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.
Full Answer Section
- Other Organs: Metastasis can also occur to other organs, such as the bones, brain, and kidneys.
Tumor Cell Markers
Tumor cell markers are substances produced by cancer cells that can be detected in the blood. In the case of pancreatic cancer, commonly ordered tumor cell markers include:
- CA 19-9: A carbohydrate antigen that is often elevated in patients with pancreatic cancer.
- CEA (Carcinoembryonic Antigen): A protein that is elevated in various cancers, including pancreatic cancer.
These markers can help monitor the progression of the disease and assess the effectiveness of treatment.
TNM Staging
The TNM staging system is used to classify the extent of cancer based on the size of the tumor (T), the involvement of lymph nodes (N), and the presence of distant metastases (M). Based on the information provided, J.C.'s pancreatic cancer would likely be classified as:
- T3: The tumor is more than 5 cm in size or extends directly into adjacent organs.
- N1: Regional lymph nodes are involved.
- M1: Distant metastases are present.
Therefore, J.C.'s tumor would be classified as T3N1M1, indicating a stage IV pancreatic cancer.
Characteristics of Malignant Tumors
Malignant tumors are characterized by:
- Uncontrolled Growth: Malignant cells divide rapidly and uncontrollably.
- Invasion: Malignant cells can invade surrounding tissues and organs.
- Metastasis: Malignant cells can spread to distant sites in the body.
- Atypical Appearance: Malignant cells often have abnormal features, such as abnormal nuclei or cell division.
Carcinogenesis Phase
The stage of carcinogenesis when a tumor metastasizes is known as the metastatic stage. This stage involves the invasion of surrounding tissues, intravasation (entry into blood vessels), and extravasation (exit from blood vessels) to form metastases in distant organs.
Tissue Level Affected
The tissue level affected in J.C.'s case is epithelial. Pancreatic cancer is a type of adenocarcinoma, which arises from epithelial cells lining the ducts of the pancreas.