Man Up to Cancer: Bill Thach On Identity, Resilience, and Community

Bill Thach was 33 when he learned he had stage 4 neuroendocrine carcinoma (NEC), a rare and aggressive subtype of colorectal cancer. In the eight years since, he has undergone an 18-hour surgery, cycled through multiple clinical trials, learned to live immunocompromised, and run an ultramarathon. The cancer is still there, but he is still going.

His story is not a recovery arc. It is something grittier and more authentic, a portrait of a man learning in real time what it means to keep showing up for the people he loves, for himself, and for a community of men who need to see that it is possible to keep going. Today, Bill serves as Director of Diversity at Man Up to Cancer (MUTC), where he works to build culturally responsive support for young adults and men of color navigating cancer.

Neuroendocrine carcinoma (NEC) is a rare and aggressive cancer that develops in the neuroendocrine system, a network of glands and nerve cells that regulates essential bodily functions by releasing hormones into the bloodstream. Unlike more common cancers, it can originate in different parts of the body, including the stomach, bowel, pancreas, or lungs, making it difficult to detect early and even harder to treat.

In Bill's case, it began in his rectum. When he first raised his concerns with his general practitioner, he was dismissed and told it was likely hemorrhoids. Unsatisfied, he sought a second opinion, which eventually led to a colonoscopy and his diagnosis in November 2018. At the time of diagnosis, the disease was only in the rectum and lymph nodes, and then later metastasized to other organs, including his bladder, prostate, liver, and seminal vesicles. Because NEC is so rare, many patients find themselves navigating a diagnosis that even their own care team has limited experience with. They must navigate it with a smaller community of survivors, widespread lack of awareness, and a prognosis that can feel overwhelming and hard to confront. Stories like Bill's exist to change that.

To set the scene, could you walk us through how your diagnosis unfolded and what the treatment plan looked like?

“As with many stage 4 NEC patients, my symptoms started with blood in my stools. I've been through nine lines of treatment. I had two surgeries, one lasting 18 hours and another 2 to 3 hours. After that, I've been on four clinical trials. I don't have an endpoint in my treatment, so I'll be on treatment for life.

I have a very rare cancer, so I've already run through my standard of care. A lot of the treatments I'm on now are clinical trials. I received news last week that my 9th line of treatment is no longer working, so I will now be starting my 10th line and 5th clinical trial. Just understanding the nuances of going through a new trial, seeing the question marks about what's going to happen, is challenging, and the stigma of being Asian is another big challenge.”

You noticed something was wrong, sought help, and were told it was probably hemorrhoids. How did you navigate being dismissed, and what would you say to someone going through the same thing today?

“Ask your doctor why they have landed on that diagnosis, because what you have been experiencing may not match it. Don't be afraid to fire your doctor. Don't be afraid to get a second opinion. Doctors aren't always right.

I came from a role where I challenged doctors, so questioning them has never been difficult for me. But I know a lot of people who find it incredibly hard. Navigating the medical system is stressful, but I approached it with curiosity. The thing I want people to take away is this: you alone are accountable for your health. You cannot rely on a doctor or the health system, because in the end, only you can advocate for yourself.”

How did the diagnosis shift the way you saw yourself, not just physically, but in your sense of who you are?

“I had to constantly reinvent my identity. I was a working man, a father, a provider. When I retired in May 2024, I had to re-identify who I was, and that's not easy. It could easily numb someone into giving up. But I saw it as a hard reset. Reinventing yourself can be an opportunity to become the person you actually want to be, and every day gives you another chance to do that.”

A few years after your diagnosis, you signed up for an ultramarathon. How did that start, and what does movement give you that treatment can't?

“I've only been running for two years, and I started purely out of curiosity. I'd been doing long-distance cycling and wondered if I could run. One of the clinical trial drugs I was on caused severe cramping (Charlie Horse Cramping) throughout my body, so I physically couldn’t. When that drug stopped working, I just tried it in the time between my treatments. I had bad blood markers that did not allow me to be on treatment anymore. So, at that time, to get through the day and my anxieties, I started running.

It was painful at first because I didn't know what I was doing, but it eventually built a muscle of resilience. Long-distance running gave me time alone with my thoughts. You realize how little you know about yourself until you're truly alone and forced to sit with what you're feeling. It allowed me to go into an introspective meditation.

Running an ultramarathon as a terminal cancer patient on active treatment showed me that things are possible even with the cards I was dealt. There are real parallels between marathons and cancer. Everybody feels like they can do anything when they’re fresh. During the initial diagnosis, you will be motivated to do whatever possible that your body can take. But at mile 20, after hospitalizations, blood transfusions, and side effects, you start to question your ability to keep moving. Physical endurance trains your mind and body to sit with uncertainty, and that muscle of resilience transfers directly to how you handle everything else.

There is also medical literature showing that high-intensity physical activity can contribute to reducing metastatic disease progression and improving treatment resilience. It's common for me to do chemotherapy and then run ten miles to feel better afterward.

I know I am an outlier. Not everyone can do what I do, and I never want to suggest otherwise. But I use my voice to show that there is more to being a cancer patient than cancer. No one believes that I have cancer because they always say, ‘You can do a lot more than I can, and I’m not even a cancer patient.’ Especially with my type of cancer, there aren’t many advocates because you’re trying to stay alive and survive the diagnosis. With NEC, patients typically have roughly a year. I am entering my eighth.”

When it came to asking for help, was it a sudden decision you made, or something that happened gradually?

“Going to the Gathering of Wolves, MUTC's flagship retreat, was the turning point for me. I was six years into non-stop treatment and didn't fully understand how much the mental weight had accumulated. I viewed each challenge as something to check off a list. But when my eighth line of treatment stopped working, I didn't know if I could keep going.

At that retreat, I saw men being openly vulnerable, and I saw my own struggles reflected and validated in theirs. I realized I had normalized a level of trauma that no person should carry alone and managed it using dangerous coping mechanisms that helped me avoid reality, like running ten hours and going straight to bed rather than facing what I was going through.

After the retreat, I found a psychologist and started therapy. The biggest thing therapy gave me was a way to approach my problems as information, to process them, and then communicate them to the people around me. Having a community that has your back and is genuinely empathetic to your situation moves you light-years in your healing. When I did that, my treatment started working better, my relationships improved, and things opened up in ways I didn't expect.”

There is a lot of stigma around men being vulnerable, especially when facing illness. Did that show up for you?

“I did struggle with vulnerability initially. Part of it was pride, and part of it was a sense of duty. Coming from an Asian background, especially as a male, you are expected to be the strong head of household. I think that expectation exists across many cultures, but for Asians, it runs particularly deep because of our cultural history and intergenerational trauma. Asian men, in particular, are conditioned not to speak about what they are carrying. I have tried to connect with other Asian men in similar situations, but that has been one of the hardest things to do.”

How did you first come across Man Up to Cancer, and what did you find there that you hadn't been able to find elsewhere?

“Going to the retreat was out of pure curiosity. When I joined the Facebook group, I saw community and support, but I was curious to know if this was going to be reflected in person. I have a level of skepticism where I tend to believe only what I see with my own eyes.

When I went there and witnessed it, I understood. The radical inclusion, where it didn't matter my color, socioeconomic status, where I was from, or what type of cancer I had, none of that mattered. They just cared that you were going through the same thing they were going through, and they were there to support you. It's undying love for another brother.

When you come to an event like that, you automatically assume you have the worst story in the room. Then you start listening to others, and you realize that's not true. It gives you a sense of gratitude because there’s an individual who has shown you their vulnerability, and they are not broken by it.”

What did you have to unlearn to get something real out of that community?

“Unlearning that I could figure it out on my own was one of the biggest things. I have always been very type A, someone who lives by the words "prove me wrong." In the end, I proved myself wrong. I can’t do this alone. Seeing what another person from the community can do for another individual who was going through cancer, all being strangers, was very heartfelt. It brought tears to my eyes because it was one of those things that you don’t see in pop culture. Vulnerability needs to be reclaimed as strength. The old idea of what it means to be a man has caused too much damage, and we are seeing the consequences of that now, where men are increasingly losing their lives to this battle.”

From everything you have seen and experienced, what do men most need when navigating cancer, and what do they most struggle to ask for?

“The best way to get a man to open up is to introduce him to another man who is going through the same thing. There are things a man will never tell his family or his partner, but will tell a stranger who shares his experience. Shared trauma creates a kind of shortcut to honesty that nothing else can replicate.

There also needs to be more conversation about Adolescent and Young Adult (AYA) patients and Men of Diversity (MOD) because we are a complex and underrepresented population. We need more people with different faces in this space, and we need to talk about the fact that cancer in young adults is rising rapidly. I am part of both of those populations.”

You seem to lead with curiosity, in your career, your running, your approach to treatment. Is that what keeps you moving forward?

“Curiosity has helped me in my career because without that mindset, you can’t find out what the pain point is. Being curious also opens you up to new opportunities and new experiences. The feeling of being in awe never comes from not being curious. There’s a Japanese practice called Misogi, where I do something either physically or psychologically so hard that I know I have a high chance of failing. And if I do achieve that Misogi, it sets up the next 365 days of my life.”

How has living with NEC changed what you pay attention to?

“I am so much more in tune with my body. It’s almost to the level of paranoia because with every little thing, you automatically assume it’s cancer. But that awareness teaches you what your body actually needs, which most of us never stop to consider. We tend to attribute blame but don’t examine our habits, our food, our sleep, how often we look at our phones, how much sunlight we get, or our relationships. I learned over time that blood alone does not entitle someone to your time or your energy. Being Asian, my feelings were constantly invalidated, and I shouldn’t feel that way. There were many expectations imposed ‘because I say so’ and comparisons for a career.”

Your trials continue, and you still show up every day. Could you share what keeps you going and what you are still trying to figure out right now?

“I am not trying to figure out anything. I’m just trying to enjoy life. Before cancer, I was on a hamster wheel, chasing the car, the career, the ladder. Cancer stripped all of that back and simplified things. I no longer care what other people think. I do what I want, when I want, and I'm not here to prove anything to anyone. I am doing what I want for the community and myself, and that’s all that matters to me.”

What do you want caregivers and loved ones to understand about what men like you are quietly carrying?

“Do not weaponize our vulnerability. Your family can be a gateway to healing or a knife to the chest. They can take your vulnerability with open arms, or they could weaponize it, which can create a chain reaction of havoc. I experienced that challenge with my ex-wife, where it didn’t work out between us. Many cancer patients go through relationship breakdowns because the other person didn't sign up for this, and there is no guidebook for either side. In addition, dealing with a male who is not very good at communicating their feelings is another challenge.

Patience is one thing, but I would say the best advice I can give is to introduce him to another man who is going through it. Don't try to be the only source of support. A shared experience between men will move the needle faster than almost anything else.”

What are three things you want readers to take from this?

“What you thought was rare is no longer rare.

Everything that you’ve learned in your education is no longer valid.

The unprecedented is becoming the precedent.”

What is a quote that you live by?

“Amor fati. It’s Latin for love thy fate.”