Description
Discussion #1 Abigyale
reply to this with at least 250 words and min two scholarly references:
J.C. has a ductal adenocarcinoma, and therefore the most common potential sites for metastasis on J.C. are the liver, portal vein, lymph nodes, Pancreatic cancers often spread to the liver and other areas in the stomach. It can also spread to the lungs and peritoneum in some cases. The location of the tumor plays an essential role in the ability of the tumor to metastasize. This patients’ health status, such as older age, presence of diabetes, hypertension, and atrial fibrillation does not aide in the suppression of the cancer due to having multiple host factors.
Tumor cell markers refer to materials that are secreted by the cancer cells for particular types of cancers. Tumor cell markers are pertinent information in helping identify cancer and also aide in tracking the progression of the disease. Tumor cell markers are ordered for a patient with cancer to also help in monitoring treatment response where applicable, and can reveal if the disease is getting better or worse. Tumor markers do not help with early detection of pancreatic cancer but would be ordered for J.C. to see disease progression.
Based on the case study presented, this patients’ tumor would be classified as T1 N1 M1 regarding TNM stage classification. This classification is important because it identifies the size of the size/extent of the tumor, the location and number of lymph node or nodes that contain cancer, and that the cancer has metastasized. In patients that have pancreatic cancer, like J.C., metastasis into the lymph nodes is common. Spread of the cancer to lymph nodes for patients with pancreatic cancer has been linked to a poor prognosis (Fink et al., 2016).
When a tumor metastasizes, it is in the final phase of carcinogenesis, which is progression. The progression phase of carcinogenesis is permanent and irreversible; therefore, it is much better to catch cancer in the initiation or promotion phase of carcinogenesis. J.C. does not have a great prognosis due to the fact that the cancer has already began to metastasize and is therefore irreversible and also his presence of comorbidities. The average five-year survival rate for pancreatic ductal adenocarcinoma is less than 10 percent (Sarantis et al., 2020). Based on the data provided in the case study, the tissue level that is affected on JC is the connective tissue. Research studies have shown that connective tissue growth factor expression is typically elevated in pancreatic adenocarcinomas (Nadjia et al., 2006). J.C. has spread to lymph nodes and lymph nodes are surrounded by connective tissue.
References
Fink, D. M., Steele, M. M., & Hollingsworth, M. A. (2016). The lymphatic system and pancreatic cancer. Cancer Letters, 381(1), 217–236. https://doi.org/10.1016/j.canlet.2015.11.048Links to an external site.
Nadja Dornhöfer, Spong, S. M., Bennewith, K. L., Salim, A., Klaus, S. J., Neeraja Kambham, Wong, C. A., Kaper, F., Sutphin, P. D., Rendall Nacalumi, Höckel, M., Le, Q.-T., Longaker, M. T., Yang, G. P., Koong, A. C., & Giaccia, A. J. (2006). Connective Tissue Growth Factor–Specific Monoclonal Antibody Therapy Inhibits Pancreatic Tumor Growth and Metastasis. Stanford University School of Medicine, 66(11), 5816–5827. https://doi.org/10.1158/0008-5472.can-06-0081
Sarantis, P., Koustas, E., Papadimitropoulou, A., Papavassiliou, A. G., & Karamouzis, M. V. (2020). Pancreatic ductal adenocarcinoma: Treatment hurdles, tumor microenvironment and immunotherapy. World Journal of Gastrointestinal Oncology, 12(2), 173–181. https://doi.org/10.4251/wjgo.v12.i2.173
Discussion #2 Jennifer
reply to this with at least 250 words and min two scholarly references: Case Study
Pancreatic tumors, particularly pancreatic ductal adenocarcinoma (PDAC), most commonly metastasize to the liver. This pattern of metastasis is observed in a significant number of pancreatic cancer cases, and several factors contribute to the preference for liver metastasis: The liver receives blood directly from the pancreas through the portal vein, making it a convenient site for cancer cells to travel. The portal vein carries blood rich in nutrients and potentially cancer cells from the digestive organs, including the pancreas, to the liver. The liver has a rich blood supply which allows the growth factors and nutrients needed for cancer cells to survive to flow more freely through the blood stream. Certain functions of the liver allow cancer cells to evade the immune system which otherwise might help to destroy cancer cells.
Tumor markers are substances secreted by the cancer cells and can aid in cancer detection as well as tracking disease progression and treatment response. The more common tumor markers associated with ductal adenocarcinoma, include but are not limited to carbohydrate antigen 19 19 (CA 19-9) and carcinoembryonic antigen (CFA) (Isaji et al., 2018).
Carcinogenesis, the process of metastasis involves a series of steps, including invasion into surrounding tissues, intravasation into blood vessels, circulation through the bloodstream, extravasation at a distant site, and colonization to form secondary tumors (Dlugasch & Story, 2019, p. 356). The liver appears to be a favorable environment for pancreatic cancer cells to undergo these metastatic steps successfully.
The TNM staging system, which stands for tumor, node, metastasize, evaluates the tumor size, nodal involvement, and metastatic progress (Morana, 2010). The diagnostic test revealed the tumor is 4 cm, is infiltrating the Wirsung duct as well as the superior mesenteric vein and there is nodal involvement. The tumor described in this case study is T4, Any N, M0. The cancer is growing outside the pancreas and into nearby major blood vessels (T4). The cancer may or may not have spread to nearby lymph nodes (Any N). It has not spread to distant sites (M0).
The pancreas is a gland and is therefore made up of glandular epithelial cells. These cells produce and secrete hormones and digestive enzymes. The pancreas is considered a special gland because it contains both an exocrine portion, responsible for the secretion of digestive enzymes, as well as an endocrine portion, responsible for the secretion of several hormones, including insulin and glucagon (Dlugasch & Story, 2019, p. 400).
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Dlugasch, L., & Story, L. (2019). Applied pathophysiology for the advanced practice nurse (1st ed.). Jones & Bartlett Learning.
Isaji, S., Mizuno, S., Windsor, J. A., Bassi, C., Fernández-del Castillo, C., Hackert, T., Hayasaki, A., Katz, M. H., Kim, S.-W., Kishiwada, M., Kitagawa, H., Michalski, C. W., & Wolfgang, C. L. (2018). International consensus on definition and criteria of borderline resectable pancreatic ductal adenocarcinoma 2017. Pancreatology, 18(1), 2–11. Retrieved January 11, 2024, from https://doi.org/10.1016/j.pan.2017.11.011Links to an external site.
Meng, Q., Shi, S., Liang, C., Liang, D., Xu, W., Ji, S., Zhang, B., Ni, Q., Xu, J., & Yu, X. (2017). Diagnostic and prognostic value of carcinoembryonic antigen in pancreatic cancer: A systematic review and meta-analysis. OncoTargets and Therapy, Volume 10, 4591–4598. Retrieved January 11, 2024, from https://doi.org/10.2147/ott.s145708Links to an external site.
Morana, G. (2010). Staging cancer of the pancreas. National Library of Medicine. Retrieved January 11, 2024, from https://doi.org/10.1102/1470-7330.2010.9028Links to an external site.
Pancreatic cancer – pancreatic cancer. (n.d.). Johns Hopkins Medicine Pathology. Retrieved January 11, 2024, from https://pathology.jhu.edu/pancreas/Links to an external site.
van Overbeeke, J. J. (2000). Connections of sympathetic fibers inside the cavernous sinus: A microanatomical study. National Library of Medicine. Retrieved January 11, 2024, from https://doi.org/10.1016/s0303-8467(00)00104-9Links to an external site.
