Case study : 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.
Discussion 1

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 is 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 600 words, formatted and cited in current APA style with support from at least 2 academic sources.

· Each question must be answered individually. Not in an essay format.

· Example: Question 1, followed by the answer to question 1; Question 2, followed by the answer to question 2; etc.

· Grading Rubric

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· Your assignment will be graded according to the grading rubric.

Discussion Rubric

Criteria

Ratings

Points

Identification of Main Issues, Problems, and Concepts

Distinguished – 5 points Identify and demonstrate a sophisticated understanding of the issues, problems, and concepts.

Excellent – 4 points Identifies and demonstrate an accomplished understanding of most of issues, problems, and concepts.

Fair – 2 points Identifies and demonstrate an acceptable understanding of most of issues, problems, and concepts.

Poor – 1 point Identifies and demonstrate an unacceptable understanding of most of issues, problems, and concepts.

5 points

Use of Citations, Writing Mechanics and APA Formatting Guidelines

Distinguished – 3 points 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.

Excellent – 2 points 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.

Fair – 1 point 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.

Poor – 0 points Ineffectively uses the literature and other resources to inform their work. An unacceptable use of citations and extended referencing. APA style and writing mechanics need serious attention.

3 points

Response to Posts of Peers

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

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

Poor – 0 points Student provided no response to a peer’s post.

2 points

Total Points

10