Pancreatic Cancer

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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.

Sample Solution

The phase of carcinogenesis you’re interested in is called metastasis. It’s when cancer cells break free from the original tumor, travel through the body, and establish new tumors in distant organs. This marks a critical turning point in cancer progression, making it significantly more challenging to treat.

Here’s a breakdown of the metastatic process:

  1. Local invasion: Cancer cells breach the surrounding tissue barriers and enter the bloodstream or lymphatic system.
  2. Dissemination: Cancer cells travel through these circulatory systems, potentially encountering various organs and tissues.
  3. Colonization: If conditions are favorable, the circulating cancer cells adhere to specific sites in distant organs, proliferate, and form new tumors, known as metastases.

Understanding the mechanisms of metastasis is crucial for developing effective cancer treatments. Researchers are actively investigating ways to:

  • Prevent local invasion: Targeting molecules that help cancer cells migrate and penetrate tissues.
  • Block dissemination: Disrupting the circulatory pathways used by cancer cells to spread.
  • Inhibit colonization: Impeding the ability of cancer cells to establish new tumors in distant organs.

While metastasis presents a significant challenge, ongoing research offers hope for improving cancer treatment strategies and potentially preventing this critical stage of the disease.

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