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:
● Write a paper 500 words, formatted and cited in current APA 7 style with
support from at least 2 academic sources
Title: Understanding Pancreatic Cancer: A Case Study Analysis
Introduction: Pancreatic cancer is a devastating disease often diagnosed at advanced stages, leading to poor outcomes. This essay aims to analyze the case of J.C, an 82-year-old man diagnosed with pancreatic adenocarcinoma, addressing questions related to metastasis sites, tumor markers, TNM staging, characteristics of malignant tumors, carcinogenesis phases, and tissue level affected.
1. Potential Sites for Metastasis: Common sites for metastasis in pancreatic cancer include the liver, peritoneum, lungs, and distant lymph nodes. The liver is a common site due to its anatomical proximity to the pancreas and the hepatic portal system’s drainage from the pancreas. Lymphatic spread can lead to distant lymph node involvement, while peritoneal metastasis often occurs through peritoneal fluid circulation. Additionally, hematogenous spread may involve the lungs due to the rich vascularization of the pancreas.
2. Tumor Cell Markers: Tumor markers such as CA 19-9 and CEA (carcinoembryonic antigen) are commonly ordered for pancreatic cancer patients. CA 19-9 is elevated in 70-80% of pancreatic cancers and can be useful for diagnosis, monitoring treatment response, and detecting recurrence. CEA, although less specific, can also aid in diagnosis and monitoring. These markers provide valuable information on disease progression and treatment effectiveness.
3. TNM Staging: Based on the TNM (Tumor, Node, Metastasis) classification, the tumor described in the case study can be classified as T3 (due to infiltration into the superior mesenteric vein), N1 (due to presence of perilesional lymph node metastasis), and M1 (due to distant metastasis). This classification is important as it helps in determining prognosis, guiding treatment decisions, and standardizing communication among healthcare professionals.
4. Characteristics of Malignant Tumors: Malignant tumors exhibit several characteristic features. They are composed of abnormal cells with uncontrolled growth, leading to the formation of a mass or tumor. These cells have the ability to invade surrounding tissues and metastasize to distant sites through blood or lymphatic vessels. Malignant tumors also exhibit angiogenesis, the formation of new blood vessels to support their growth and spread.
5. Carcinogenesis and Metastasis: Metastasis is a complex process involving multiple steps. During carcinogenesis, genetic mutations accumulate in normal cells, leading to their transformation into cancer cells. These cells acquire the ability to invade surrounding tissues and enter blood or lymphatic vessels. Once in circulation, they can travel to distant sites, extravasate, and establish secondary tumors. This multistep process involves interactions between tumor cells and the microenvironment, including immune cells and blood vessels.
6. Tissue Level Affected: The tissue level affected in pancreatic cancer is epithelial. Pancreatic adenocarcinoma arises from the ductal epithelium of the pancreas. The tumor originates from abnormal epithelial cells lining the pancreatic ducts and acini. This malignancy disrupts the normal function of the pancreas and surrounding tissues, leading to the characteristic symptoms observed in patients like J.C.
Conclusion: Pancreatic cancer poses significant challenges due to its aggressive nature and propensity for metastasis. Understanding the mechanisms of metastasis, tumor markers, TNM staging, and tissue involvement is crucial for guiding treatment decisions and improving patient outcomes. Through comprehensive evaluation and management, healthcare professionals can strive to alleviate symptoms, prolong survival, and enhance the quality of life for patients with pancreatic cancer.
The post Tumor Cell Markers appeared first on Nursing Depo.
