GI specialist due to abdominal discomfort
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:
• Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources. Your initial post is worth 8 points.
• You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. Your reply posts are worth 2 points (1 point per response.)
• All replies must be constructive and use literature where possible.
• Please post your initial response by 11:59 PM ET Thursday, and comment on the posts of two classmates by 11:59 PM ET Sunday.
• You can expect feedback from the instructor within 48 to 72 hours from the Sunday due date.
Sample Solution
1. The potential most common sites for metastasis on J.C would be liver, lymph nodes, and lungs since these are the areas that cancer cells typically spread to first from the pancreas. Liver metastases occur in around 40-50% of patients with pancreatic cancer affecting approximately one third of all cases. Lymph node involvement is present in 20-25% of all cases and lung metastases can be seen in up to 10%. It is also possible for it to spread to more distant organs such as peritoneum or spinal bones (Kumar & Clark, 2018).
2. Tumor cell markers are proteins which can appear on the surface of certain tumor cells and used to diagnose cancers by identifying them (Giraud et al., 2020). These markers often have specific phases during a disease’s progression: they may increase when cancer is active or decrease when it has been treated successfully (Giraud et al., 2020). For example, CA 19-9 is a commonly ordered serum marker for pancreatic cancer that can help detect recurrent disease or monitor its progress after treatment (Kumar & Clark, 2018). Other tumor cell markers that can be examined include carcinoembryonic antigen (CEA), alpha fetoprotein (AFP), prostate specific antigen (PSA) and others depending on the type of cancer being tested for.
3. Based on the case study described above, this tumor would likely be classified as Stage III according to TNM staging system since there appears to be infiltration into Wirsung duct, perilesional node detected with 1.5 cm size and fine needle aspiration biopsy revealed ductal adenocarcinoma which implies an advanced stage of disease at diagnosis(Kumar & Clark, 2018). This classification system helps clinicians assess whether a patient will require chemotherapy or radiation therapies alone or need combination therapy based upon how extensive their tumor has grown within their body at diagnosis (Nieder et al., 2017). Additionally , this classification provides important prognostic information so that physicians can better understand how long a patient may potentially survive given certain factors associated with our TNM Staging System such as location of primary tumor site and presence/absence of lymph node involvement (Nieder et al., 2017).
