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:

1. Please name the potential most common sites for metastasis on J.C and why?
2. What are tumor cell markers and why tumor cell markers are ordered for a patient with pancreatic cancer?
3. Based on the case study described, proceed to classify the tumor based on the TNM Stage classification. Why this classification important?
4. Discussed characteristic of malignant tumors regarding it cells, growth and ability to spread.
5. Describe the carcinogenesis phase when a tumor metastasizes.
6. Choose the tissue level that is affected on the patient discussed above: Epithelial, Connective, Muscle or Neural. Support your answer.

Submission Instructions:

• Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources. Your initial post is worth 8 points.
• You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. Your reply posts are worth 2 points (1 point per response.) 
• All replies must be constructive and use literature where possible.

Please use this rubric

Discussion Rubric

Discussion Rubric

CriteriaRatingsPts

This criterion is linked to a Learning OutcomeIdentification of Main Issues, Problems, and Concepts

5 to >4.0 ptsDistinguished
Identifies and demonstrates a sophisticated understanding of the issues, problems, and concepts.

4 to >3.0 ptsExcellent
Identifies and demonstrates an accomplished understanding of most issues, problems, and concepts.

3 to >0.0 ptsFair
Identifies and demonstrates an acceptable understanding of most issues, problems, and concepts.

0 ptsPoor
Identifies and demonstrates an unacceptable understanding of most issues, problems, and concepts. Or nothing was posted.

5 pts

This criterion is linked to a Learning OutcomeUse of Citations, Writing Mechanics and APA Formatting Guidelines

3 ptsDistinguished
Effectively uses the literature and other resources to inform their work. Exceptional use of citations and extended referencing. High level of APA precision and free of grammar and spelling errors.

2 ptsExcellent
Effectively uses the literature and other resources to inform their work. Moderate use of citations and extended referencing. Moderate level of APA precision and free of grammar and spelling errors.

1 ptsFair
Ineffectively uses the literature and other resources to inform their work. Moderate use of citations and extended referencing. APA style and writing mechanics need more precision and attention to detail.

0 ptsPoor
Ineffectively uses the literature and other resources to inform their work. Unacceptable use of citations and extended referencing. APA style and writing mechanics need serious attention. Or nothing was posted.

3 pts

This criterion is linked to a Learning OutcomeResponse to Posts of Peers

2 ptsDistinguished
Student constructively responded to two other posts and either extended, expanded or provided a rebuttal to each.

1 ptsFair
Student constructively responded to one other post and either extended, expanded or provided a rebuttal.

0 ptsPoor
Student provided no response to a peer’s post.

2 pts

Total Points: 10