon ahead.