PMC10156971_01
Abdominal CT scan (2022-08-05): a soft tissue mass shadow was seen in the pancreas head, approximately 57*32 mm; meanwhile, the gastroduodenal artery and superior mesenteric vein were also involved.
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F1
CA 19-9, 69.8 IU/mL; CEA, 1.39 ng/mL; CA 15-3, 10.60 U/mL; CA 125, 14.30 U/mL; and AFP, 1.77 ng/mL. CT scan images of admission (Figure 1) showed occupancy in the pancreas head, which was considered to be cancer, with an involvement of the gastroduodenal artery and the superior mesenteric vein, and a soft tissue mass shadow was observed in the pancreas head, approximately 57*32 mm.
Abdominal CT scan (2022.08.27): a mass of shadow in the neck of the pancreatic head, approximately 57*32 mm; tumor with cystic necrosis was considered as a small amount of local bleeding.
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F2
It was inferred that the disease has been controlled (Figure 2).
CT imaging of the abdomen (2022.9.26): a slightly hypodense mass of approximately 35*28 mm with mild enhancement at the margin was observed in the neck of the pancreatic head, and the right wall of the proximal end of the adjacent superior mesenteric vein was involved with a slightly narrower lumen. The tumor was 52% smaller than before treatment.
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F3
The efficacy of lenvatinib and icaritin soft capsules was evaluated comprehensively and reached PR with significant tumor remission after 2 months (Figure 3).
CT scan of the abdomen (2022.10.15): a slightly hypodense mass of approximately 35*28 mm with mild edge enhancement was seen in the neck of the pancreatic head, with a slightly reduced lesion compared to the last imaging (2022.09.26), and with a relief of the proximal stenosis in the adjacent SMV. It showed better improvement than before for the vague edema and thickening of the lateral wall of the greater curvature of the gastric antrum and the colorectal wall, and the vague inflammatory exudation of the gastrocolic ligament. The tumor was 20% smaller than in the last review.
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F4
CRP, 156.3 mg/L; blood amylase, 211.6 IU/L; and lipase, 224.0 IU/L. CT of the abdomen showed a diffuse inflammatory exudate below the pancreas, suggesting secondary acute pancreatitis (Figure 4). The patient's condition was regarded to be locally advanced pancreatic cancer as before, and the surgical assessment met the criteria for SMV resection and reconstruction (Figure 4).
Changes in tumor markers: the patient took two drugs for 2 months between August and stopped them in early October for financial reasons, later replaced them with Tegio in early November, and followed up about 3 months after the drug's withdrawal.
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F5
Later, the patient took Tegio as treatment, and CA 19-9 increased to 501.6 U/mL in December without a CT review (Figure 5).