NUR 502 Module 1 Discussion: J.C is an 82-year-old white man

Module 1 Discussion

Discussion 1

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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:

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:

• Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources. Your initial post is worth 8 points.
• You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. Your reply posts are worth 2 points (1 point per response.) Must have intext citation and one reference, and 150 words.
• All replies must be constructive and use literature. MUST be done on a SEPARATE day from the initial post.
• Please post your initial post by 11:59 PM ET Thursday, and comment on the posts of two classmates by 11:59 PM ET Sunday.
• You can expect feedback from the instructor within 48 to 72 hours from the Sunday due date. 

Case Study

Potential most common sites for metastasis

            The case study is of an 82-year-old man with a complaint of abdominal discomfort and a considerable loss of appetite as well as loss of weight, general weakness and frequent nausea. With a diagnosis of ductal adenocarcinoma, a variation of pancreatic cancer, the most common sites when it comes to metastasis would be the lining within the ducts of the pancreas, bones and lungs as well as the liver and lymph nodes (Anderson et al., 2021). These are considered to cover close to 60% of the reported cases of the condition.

What are tumor cell markers

            Tumor cell markers are defined as being anything contained in or produced by cancer cells that can provide a descriptive function about the cancer type. This also extends to things produced by other cells within the body that do this as a general response to the presence of the cancerous cells and does not necessarily just have to be the cancer cells reacting (Sarantis et al., 2020). They are ordered for pancreatic patients because tumor cell markers can provide a lot of information concerning the cancer type. For instance, the tumor marker referred to as CA 19-9 and it helps to describe a pancreatic malignant situation.

TNM Stage classification

            Using the TNM Stage Classification, the patient in the case study has a cancer classification of T4N1M0 which is considered to be Stage III (Sarantis et al., 2020). There are a variety of reasons as to why classification is important. A simple one is that the staging allows the physician to know how aggressive the cancer is and what the suitable treatment module will be to start with. The treatments for cancer are numerous and choosing an appropriate one early on can go a long way to increasing chances of recovery. It also helps determine if the patient needs palliative care if the cancer is too aggressive at this point.

Characteristic of malignant tumors

            Malignant tumors are primarily characterized by having a rapid and uncontrolled growth cycle as well as an increased loss of differentiation, in addition to having poor boundaries as well as the capacity to tear away from the tumor site and move within the body (Anderson et al., 2021). This can be locally or within the blood stream of the patient. Their function becomes altered and they end up invading the surrounding cells as the metastasize and move within the circulatory system meaning if aggressive enough they can extend deep within the body. It can lead to multiple proliferation sites as the cancer spreads throughout.

Carcinogenesis Phase

            In the event a tumor metastasizes, the carcinogenic phase at this point will be found in the third stage. This point is referred to as the progression stage and it will see the tumor invade other cells as it moves away from its original site and then subsequently spreads (Principe et al., 2021). It will have increased resistance to pharmacological interventions and is deemed the last stage. It is irreversible.

Tissue Level

            With regards to the case in question, the tissue level that has been affected would be the epithelial tissue (Principe et al., 2021). The categorization of the tumor under adenocarcinoma is what shows that the epithelium is what is most affected.

References

 Anderson, E. M., Thomassian, S., Gong, J., Hendifar, A., & Osipov, A. (2021). Advances in pancreatic ductal adenocarcinoma treatment. Cancers, 13(21), 5510.

Principe, D. R., Underwood, P. W., Korc, M., Trevino, J. G., Munshi, H. G., & Rana, A. (2021). The current treatment paradigm for pancreatic ductal adenocarcinoma and barriers to therapeutic efficacy. Frontiers in Oncology, 11, 688377.

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.

Grading Rubric 

Your assignment will be graded according to the grading rubric.

Metastatic Sites

Two common sites of metastasis are the liver and peritoneum; due to the proximity of the two organs, cells can migrate to nearby structures/organs. Along with physical proximity, another mode of metastasis is via blood or lymphatic spread. Blood leaves the pancreas and enters the portal vein, which flows directly to the liver, carrying cancer cells. Another common site of metastasis is the lung. Lungs are the next highly vascular tissue the blood passes through after it leaves the liver and cancer cells can become trapped in the vast capillary beds.   

Tumor Markers

Tumor markers are substances that are secreted by cancer cells. Assessing the levels of the markers can aid in determining the disease progression as well as the effectiveness of treatment. There are no tumor markers that are specific for pancreatic cancer only, but some of the markers that are helpful and that are shared with other disease states are CA19-9, Carcinoembryonic Antigen (CEA), CA 125, Human Chorionic Gonadotropin, Neuron-specific Enolase. CA 19-9 is the preferred marker for pancreatic cancer (Luo et al., 2021). 

Tumor Staging

Mr. JC has Pancreatic Adenocarcinoma T2N1M0 (Roalso et al., 2020), T2 for a tumor size less than or equal to 4 cm, N1 for 1 reported lymph node, and M0 for no distant metastasis. The TNM staging is used to stage the patient’s cancer. Staging is a reliable indicator of the patient’s prognosis, i.e., the 5-year survival rate. It is also used to determine the type of treatment the patient will receive and as an indicator to determine the effectiveness of therapy. 

Carcinogenesis and Malignant Tumor Ability to Spread

 Malignant tumors are poorly differentiated cells that no longer resemble the original source cells. They can have mutations in the proto-oncogene; this mutation causes unfettered cell growth (Dlugasch & Story, 2020). They are also insensitive to anti-growth signals from the tumor suppressor genes, which are signals to tell cells to stop growing (Dlugasch & Story, 2020). Cells within the tumor promote the growth of new blood vessels in a process called angiogenesis. The increased blood supply provides more nutrients and oxygen to further promote rapid growth. As the tumor grows, it begins to compromise the organ and can eventually start to invade surrounding tissue. Cells can break off from the tumor and enter the bloodstream or lymphatic system, where it can spread throughout the body.

Tumor Cell Type

The pancreas is a large gland comprising of epithelial cells and non-epithelial cells surrounded by connective tissue. According to Dlugasch and Story (2020), all interior linings (such as ducts) are made up of epithelial tissue. Mr. JC has cancer of the epithelial tissue of the pancreas.

References

Dlugasch, L., & Story, L. (2020). Applied Pathophysiology for the Advanced Practice Nurse. Jones and Bartlett Learning.

Luo, G., Jin, K., Deng, S., Cheng, H., Fan, Z., Gong, Y., Qian, Y., Huang, Q., Ni, Q., Liu, C., & Yu, X. (2021). Roles of ca19-9 in pancreatic cancer: Biomarker, predictor and                         promoter. Biochimica et Biophysica Acta (BBA) – Reviews on Cancer, 1875(2), 188409. https://doi.org/10.1016/j.bbcan.2020.188409

Links to an external site.

Orth, M., Metzger, P., Gerum, S., Mayerle, J., Schneider, G., Belka, C., Schnurr, M., & Lauber, K. (2019). Pancreatic ductal adenocarcinoma: Biological hallmarks, current status,           and future perspectives of combined modality treatment approaches. Radiation Oncology, 14(1). https://doi.org/10.1186/s13014-019-1345-6

Links to an external site.

Roalso, M., Aunan, J., & Soreide, K. (2020). Refined tnm-staging for pancreatic adenocarcinoma – real progress or much ado about nothing? European Journal of Surgical                        Oncology, 46(8), 1554–1557. https://doi.org/10.1016/j.ejso.2020.02.014

Links to an external site.

Ruoslahti, E. (1996). How Cancer Spreads. Scientific American, 275(3), 72–77.