Tumor cell markers
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:
One paragraph per question. Total six questions, six paragraphs
1. Describe the potential most common sites for metastasis on J.C and (One paragraph):
a. why?
2. Describe the tumor cell markers and (One paragraph):
a. Why tumor cell markers are ordered for a patient with pancreatic cancer?
3. Classify the tumor based on the TNM Stage classification based on the case study described, and (One paragraph):
a. Why this classification important?
4. Describe characteristics of malignant tumors regarding it (One paragraph):
a.Cells
b. Growth
c. Ability to spread.
5. Describe the carcinogenesis phase when a tumor metastasized (One paragraph) .
6. Select and describe the tissue level that is affected on the patient discussed above: Epithelial, Connective, Muscle, or Neural (One paragraph).
Sample Solution
Pancreatic cancer can either be exocrine or neuroendocrine (endocrine tumors), depending on the cell of origin. About 93% of pancreatic cancers are exocrine tumors, the most common type being pancreatic ductal adenocarcinoma (PDA). The remaining 7% are neuroendocrine tumors (PNET), also called islet tumors, which often grow more slowly than their exocrine counterparts (Antonello et al. 2009; Amin & Kim 2016). In addition to the low frequency of cases, PNET are mostly characterized as indolent. While 40%-80% of patients with PNET are metastatic at presentation, usually involving the liver (40%-93%) (Lawrence et al. 2011), treatment options do exist and include locoregional therapy, chemotherapy, as well as liver transplant.
