Pathophysiology Reply To Peer Discussion

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  • Pancreatic Cancer

With J.C’s diagnostic tests results from endoscopic ultrasound and biopsy, it is likely for metastasis. With different types of pancreatic cancer, distant metastasis will occur more commonly in the liver. Studies have also shown a higher percentage of metastasis in adrenal glands, peritoneum, lungs and pleura, and bones (Yachida & Iacobuzio-Donahue, 2009). Since J.C has abdominal discomfort and nausea, it could be suspected that the abdominal lymph nodes are also involved, this can be caused by hepatofugal portosystemic shunting, which is a result of blood flow being drawn into the systemic circulation (Yachida & Iacobuzio-Donahue, 2009).

Tumor markers are a substance that can be found in blood, urine, or any body tissue. Both, cancer and healthy cells, can produce tumor markers, which can help diagnose different types of cancer. For pancreatic cancer, a blood marker, CA 19-9, is known to be elevated (Yachida & Iacobuzio-Donahue, 2009). Therefore, diagnostic tests to screen for marker levels in the blood can help diagnosis and outline the prognosis of a patient suspected for pancreatic cancer.

The tumor node metastasized (i.e. TNM) system is based on three factors (American Joint Committee on Cancer, 2017). Since J.C has a solid mass in the head of the pancreas at four centimeters, and the perilesional node detected at 1.5 centimeters with metastatic aspect, the tumor can be graded to be stage two B with tumor two, nodes one and metastasized zero. Classification is important because it determines how much cancer is in the body. It helps to identify how to treat it, and what the prognosis is (American Joint Committee on Cancer, 2017).

Malignant tumors have cells that can grow at higher rates than normal cells, also they divide at a faster rate. By doing this, they can migrate to other parts of the body by the circulatory system and invade tissues of the surrounding organs, known as metastasis. The invasiveness of malignant tumors is what makes it easier to differentiate them from benign tumors (Holland et al., 2017).

The carcinogenesis phase has four stages: initiation, promotion, progression, and metastasis (Koorstra et al., 2008). During initiation, changes and mutations spontaneously occur to normal cells leading to carcinogenic agents becoming available in the body. Promotion is where the cancer cells proliferate and grow in numbers. During this time chemotherapy agents can be used to slow the growth rates and decrease tumor size. The third stage of progression is where phenotypic and genotypic changes occur where the tumor cells grow very rapidly by having invasive and metastatic consequences. The last stage is metastasis, in which the cancer cells spread to other parts of the body through the bloodstream or the lymph system (Koorstra et al., 2008).

The tissue level that is affected on J.C. is epithelial tissues since his cancer spread from the glandular secretory cells of the pancreas. The symptoms of abdominal discomfort, loss of appetite, nausea, and weight loss, all correlate with the digestive epithelial cells which release substances such as mucus, digestive juices, and other fluids, which regulate digestion. Also, due to the Wirsung duct being infiltrated by the tumor, the bile acids stored in the liver and gallbladder cannot aid in the process of digestion (Yachida & Iacobuzio-Donahue, 2009).

References

American Joint Committee on Cancer. (2017). Exocrine pancreas. In AJCC cancer staging manual (8th ed., p. 337). Springer.

Holland, J. F., Hong, W. K., Kufe, D. W., Bast, R. C., Hait, W. N., Pollock, R. E., & Weichselbaum, R. R. (2017). Cardinal manifestations of cancer. Holland-Frei Cancer Medicine, 1-3. https://doi.org/10.1002/9781119000822.hfcm001 (Links to an external site.)

Koorstra, J. M., Hustinx, S. R., Offerhaus, G. J., & Maitra, A. (2008). Pancreatic carcinogenesis. Pancreatology, 8(2), 110-125. https://doi.org/10.1159/000123838 (Links to an external site.)

Yachida, S., & Iacobuzio-Donahue, C. A. (2009). The pathology and genetics of metastatic pancreatic cancer. Archives of Pathology & Laboratory Medicine, 133(3), 413-422. https://www.archivesofpathology.org/doi/full/10.1043/1543-2165-133.3.413 (Links to an external site.)

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