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Carcinogenesis phase when a tumor metastasizes.

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 Instruction You must complete both case studies

Full Answer Section

Lungs: Less common than liver or peritoneum, but lung metastases can occur.

2. Tumor Cell Markers

Tumor cell markers are substances produced by cancer cells or by normal cells in response to cancer.
Purpose:
- Diagnosis: Help confirm the presence of cancer.
- Prognosis: Provide information about the extent of the disease and potential prognosis.
- Monitoring: Track the response to treatment and monitor for recurrence.
For pancreatic cancer, common tumor markers include:
- CA 19-9: A glycoprotein often elevated in pancreatic cancer, but can also be elevated in other conditions.
- Carbohydrate Antigen (CA) 24-2: Another tumor marker that may be elevated in pancreatic cancer.

3. TNM Staging

TNM staging is a system used to describe the extent of cancer in the body.
- T refers to the tumor size and extent of the primary tumor.
- N refers to the involvement of regional lymph nodes.
- M refers to the presence of distant metastases.
Importance of TNM Staging:
- Guides treatment decisions: Treatment options (surgery, chemotherapy, radiation) vary depending on the stage of the cancer.
- Predicts prognosis: Provides an estimate of the patient's overall prognosis and survival outlook.
- Facilitates communication: Allows for standardized communication and comparison of patient outcomes among healthcare providers.

4. Characteristics of Malignant Tumors

Uncontrolled growth: Malignant tumors grow uncontrollably, invading surrounding tissues and potentially spreading to other parts of the body (metastasis).
Loss of differentiation: Malignant cells often lose their normal specialized functions and appear abnormal under a microscope.
Ability to invade and metastasize: Malignant cells can invade surrounding tissues and spread to distant organs through the bloodstream or lymphatic system.
Genetic instability: Malignant cells often have genetic abnormalities, such as mutations in genes that control cell growth and division.

5. Carcinogenesis Phase: Metastasis

Metastasis is the process by which cancer cells spread from the primary tumor to other parts of the body.
Steps in Metastasis:
1. Local invasion: Cancer cells invade surrounding tissues.
2. Intravasation: Cancer cells penetrate blood vessels or lymphatic vessels.
3. Circulation: Cancer cells travel through the bloodstream or lymphatic system.
4. Extravasation: Cancer cells exit the bloodstream or lymphatic system and invade a new organ.
5. Colonization: Cancer cells establish a secondary tumor in the new organ.

6. Tissue Level Affected:

Epithelial: The tumor in this case is a ductal adenocarcinoma, originating from the epithelial cells lining the pancreatic ducts.

Sample Answer

This is for informational purposes only. For medical advice or diagnosis, consult a professional.

1. Potential Most Common Sites for Metastasis

Liver: The liver is the most common site for pancreatic cancer metastasis due to its proximity and direct blood supply.
Peritoneum: The peritoneum (lining of the abdominal cavity) is another common site for spread, often through direct seeding.
Lymph Nodes: Regional lymph nodes, particularly those around the pancreas and along the celiac axis, are frequently involved.