Patient is Diabetic

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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

Potential Metastasis Sites for J.C.

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:

  1. Liver: The pancreas is closely connected to the liver, and pancreatic cancer cells can easily spread through the portal vein system.
  2. Peritoneum: The peritoneum is the lining of the abdominal cavity, and cancer cells can shed into it and spread to other organs.
  3. Lymph nodes: The lymph nodes are part of the immune system and can filter cancer cells.
  4. Lungs: Cancer cells can spread through the bloodstream to the lungs.
  5. Other organs: Less common sites of metastasis include bones, brain, and adrenal glands.

Tumor Cell Markers

Tumor cell markers are substances produced by cancer cells or in response to cancer cells. They can be used to:

  • Diagnose cancer: Elevated levels of certain tumor cell markers can indicate the presence of cancer.
  • Monitor the progression of cancer: Changes in tumor cell marker levels can help track the growth and spread of a tumor.
  • Assess the effectiveness of treatment: If tumor cell marker levels decrease after treatment, it may indicate that the treatment is working.

Common tumor cell markers for pancreatic cancer include:

  • CA 19-9: A glycoprotein produced by the pancreas and other tissues.
  • CEA: A protein found in the digestive tract and other tissues.

TNM Stage Classification

The TNM stage classification is a system used to stage cancer based on the size of the tumor (T), the extent of spread to nearby lymph nodes (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 or has grown into nearby organs.
  • N1: There is spread to one to three regional lymph nodes.
  • M1: There is distant metastasis.

The TNM stage classification is important because it helps determine the prognosis and appropriate treatment for a cancer patient. Higher stages generally indicate a poorer prognosis, while lower stages may be associated with a better outcome.

Characteristics of Malignant Tumors

Malignant tumors are characterized by:

  • Abnormal cells: They have abnormal growth and behavior compared to normal cells.
  • Invasive growth: They can invade and destroy surrounding tissues.
  • Metastasis: They can spread to other parts of the body.
  • Rapid growth: They often grow quickly and can become resistant to treatment.

Carcinogenesis Phase When a Tumor Metastasizes

The metastasis phase of carcinogenesis occurs when cancer cells break away from the primary tumor and spread to other parts of the body. This involves several steps, including:

  1. Invasion: Cancer cells invade the surrounding tissue.
  2. Intravasation: Cancer cells enter the bloodstream or lymphatic system.
  3. Circulation: Cancer cells travel through the bloodstream or lymphatic system.
  4. Extravasation: Cancer cells leave the bloodstream or lymphatic system and invade a new tissue.
  5. Colonization: Cancer cells grow and form a new tumor.

Tissue Level Affected

The tissue level affected in J.C. is epithelial. The pancreas is an organ composed of epithelial tissue, which lines the ducts and acini of the gland. The adenocarcinoma in J.C. is a cancer of the epithelial cells.

 

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