Pancreatic Stage IV: Singaporean Treatment Journey with Chemotherapy and ECCT as Cancer Supportive Treatment

Sometimes, when you look back at a cancer journey, it is not one dramatic moment that tells the story. It is a series of scans, blood tests, treatment days, difficult weeks, and then, gradually, changes that begin to show up in places you can actually measure.

This was the journey of Joey (nickname), 50-year-old Singaporean women whose diagnosis of stage IV pancreatic cancer unfolded very quickly at the end of 2025.

It started with blood in the urine:

In December 2025, Joey developed persistent haematuria. At first, she was treated for what was thought to be a urinary tract infection. However, the bleeding continued even after antibiotics, and she eventually went to the hospital for further investigation.

A CT scan on 20 December 2025 revealed several concerning findings. There was a large multiloculated abdominopelvic mass measuring approximately 10.6 × 10.4 × 12.0 cm, extensive peritoneal abnormalities, ascites, and an abnormal lesion in the tail of the pancreas.

Further investigations moved quickly.

On 21 December, her tumour marker CA 19-9 was 3,490 U/mL, while CA-125 was 222 U/mL.

The following day, a fine-needle biopsy of the pancreatic tail confirmed adenocarcinoma.

A PET-CT on 23 December painted a broader picture. The pancreatic tail lesion was FDG-avid, and there were also multiple FDG-avid peritoneal lesions, suspicious lymph nodes and a liver lesion. There was also a very large FDG-avid abdominopelvic solid-cystic mass. While the pelvic mass raised concern for ovarian malignancy, the available biopsy confirmation was from the pancreatic lesion, and the clinical team considered metastatic pancreatic cancer as the working diagnosis. In other words, this was not a small or straightforward disease presentation.

Joey was dealing with biopsy-confirmed pancreatic adenocarcinoma with metastatic disease involving the peritoneum and liver, with suspicious nodal involvement and a large abdominopelvic mass, and later imaging also raised concern for bone metastasis at L5.

Her chemotherapy began without delay:

Joey began systemic chemotherapy and continued through the first-line treatment plan. By early February 2026, she had already completed two cycles and was preparing for her third.

The treatment was not easy.

She experienced hair loss, giddiness and vomiting around chemotherapy, along with reduced appetite. There were also concerns about anaemia and liver function. At one point, her haemoglobin was documented as low as 6.7 g/dL, and the family and medical team were concerned about whether ongoing bleeding or other factors were contributing.

Despite all of this, there were some encouraging things in her day-to-day condition. She had no significant constant pain, could still sleep, and remained independent in her daily activities during the earlier phase of treatment.

ECCT was added as Cancer Supportive Treatment alongside chemotherapy:

ECCT was introduced on 4 February 2026, while Joey was continuing chemotherapy.

The approach was gradual rather than aggressive. She started with short sessions using the blanket and then progressively increased the duration over time while she continued receiving conventional systemic treatment. ECCT was used as an additional supportive intervention rather than a replacement of standard of care.

Her first scan:

On 16 February 2026, only less than two weeks after ECCT began, Joey underwent a CT scan. Unfortunately, the large abdominopelvic mass had increased in size compared with the December PET-CT, measuring approximately 15.3 × 10.2 × 15.4 cm, compared with 14.4 × 10.9 cm previously. However, the same scan also showed some encouraging findings elsewhere:

• The pancreatic tail lesion was stable to slightly smaller, measuring about 2.9 × 1.6 cm, compared with 3.6 × 2.2 cm previously.

• The previously identified liver lesion in segment VI appeared smaller and less obvious.

• Ascites had improved.

• Previous pleural effusions had resolved.

At the same time, there was also a new lucent lesion at L5 that was suspicious for metastasis.

So, this was not a simple “everything improved” scan. It was a mixed response, which is an important part of the story. The disease was still active, and different sites were behaving differently. Despite a disappointing scan at early stage, she continues with her standard of care and ECCT persistently.

Then the blood markers began to tell a different story:

Before ECCT was introduced, Joey's CA 19-9 had been rising:

• 21 December 2025: 3,490

• 8 January 2026: 3,736

• 21 January: 6,193

• 6 February: 7,199

ECCT began on 4 February, while chemotherapy continued.

The CA 19-9 did not immediately fall in a straight line. It dropped to 4,807 on 16 February, then rose again to 5,951 on 20 February, before beginning a more sustained downward trend:

Her CA-125 also fell substantially, from 560 in January to 288 in early February, 72 by late March, and later into the 20–40 range. The important thing was not simply that one blood test was better than another. It was the sustained direction of change over several months. The numbers did not improve overnight. They moved up and down at first, but from late February and March onward, the overall trend became increasingly clear.

The scans eventually followed:

The next major CT scan, on 20 April 2026 showed a much more encouraging radiological picture with her combination approach.

• The large abdominopelvic mass had decreased dramatically, from approximately 15.3 × 10.2 cm in February to 8.6 × 7.6 cm.

• The pancreatic tail lesion remained stable at approximately 2.3 × 1.8 cm.

• There were no new destructive bone lesions, the peritoneal nodules were stable, and the L5 lesion remained stable.

Improvement is not always a straight line, and a positive scan does not mean the journey suddenly becomes easy. But a positive news encourages her and her persistent strengthen her fighting will.

By June, the improvement was no longer limited to one area

The CT scan on 25 June 2026 provided another important update.

• The abdominopelvic mass had reduced further to approximately 5.84 × 7.04 cm.

• The pancreatic tail lesion had also decreased further to approximately 1.48 × 2.37 cm.

• Other findings included:

• Reduction in the size of a peritoneal nodule.

• Another previously seen pouch of Douglas peritoneal nodule was no longer well visualised.

• Less prominent peritoneal nodularity.

• No focal or suspicious liver lesion identified.

• No new sites of disease detected.

• The L5 bone lesion remained stable.

The radiology summary was straightforward: the abdominopelvic mass and peritoneal nodules had decreased, the pancreatic tail lesion had decreased, and no new sites of disease were detected.

Looking back at the whole journey:

From December 2025 to the following months, Joey's treatment journey followed a clear chronology:

1. December 2025: Persistent haematuria led to further investigation.

2. 20–23 December: CT, tumour marker testing, pancreatic biopsy and PET-CT established biopsy-confirmed pancreatic adenocarcinoma with metastatic disease on imaging.

3. Late December to January: Systemic chemotherapy was initiated.

4. 4 February 2026: ECCT was added while chemotherapy continued.

5. February to March: ECCT exposure was gradually increased from short 15-minute sessions to 30 minutes, then 1 hour, and later 2-hour sessions.

6. Throughout this period: Chemotherapy continued in cycles.

7. 16 February: Imaging showed a mixed picture, with improvement or stability in some sites but progression of the large abdominopelvic mass and a new suspicious L5 lesion.

8. March onward: CA 19-9 and CA-125 began showing a sustained overall downward trend.

9. 20 April: Significant reduction in the large abdominopelvic mass was documented, while the pancreatic lesion and other metastatic findings were largely stable.

10. 25 June: Further reduction in both the abdominopelvic mass and pancreatic tail lesion was documented, with improvement in peritoneal disease and no new sites of disease.

The progression of Joey's CA 19-9 is particularly striking when viewed as a timeline. It rose from 3,490 in December to a peak recorded value of 7,199 shortly after ECCT was introduced, before subsequently falling to 166 by August while chemotherapy and ECCT continued together.

For Joey and her family, the story was not about choosing one treatment over another. It was about continuing to fight on several fronts. And despite the challenges of treatment, Joey continued to move forward, one cycle, one scan and one blood test at a time.

This case describes an individual patient's documented journey. Individual outcomes may vary, and this case should not be interpreted as a guarantee of any particular outcome, response, improvement, or indication of result in another user.