Scuba diving with metastatic cancer

This story doesn’t begin underwater, but with a turning point that changes everything: the diagnosis of metastatic neuroendocrine carcinoma. From the very start, it’s clear that there will be no cure. From one moment to the next, daily life and routine are no longer the focus; instead, it’s all about treatments—and the question of what comes next.

This article is based on the “Leben mit Metastasen” (“Living with Metastases”) campaign, in which Patricia, a doctor and diver, openly shares her story in a podcast.

Image: Patricia Kressig

At first, chemotherapy and immunotherapy dominate her daily life. After completing her first course of treatment, Patricia is doing very well. At the same time, the reality remains: the disease is considered incurable, and a relapse is to be expected at some point. But for now, she is clinically stable, in good overall health—and is regaining a measure of physical normality.

What now? Unable to work, but feeling well—what does life mean in this situation?

For Patricia, the answer is clear: for her, life means diving. Diving is far more than a hobby to her—it is her great passion. Over the years, she has not only dived but also worked as a diving instructor at times. The water is a central part of her identity.

As her condition stabilizes, her desire to return grows. She reaches out to friends who run a dive center in Indonesia. She speaks openly about her illness—and about her wish to be able to dive there again. The response is supportive, but comes with a clear requirement: a doctor’s clearance.

This raises the crucial question: Is she fit to dive? There is a great deal of uncertainty among those around her; at first, some even think her request is a bad joke.

Finally, Patricia turns to a colleague—himself a passionate diver with experience in diving medicine. Even he is hesitant at first upon hearing the diagnosis. But in the end, he reaches the decision: Patricia is fit to dive.

She doesn’t hesitate for long after this decision. She travels to Indonesia and returns to the water. Diving once again becomes an integral part of her life.

In the time that follows, her fitness for diving is medically confirmed twice more. And so, a few dives turn into many. Patricia has completed over three hundred since her diagnosis—more than some people do in their entire lives.

Assessing Fitness for Diving in Patients with Metastatic Cancer

Assessing the fitness for diving of a patient with metastatic neuroendocrine carcinoma is likely to be a challenge for any diving medicine specialist. What factors would need to be considered in this situation?

Remission

First, one would consider the patient’s current oncological status. Is the patient in complete remission at the time of the assessment? This would mean that the disease is no longer detectable using available diagnostic methods—both imaging (e.g., PET-CT) and laboratory tests. Particularly with neuroendocrine tumors, it is also important to consider that these can exert a wide range of systemic effects through hormonal activity, regardless of their tumor burden. Electrolyte imbalances or coagulation disorders would be typical examples here—both factors that are potentially safety-relevant under diving conditions.

General Fitness

Furthermore, the individual’s general physical condition would need to be assessed independently of the tumor disease. Is the individual currently sufficiently resilient? Are there functional limitations resulting from chemotherapy, immunotherapy, or a previous surgery? What is the level of cardiorespiratory fitness? In this context, the standard criteria for a diving medical examination would ultimately also apply.

Time perspective

Another key aspect would be the time perspective. How likely is it that the disease will remain stable during the relevant period—such as during a planned diving trip? Or is there a high probability of a short-term recurrence (a flare-up of the cancer) or clinical deterioration? This assessment is subject to uncertainty, but would have a significant influence on decision-making. An expectedly unstable situation or a relapse expected in the near future would argue against confirming fitness for diving.

Individual Factors

Finally, the experience and understanding of the individual concerned also play a role. In the case of a medically trained, experienced diver, as in this instance, it can be assumed that both the specific risks of diving and potential warning signs of clinical deterioration will be realistically assessed. This does not replace a medical evaluation but can be relevant within the context of shared decision-making.

Overall, such a situation would be guided less by rigid criteria and more by a careful, individual risk-benefit assessment—with a focus on the current condition, the short-term prognosis, and the specific demands of diving.

Easy dives

The specific nature of the dives would also have to be clearly restricted. In such a scenario, only “easy dives” would be considered: that is, conservative, low-risk dive profiles without technical ambitions. This would mean no decompression dives, no complex gas changes, and no increased demands on the equipment.

The number of dives would have to be limited—for example, to a maximum of one or two per day—with sufficiently long surface intervals. The profiles themselves should clearly remain within the no-decompression limit and be deliberately planned conservatively.

Central to this would also be the consistent application of “low bubble diving” principles: slow ascents, extended safety stops, avoidance of unnecessary stress, and, overall, the lowest possible inert gas load. The goal would be to minimize the formation of microbubbles as much as possible.

In addition, the general recommendations would take on greater importance; while they apply to everyone, they would need to be strictly adhered to here: consistent hydration, sufficient rest between dives, and avoiding additional stressors such as cold or exhaustion.

Overall, diving in this context would be characterized by a deliberately conservative approach—with the clear goal of keeping the residual risk as low as possible.

Transparency

Another key point is complete transparency regarding one’s health status: disclosure to dive buddies and the dive center is essential. Only then can all parties involved respond appropriately in an emergency.

Conclusion

A diagnosis of metastatic cancer is not just about the disease; it is also about life, personality, and hope. Today, modern treatments can enable a high quality of life despite the presence of metastases. And for some patients, diving can be a part of that life. Patricia’s story shows that it is possible to dive despite having metastatic cancer.