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
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
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