J.C is an 82-year-old white man who was evaluated by GI specialist due to abdominal discomfort
J.C is an 82-year-old white man who was evaluated by GI specialist due to abdominal discomfort, loss of appetite, weight lost, weakness and occasional nausea.
Past Medical History (PMH):Patient is Diabetic, controlled with Metformin 500 mg by mouth twice a day, Lantus 15 units SC bedtime. Hypertensive, controlled with Olmesartan 20 mg by mouth once a day. Atrial Fibrillation, controlled with Rivaroxaban 15 mg by mouth once a day and bisoprolol 10 mg by mouth once a day.
Labs:Hb 12.7 g/dl; Hct 38.8% WBC 8.2; Glycemia 74mg/dl; Creatinine 0.8 mg/dl; BUN 9.8 mg/dl; AST 21 U/L ALT 17 U/L; Bil T 1.90 mg/dl; Ind 0.69 mg/dl; Dir 1.21 mg/dl.Diagnostic test:Endoscopic Ultrasound of the Pancreas. Solid mass in the head of pancreas 4 cms, infiltrating Wirsung duct. The solid mass impress to infiltrate the superior mesenteric vein. Perilesional node is detected, 1.5 cms, metastatic aspect. Fine needle aspiration (FNA) biopsy: Ductal adenocarcinoma.
Case study questions:
- Please name the potential most common sites for metastasis on J.C and why?
- What are tumor cell markers and why tumor cell markers are ordered for a patient with pancreatic cancer?
- Based on the case study described, proceed to classify the tumor based on the TNM Stage classification. Why this classification important?
- Discussed characteristic of malignant tumors regarding it cells, growth and ability to spread.
- Describe the carcinogenesis phase when a tumor metastasizes.
- Choose the tissue level that is affected on the patient discussed above: Epithelial, Connective, Muscle or Neural. Support your answer.
Submission Instructions:
- Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources. Your initial post is worth 8 points.
- You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. Your reply posts are worth 2 points (1 point per response.)
- All replies must be constructive and use literature where possible.
Expert Answer and Explanation
J.C Case Study
Potential Most Common Sites for Metastasis
The potential most common sites for metastasis in the case of J.C. with pancreatic cancer include the liver, peritoneum, lungs, and regional lymph nodes. Pancreatic cancer often spreads to nearby organs and tissues within the abdominal cavity. Most of the affected areas include but not limited to the liver and peritoneum, due to the close proximity of these structures to the pancreas (De Dosso et al., 2021).
Be that as it may, cancer cells can travel through the bloodstream or lymphatic system to distant sites like the lungs and regional lymph nodes. Metastasis to the liver is particularly common due to its role in filtering blood from the digestive tract, where pancreatic cancer cells may enter circulation.
Tumor Cell Markers
When a person has cancer, the body responds by producing tumor cell markers. Sometimes, these markers can be produced by the cancer cells and deposited in body fluids ranging from the blood, urine or in tissue samples. Healthcare professionals are able to identifies the presence of tumor cell markers during diagnosis to ascertain the presence of cancer in a patient (Lin et al., 2021). The concentration of tumor cells can also help in monitoring, and the overall management of the disease. In pancreatic cancer, tumor cell markers such as CA 19-9 and CEA (carcinoembryonic antigen) are commonly ordered.
TNM Stage Classification
Based on the information provided in the case study, C.J.’s tumor can be classified based on the TNM Stage classification as follows: T3, N1, M1. The tumor is classified as T3 because it measures 4 cm and has invaded adjacent structures, including the Wirsung duct and superior mesenteric vein. In addition, the presence of a perilesional node with metastatic features indicates nodal involvement (N1). The detection of distant metastasis to the perilesional node confirms the presence of distant spread (M1).
This TNM staging provides important prognostic information and helps guide treatment decisions for C.J.’s pancreatic cancer (Rosen & Sapra, 2023). Care providers are able to offer assistance to the patient and ensure that the treatment is able to meet their individual needs.
Malignant Tumors
Malignant tumors exhibit several characteristic features which can be distinguished from other forms of tumors. For instance, a key characteristic of malignant tumor cells is their ability to display uncontrolled growth and proliferation. The cells are able to often form irregular masses or tumors (Wang et al., 2022). Additionally, malignant cells lack the ability to regulate their growth, leading to unchecked expansion and spread into surrounding tissues. The malignant tumors can also metastasize, spreading to distant sites in the body through the bloodstream.
This metastatic potential is made possible through the ability of the cells to invade nearby tissues, penetrate blood vessels or lymphatic channels, survive in circulation, and establish secondary tumors at distant sites. In like manner, malignant tumor cells often exhibit pleomorphism, with cells showing variations in size, shape, and nuclear features, reflecting their aggressive nature (Wang et al., 2022). These characteristics contribute to the aggressive behavior and poor prognosis associated with malignant tumors.
Carcinogenesis Phase When a Tumor Metastasizes
Carcinogenesis is the process by which normal cells transform into cancer cells. The process can be characterized by several stages that range from initiation, promotion, and progression. When a tumor metastasizes, cancer cells from the primary tumor site invade nearby tissues and proceed to enter the blood vessels or lymphatic channels. The spread allows the cells to travel to distant sites in the body (Xiong et al., 2021).
At the tissue level, metastasis involves the dissemination of cancer cells from the primary tumor to distant organs or tissues, where they establish secondary tumors. This process requires cancer cells to acquire specific traits that enable them to detach from the primary tumor, survive in circulation, and colonize new sites. In the case of J.C., the tumor has metastasized to a perilesional node, indicating the spread of pancreatic cancer cells beyond the primary tumor site.
Tissue Level Based on The Case
The tissue level affected in the case of C.J is epithelial. Pancreatic cancer typically originates from the epithelial cells lining the ducts of the pancreas, known as ductal adenocarcinoma (Qin et al., 2020). The endoscopic ultrasound revealed a solid mass in the head of the pancreas, infiltrating the Wirsung duct, which is consistent with epithelial cell origin. Based on the fine needle aspiration biopsy the patient was confirmed to have ductal adenocarcinoma, further supporting the epithelial nature of the tumor. This type of cancer arises from abnormal growth and proliferation of epithelial cells which forms a malignant tumor in the pancreas.
References
De Dosso, S., Siebenhüner, A. R., Winder, T., Meisel, A., Fritsch, R., Astaras, C., … & Borner, M. (2021). Treatment landscape of metastatic pancreatic cancer. Cancer treatment reviews, 96, 102180.
Lin, D., Shen, L., Luo, M., Zhang, K., Li, J., Yang, Q., … & Zhou, J. (2021). Circulating tumor cells: biology and clinical significance. Signal transduction and targeted therapy, 6(1), 404.
Qin, C., Yang, G., Yang, J., Ren, B., Wang, H., Chen, G., … & Zhao, Y. (2020). Metabolism of pancreatic cancer: paving the way to better anticancer strategies. Molecular cancer, 19, 1-19.
Rosen, R. D., & Sapra, A. (2023). TNM classification. In StatPearls [Internet]. StatPearls Publishing.
Wang, W., Meng, Q., Cheng, Y., Han, Y., Xue, Y., Kuang, Y., … & Jia, B. (2022). Immunodeficiencies Push Readmissions in Malignant Tumor Patients: A Retrospective Cohort Study Based on the Nationwide Readmission Database. Cancers, 15(1), 88.
Xiong, S., Dong, L., & Cheng, L. (2021). Neutrophils in cancer carcinogenesis and metastasis. Journal of hematology & oncology, 14, 1-17.
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