Figure 2. Changes in SCC-Ag levels, and clinical course before and after anti-estrogens use. A) Cervical cancer was first diagnosed 9 months before anti-estrogen use, with an SCC-Ag level of 1.2 ng/ml; B) After FDG-PET CT revealed central recurrence, treatment with tamoxifen was started. C) The SCC-Ag level increased to 3.5 ng/ml after 43 months of tamoxifen use. D) Three weeks later, the SCC-Ag level increased to 5.5 ng/ml, and the anti-estrogen therapy was shifted to letrozole. E) The SCC-Ag level peaked at 6.9 ng/ml, then dropped gradually to its nadir of 1.6 ng/ml in the following 11 months. F) The SCC-Ag level rebounded to 2.1 ng/ml after 15 months of letrozole use. G) The patient died 69 months after starting anti-estrogen treatment due to noncancer-related pneumonia and heart failure. CCRT – concurrent chemoradiotherapy; Bx – cervical biopsy.