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
Case Analysis: J.C., 82-year-old with Pancreatic Cancer
Potential Sites of Metastasis
Given the location of the primary tumor in the head of the pancreas, the most common sites for metastasis in J.C. would likely include:
- Liver: The pancreas is adjacent to the liver, making it a common site for metastasis.
- Peritoneum: The peritoneum is the lining of the abdominal cavity, and pancreatic cancer cells can spread to this area.
- Lungs: Pancreatic cancer cells can travel through the bloodstream and reach the lungs, where they can form secondary tumors.
- Lymph Nodes: Cancer cells can spread to nearby lymph nodes, which are part of the immune system.
Tumor Cell Markers
Tumor cell markers are substances produced by cancer cells that can be detected in the blood. They can help in the diagnosis, staging, and monitoring of cancer. In a patient with pancreatic cancer, some common tumor cell markers that may be ordered include:
- CA 19-9: A protein produced by the pancreas and other tissues. Elevated levels of CA 19-9 can be a sign of pancreatic cancer.
- CEA (Carcinoembryonic Antigen): A protein found in the blood of both fetuses and cancer patients. Elevated levels of CEA can be associated with pancreatic cancer and other cancers.
TNM Staging
The TNM staging system is a widely used system for classifying cancer based on the size of the tumor (T), the extent of regional lymph node involvement (N), and the presence of distant metastasis (M). Based on the case study, J.C.'s tumor would likely be classified as:
- T3: The tumor is more than 5 cm in size and/or extends into nearby tissues or organs.
- N1: There is regional lymph node involvement.
- M1: Distant metastasis is present.
This would classify J.C.'s pancreatic cancer as stage IV, which indicates a late-stage cancer with widespread metastasis.
Characteristics of Malignant Tumors
Malignant tumors are characterized by:
- Uncontrolled Growth: Malignant cells grow rapidly and uncontrollably.
- Invasion: Malignant cells can invade surrounding tissues and organs.
- Metastasis: Malignant cells can spread to distant parts of the body, forming secondary tumors.
- Atypical Appearance: Malignant cells often have abnormal features, such as abnormal nuclei or cell division.
Carcinogenesis Phase
The stage of carcinogenesis where a tumor metastasizes is known as invasion and metastasis. During this phase, cancer cells break away from the primary tumor, enter the bloodstream or lymphatic system, and travel to distant sites, where they can form secondary tumors.
Tissue Level Affected
The tissue level affected in J.C.'s case is epithelial. Pancreatic cancer is a type of adenocarcinoma, which is a cancer that arises from epithelial cells. Epithelial cells line the surfaces of organs and tissues, including the pancreas.