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.
Full Answer Section
- In pancreatic cancer, common tumor markers include:
- CA 19-9: This is the most frequently used marker for pancreatic cancer. It's helpful for monitoring treatment response and detecting recurrence.
- CEA (Carcinoembryonic Antigen): While less specific, CEA can also be elevated in pancreatic cancer.
- These markers are ordered to:
- Aid in diagnosis.
- Assess prognosis.
- Monitor treatment effectiveness.
- Detect recurrence.
3. TNM Stage Classification and Its Importance:
- Based on the case study:
- T (Tumor): T3 (tumor invades beyond the pancreas but without involvement of the celiac axis or superior mesenteric artery). The case states that the mass infiltrates the superior mesenteric vein.
- N (Nodes): N1 (regional lymph node metastasis present). The perilesional node is metastatic.
- M (Metastasis): M0 (no distant metastasis). The case does not mention distant metastasis.
- Therefore, the TNM stage would be T3N1M0.
- The TNM classification is vital because:
- It provides a standardized system for staging cancer.
- It helps determine prognosis.
- It guides treatment decisions.
- It facilitates communication among healthcare professionals.
4. Characteristics of Malignant Tumors:
- Cells:
- Loss of differentiation (anaplasia).
- Variations in size and shape (pleomorphism).
- Large, irregularly shaped nuclei.
- Increased mitotic activity.
- Growth:
- Uncontrolled and rapid growth.
- Invasion of surrounding tissues.
- Lack of a well-defined capsule.
- Ability to Spread:
- Metastasis: Spread to distant sites via lymphatic or hematogenous routes.
- Angiogenesis: Formation of new blood vessels to support tumor growth.
5. Carcinogenesis Phase of Metastasis:
- Metastasis involves several steps:
- Detachment: Tumor cells detach from the primary tumor.
- Invasion: They invade the surrounding extracellular matrix.
- Intravasation: They enter blood or lymphatic vessels.
- Circulation: They survive in the circulation.
- Extravasation: They exit the vessels at a distant site.
- Colonization: They form a new tumor at the metastatic site.
6. Affected Tissue Level:
- Epithelial Tissue: Ductal adenocarcinoma originates from the epithelial cells lining the pancreatic ducts. Therefore, the epithelial tissue level is affected.
- This is supported by the FNA biopsy result, which confirms ductal adenocarcinoma.