The carcinogenesis phase when a tumor metastasized

  Pathophysiology     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:   One paragraph per question. Total six questions, six paragraphs   1. Describe the potential most common sites for metastasis on J.C and (One paragraph): a. why? 2. Describe the tumor cell markers and (One paragraph): a. Why tumor cell markers are ordered for a patient with pancreatic cancer? 3. Classify the tumor based on the TNM Stage classification based on the case study described, and (One paragraph): a. Why this classification important? 4. Describe characteristics of malignant tumors regarding it (One paragraph): a.Cells b. Growth c. Ability to spread. 5. Describe the carcinogenesis phase when a tumor metastasized (One paragraph) .