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Living intentionally and with grace is how Mr Eugene Lim faces life with Stage 4 urothelial cancer.

DURING THE PANDEMIC LOCKDOWN IN 2020, like many others in Singapore and around the world, Mr Eugene Lim looked for creative ways to stay active. An avid runner, he also played rugby and practised Muay Thai, callisthenics and jiu-jitsu.

The 44-year-old even ran a full marathon around his carpark downstairs — making about 1,200 U-turns to clock 43km. Midway through one of these runs, he noticed his urine was discoloured when he stopped for a washroom break.

“I wasn’t sure if it was blood or a very dehydrated yellow that appeared brown,” he recalled. “I have a very high sweat rate when I exercise and don’t drink much water.”

Brown urine can be caused by a range of factors, such as strain, a urinary tract infection or kidney stones. “I checked with my doctor, and he ran some tests,” Mr Lim said. “I had just turned 40, so we were quite careful to check everything because I was formerly a social smoker. But we didn’t spot any red flags.”

The discolouration recurred occasionally, particularly after exercise, prompting further checks. In 2022, it became more frequent but would clear up the next day. His doctor recommended a cystoscopy to examine the bladder, but the results were clear.

A Fork in the Road

In June 2024, while training for the Chicago Marathon in October, Mr Lim travelled to Johor for a charity run with a friend — 50km over two days from Thailand to Singapore. He expected the usual brown urine and, sure enough, it appeared.

On a return trip to Johor for another run, he took extra care to stay hydrated, but something felt different. This time, his urine had a deep red tone. Concerned, he texted his doctor, who scheduled an appointment with a nephrologist. A computed tomography (CT) scan revealed a large tumour in his left kidney. Further tests, including a biopsy, confirmed Stage 4 urothelial cancer, which has spread to his lungs, neck and other parts of his body.

“Oddly enough, I was relatively calm by all measures for a few reasons,” he said. “I had time over the last four years to think about this. Obviously, when the urine discolouration first appeared, I read up a bit and knew the spectrum of what it could be.

“Also, my CT scan review was pushed up by a day, so I knew it was serious. I was already mentally prepared. I’m someone who rarely fell sick, but I always thought that one day, I would probably face a serious illness. I just didn’t expect it to happen this soon.”

Maximising Every Moment

Mr Lim’s physical resilience is matched by his mental strength, and he has approached his diagnosis with a mix of pragmatism and humour. When he first learnt he had cancer, he joked that it felt like being pregnant — growing something inside him. “I named the tumour Caleb; I’m male and it’s my cancer cells, so the tumour has to be a boy!” he said. Rather than focusing on getting rid of it, he sees “Caleb” as something he has to live with. “Every day, I’m thinking about cancer,” Mr Lim said. “It’s a reality — that’s my current perspective.”

He was determined not to let the diagnosis consume him. “In movies, you see cancer patients getting very angry, experiencing denial and breaking down,” he said. “I always told myself that I don’t want to react like that. I want control over my emotions.”

Instead, his thoughts turned to his loved ones — his partner, who would have to navigate this journey with him, and his parents, who had already cared for two aunts who passed away from cancer.

Mr Lim has undergone four cycles of antibody-drug-conjugates (ADCs) — which combine chemotherapy and targeted therapy to address gene mutation — and five cycles of traditional chemotherapy. While he has experienced fatigue, digestive issues and swelling in his arm due to a blood clot, he has coped well with the side effects. His progress is monitored through positron emission tomography (PET) scans every three months.

“The team has been great since day one,” he said. “They’ve all been super nice. Every time I come in for treatment, they are really welcoming and good-natured. That helps a lot, especially in a medical situation like this.”

Not Just Surviving, But Thriving

Despite his diagnosis, Mr Lim has continued to pursue the things he loves. Shortly after learning he had cancer, he took part in Race Against Cancer — an annual run organised by Four Seasons Hotel Singapore and the National Cancer Centre Singapore. In December, he completed a half marathon in Taipei. He has also re-registered for the Chicago Marathon this year, after deferring his entry last year.

Travel remains a big part of his life, as does spending time with his family. His parents now accompany him to all his medical appointments, a shift that has brought them closer together. “Our family dynamics have changed. We see each other more,” he said. “That’s one of the good things that’s come out of this. Previously, everyone was busy and caught up with work and life. It’s been hard on them, but they have been very supportive.

Maintaining his usual routine — whether in fitness, work or daily life — has been his way of staying grounded. “People ask me why I still train, why I run and still work,” he shared. “When a person is diagnosed with a life-threatening situation, they’re almost expected to embrace a YOLO (you only live once) mindset and do something completely different. But for me, training, running and work are things I love doing. I still need to live that life.”

He acknowledges the uncertainty that comes with a Stage 4 condition but chooses to focus on what he can control. “I went into this medical journey — though it’s not the most ideal situation — as physically fit and strong as anyone could hope to be,” he said. “Now the rest of it is about trusting the process, going with the flow and keeping myself strong mentally and emotionally.”

Far from being consumed by his illness, Mr Lim sees it as a reminder to live with intention. “In a certain way, cancer has made me more alive,” he said. “It’s made me appreciate life more. When you’re suddenly faced with certain situations, you don’t know how long you have, so you live a bit more intentionally.”

He remains realistic but undeterred. “How long will this go on for? I don’t know,” he shared openly. “With a Stage 4 condition, I have to be quite realistic. There’s really no timeline. You make the best of every decision.”

“Every day, I’m thinking about cancer. It’s a reality — that’s my current perspective.”
– Mr Eugene Lim, who has Stage 4 urothelial cancer

What your urine colour can tell you about your health

Urine colour can change for many reasons, from the food you eat to medical conditions. Some changes are harmless, while others could signal a health issue.

Common causes of urine colour changes:

• Dark yellow or brown: Usually caused by dehydration but can also be linked to liver problems or muscle breakdown from intense exercise.
• Red or pink: Can be due to certain foods (like beetroot), medications or blood in the urine, which may point to infections, kidney stones or bladder issues.
• Cloudy or foamy: May suggest a urinary tract infection or protein leakage, which can be a sign of kidney problems.

When to see a doctor:

• If your urine looks red or brown and there is no clear reason.
• If the colour change happens often, especially after exercise.
• If you also have pain, fever or need to pee more or less than usual.

Most urine changes are harmless, but if something seems unusual, see a doctor.