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Most Common Sites of Metastasis
J.C. is diagnosed with pancreatic ductal adenocarcinoma (PDAC) which may affect other organs of his body such as the liver as the most common site (40%-50%) (Jin T. et al., 2020) lungs, bones, adrenal glands, stomach, duodenum, transverse colon, left kidney and peritoneum when metastasized (Tao, Y. et al, 2022).
Tumor Cell Markers
Blood tests may be done as a screening or diagnostic of cancer. It includes tumor cell markers which not only help in the detection of cancer but assist in tracking disease progression and treatment response as well. The following are the common tumor markers that J.C’s provider may order to specifically rule out pancreatic cancer: carcinoembryonic antigen, CA 19-9, CA 27-29, CA 125, Human Chorionic Gonadotropin (HCG), and neuron-specific enolase (Dlugash, L. & Story, L., 2020).
TNM Stage Classification
The TNM staging system evaluates the tumor size, nodal involvement, and metastatic progress. It also predicts the prognosis and guides the treatment evaluation. Based on the 8th Edition of the AJCC Cancer Staging Manual: Pancreas and Hepatobiliary Cancers (Chun Y.S. et al., 2018), J.C.’s condition falls under the classification of T4, N1, M1 staging.
Tissue Level Affected
Epithelial tissue lines the exterior and interior organs of the body which helps in protection, absorption, secretion, and excretion processes. It has three types based on shape – squamous, cuboidal, and columnar (Dlugash, L. & Story, L., 2020). The histology of the pancreas shows simple and stratified cuboidal epithelium (Sorenson R. & Clark Brelje, T., 2014) thus, epithelial tissue is the affected tissue level in J.C’s situation.
Characteristics of Malignant Tumors
Malignant tumors have undifferentiated cells that grow uncontrollably and rapidly penetrating surrounding tissue and secondary sites. They spread to distant sites via the bloodstream or the lymphatic system. This spread is called metastasis. Metastasis can occur anywhere in the body and is generally named according to the organ, tissue, or cell origin. The development, invasion, and metastasis of malignant neoplasms are caused by various factors like genetic, epigenetic, and microenvironmental influences (Dlugash, L. & Story, L., 2020).
Process of Carcinogenesis
The process by which cancer develops is called carcinogenesis. It can be described as occurring in three stages which are initiation, promotion, and progression. The first stage, initiation, happens when a normal cell is exposed to carcinogens, substances or events that may damage or alter the DNA structure, causing DNA mutation. Subsequently, promotion takes place when the mutated DNA is affected by factors that promote growth, for example, hormones, nicotine, or nitrates. This stage may take right after the initiation or several years after. Lastly, the progression stage is permanent and irreversible as the tumor now invades, metastasized, and does not respond to drugs. Additionally, the extent of progression depends on the ability of the tumor to survive in the new site requiring adequate blood supply (Dlugash, L. & Story, L., 2020).
With that said, malignant tumors can multiply aggressively and require early screening and treatment to have a better prognosis. If they are caught early, treatment options are likely to be a combination of surgery, chemotherapy, radiotherapy, hormone therapy, immunotherapy, stem cell transplants, laser therapy, hyperthermia, or photodynamic therapy. The goal of treatment may be either curative, palliative, or prophylactic (Dlugash, L. & Story, L., 2020).
