Mr. J.C. Case Study



Mr. J.C. Case Study


The anatomy of the human pancreas is made up of soft lobules of glandular tissue mixed with adipose tissue. It lies in the retro-peritoneal area behind the stomach and curves into the duodenum. The normal function of a pancreas is digestion of proteins, carbohydrates, and fats by breakdown from pancreatic enzymes. The pancreas is also responsible for the secretion of insulin and glucagon. (SEER Training Modules, Pancreatic & Biliary Cancer, 2020).

Due to the proximity the pancreas is to the duodenum, distal portion of stomach and distal portion of common bile duct the liver and peritoneum are common sites for metastatic disease. The lungs and distant lymph nodes are not uncommon sites for metastatic disease. (Sohal, Mangu, & Laheru, 2017).  Diagnostic studies are used in the process of establishing a confirmed diagnosis of pancreatic cancer. One diagnostic study frequently utilized on patients highly suspected for malignancy of the pancreas is a tumor marker, Carbohydrate antigen (CA 19-9). This tumor marker, CA19-9 is expressed in pancreatic cancer cells but can also be expressed in gallbladder cancer diagnosis and benign issues such as biliary obstruction and acute pancreatitis. Another tumor marker used in the testing for pancreatic cancer is Carcinoembryonic antigen, (CEA) but does not have the specificity for pancreatic cancer as it does with colon cancer diagnosis. Once a patient receives a positive malignancy diagnosis, tumor markers are used within the course of the patient’s treatment to monitor the patient’s treatment response. (Delugash & Story, 2020).

Due to the positive perilesional lymph node, confirmed by a fine needle aspiration, (FNA) this confirms Mr. J.C has metastatic pancreatic disease. Staging for Mr. J.C. per the Tumor Metastasis Node (TMN) Staging system Mr. J.C. is stage at least T3N1M1. T3 is indicative of primary tumor identified and there is confirmation of infiltration of the peri-pancreatic tissue. N1 is indicative of a positive confirmed regional lymph node. M1 represents distant metastatic disease. Utilizing TNM staging provides uniform representation of patients cancer diagnosis. Staging information in addition to the size of the tumor and its anatomical presence it is then determined if the patient has a resectable tumor or non-resectable tumor. TNM staging is considered in addition to patient comorbidities and current performance status, to determine if surgery is a considerable treatment option. It is difficult to definitively state Mr. J.C.’s staging is Stage IV.  Confirmation that the lymph node was biopsied, or CT and or PET imaging results are needed, to include metastatic lymph node component to his staging. The pancreas is vascular organ, therefore alternative imaging can be questionable.  (Sohal, Mangu, & Laheru, 2017). Assuming the scenario is indicating confirmed evidence of metastatic disease, in the case of Mr. J.C, the patient is considered non-resectable.

Cancer cells are identified with a high-powered microscope utilizing specific stains prepared on slides of tissue obtained during a core tissue biopsy or cytology cells from an FNA biopsy.  Cellular growth and the rapidness of replication of cancer cells are specific to different types of cancer, compared to cancer with smaller growth and slower replicating cancer cells. Mr. J.C. has biopsy proven ductal cell adenocarcinoma. This type of cancer originates in the stroma lining of cells. Adenocarcinoma is an aggressive behaving cancer cell. Ductal adenocarcinoma of the pancreas is typically found to have a mixture of stromal, inflammatory, and extracellular proteins, which is attributed to its aggressive nature. (Delugash & Story, 2020)



Delugash, L., & Story, L. (2020). Applied Pathophysiology for the Advanced Practice Nurse. Burlington, MA: Jones and Bartlett Learning.

SEER Training Modules, Pancreatic & Biliary Cancer. (2020, July 2). Retrieved from U. S. National Institutes of Health, National Cancer Institute:

Sohal, D., Mangu, P. B., & Laheru, D. (2017). Metastatic Pancreatic Cancer: American Society of Clinical Oncology Clinical Practice Guideline Summary. Journal of Oncology Practice, 13(4), 261-264. Retrieved 7 2, 2020, from

TNM staging system. (2020, July 2). Retrieved from National Cancer Institute:


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