ANSWER
Case Study Analysis: Pancreatic Cancer in J.C. 1. Potential Common Sites for Metastasis and Reason
Aggressive malignancy with common metastatic sites including pancreatic ductal adenocarcinoma (PDAC), is:
The pancreas empties venous blood into the portal vein, so the liver is the main site of hematogenous spread.
Because the pancreas runs next to the peritoneal cavity, direct extension and peritoneal seeding are typical.
Lungs: Hematogenous spread via the systemic circulation lets metastases reach the lungs.
Regional lymph nodes: Especially to the mesenteric and peripancreatic nodes, lymphatic dissemination is common.
The lymphatic and circulatory paths linked to the pancreas cause these areas to be often implicated.
2. Pancreatic cancer: Tumour cell markers and their use
Tumour cell markers: Tumour markers are molecules generated by either the body in reaction to cancer or by cancer cells. Common indicators in pancreatic cancer are:
Most usually utilised for diagnosis and monitoring, CA 19-9 (Carbohydrate Antigen 19-9) is raised in most cases of PDAC.
Added as a supplemental marker for illness monitoring and prognosis is CEA (carinoembryonic antigen).
Why Order:
Monitoring and diagnosis: Rising CA 19-9 levels support the diagnosis and are tracked via therapy response and recurrence.
Tumour markers help to reveal the tumour load and metastatic potential.
High degrees usually correspond with advanced disease and worse prognosis.
3. Classification of TNM Stages
The TNM system groups cancers depending on:
Tumour: Local extent and size of a tumour.
N (Nodes) : Regional lymph node involvement present.
M (Metastasis) – Distant metastases.
Classification for J.C.:
T3: Four centimetre mass invading the Wirsung duct and the superior mesenteric vein.
N1: One 1.5 cm perilesional lymph node with metastatic properties.
M0: Not mentioned in the diagnostic report any indication of distant metastases.
T3N1M0, Stage III, TNM Level
The relevance of TNM classification
Treatment planning directs choices on palliative care, chemotherapy, or surgery.
Forecasts of illness progression and survival rates are given here.
Standardisation helps healthcare professionals communicate better and makes study comparisons of results possible.
4. Features of Dangerous Tumours
Like ductal adenocarcinoma, malignant tumours show the following:
Large nuclei, pleomorphism, and poor differentiation define cells.
High mitotic rate and altered normal cellular architecture loss.
Development Routes:
Quick, unchecked spread capable of invading nearby tissues.
Local invasion into nearby buildings, lymphatic spread, and hematogenous dispersion.
5. phase of carcinogenesis When a tumour metastases
In carcinogenesis, metastases arise during the progression phase. During this stage:
Tumour cells cause fresh blood vessel development to support their growth.
Tumour cells tear through extracellular matrix and the basement membrane.
Tumour cells first pass into the lymphatic system or circulation.
Tumour cells move and hide from immune monitoring.
Tumour cells leave the arteries at a far-off location to become secondary tumours via extrasation and colonisation.
6. Tissue Level Influenced
For J.C., the tissue impacted is epithelial tissue.
Rationale:
Origin of pancreatic ductal adenocarcinoma is epithelial cells lining the pancreatic ducts. Genetic changes in these cells produce aberrant proliferation, loss of differentiation, and invasion of surrounding tissue.
In summary,
The case of J.C. shows advanced pancreatic ductal adenocarcinoma involving lymph nodes and local invasion. Knowing the common metastatic sites, function of tumour markers, TNM classification, and the biology of malignant tumours guides proper treatment planning and prognosis.
Citations
Jemal, A.; Miller, K. D.; Siegel, R. L. (2020). 2020 cancer statistics. CA: A Cancer Journal for Clinicians, seventy-one (1), 7–30. 10.3322/caac.21590 @doi.org/10.3322
2019 McCance, K. L.; Huether, S. E.; Brashers, V. L.; Rote, N. S. Pathophysiology: The biologic foundation of disease in adults and children (8th ed.). Other than Elsevier.
Tempero, M. A.; Malafa, M. P.; Al-Hawary, M.; et al. (2021) Version 2.20211 Pancreatic Adenocarcinoma Journal of National Comprehensive Cancer Network, 19(4), 439– 457. 10.6004/jnccn.2021.0017 https://doi.org
QUESTION
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