ANSWER
First case study: pancreatic cancer in J.C. 1. Most Common Sites for Metastasis and Reason
In pancreatic ductal adenocarcinoma (PDAC), most often occurring locations for metastases are:
The main source of hematogenous spread is the liver since the pancreas empties venous blood into the portal vein.
Pancreas’ closeness to the peritoneal cavity helps direct invasion and seeding.
Lungs: Pulmonary metastases usually result from hematogenous spread through systemic circulation.
Lymphatic spread usually consists in peripancreatic and mesenteric lymph nodes.
The abundant lymphatic and vascular flow of the pancreas, which offers channels for tumour spread, causes common effects on several sites.
2. Tumour Cell Markers: Applications
Tumour cell markers are molecules created by either the body in reaction to malignancy or cancer cells. Most often used indicators for pancreatic cancer are:
Elevated in most pancreatic cancer patients, CA 19-9 (Carbohydrate Antigen 19-9) is utilised for diagnosis, tracking therapy response, and recurrence detection.
A additional marker with predictive information is CEA (carcelinoembryonic antigen).
Why arranged:
Along with imaging and biopsy results, to support diagnosis.
To estimate tumour load and track response to treatment.
To spot early recurrence following treatment.
3. TNM Stage Organisation
The degree of cancer is denoted by the TNM classification system:
Tumour (T): Local tumour scope and size.
T3: Tumour involves the celiac axis or superior mesenteric artery but stretches outside the pancreas.
Regional lymph node involvement, N:
N1: One to three regional lymph nodes are metastasised.
Metastasis (M) is distant spreading.
M0: No distant metastases seen.
Classification for J.C: Stage III T3N1M0
The value of TNM classification:
Direct therapy decisions (e.g., palliative care, chemotherapy, or surgical resection).
offers prognostic information and aids in survival prediction.
promotes in clinical and research environments standardisation and communication.
4. Features of Harmful Tumours
Malignant tumours including ductal adenocarcinoma show the following characteristics:
Poor differentiation, big nuclei, and many mitotic figures define a cell.
Growth patterns: rapid, unchecked spread with possibilities to infiltrate nearby organs and tissues.
Capacity for Distribution:
As shown with the superior mesenteric vein in this case, tumour invades surrounding tissue.
The perilesional metastatic node shows that tumour cells permeate lymph nodes.
Hematogenous Spread: Distribution by blood to far-off locations, say the lungs or the liver.
5. Phase of Carcinogenesis When a tumour metastases
In carcinogenesis, metastases arise throughout the phase of progression. This stage consists in:
Tumour cells cause the synthesis of fresh blood vessels to support expansion.
Tumour cells destroy the extracellular matrix, invading nearby tissues.
Tumour cells pass into blood or lymphatic channels.
Tumour cells hide immune detection and persist in circulation.
Tumour cells leave arteries at a far-off location in extravasation.
Target organs like the liver or lungs allow secondary tumours to develop.
6. Level Affected in Tissue
For J.C., the tissue level mostly impacted is epithelial tissue.
Motive:
Beginning in the epithelial cells lining the pancreatic ducts, pancreatic ductal adenocarcinoma occurs.
Mutations in these cells lead to unchecked proliferation, lack of differentiation, and invading behaviour.
In essence,
With local invasion and lymphatic dissemination, J.C.’s case emphasises advanced pancreatic ductal adenocarcinoma. Knowing the common metastatic routes, the function of tumour markers, and the TNM classification helps one to appreciate the need of early identification and focused therapy plans. Therapeutic strategies and patient outcomes can be improved by addressing the biological features of malignant tumours and the phases of metastases. J.C. is one such patient.
Source Notes
Jemal, A., Miller, K. D., & Siegel, R. L. 2020. Cancer statistics, 2020. CA: A Cancer Journal for Clinicians, 70(1), 7–30. 10.3322/caac.21590 https://doi.org/
Tempero, M. A.; Al-Hawary, M.; Malafa, M. P.; et al. (2021). Version 2.20211 Pancreatic Adenocarcinoma Journal of National Comprehensive Cancer Network, 19(4), 439– 457. 10.6004/jnccn.2021.0017 @ doi.org/10.6004
QUESTION
Case Study 1
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:
1. Please name the potential most common sites for metastasis on J.C and why?
2. What are tumor cell markers and why tumor cell markers are ordered for a patient with pancreatic cancer?
3. Based on the case study described, proceed to classify the tumor based on the TNM Stage classification. Why this classification important?
4. Discussed characteristic of malignant tumors regarding it cells, growth and ability to spread.
5. Describe the carcinogenesis phase when a tumor metastasizes. 6. Choose the tissue level that is affected on the patient discussed above:
Epithelial, Connective, Muscle or Neural. Support your answer.
Submission Instructions:
● Write a paper 500 words, formatted and cited in current APA 7 style with support from at least 2 academic sources.