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Malignant tumors exhibit uncontrolled proliferation, dividing rapidly and without the usual regulatory mechanisms that govern cell growth and division. These cells vary in size and shape, with irregular nuclei and abnormal cellular architecture due to the disproportionately large nucleus compared to the amount of cytoplasm. Malignant tumors have the ability to invade surrounding tissues and structures, infiltrating nearby blood vessels and lymphatic channels. This growth is facilitated by various mechanism such as Matrix Metalloproteinases (MMPs) and Plasminogen Activators (PA) System. Metastasis is the most defining characteristic of malignant tumors is their ability to spread to distant sites in the body. Malignant cells can detach from the primary tumor, enter the bloodstream or lymphatic system, and establish secondary tumors (metastases) in distant organs. This process involves cell migration, invasion, survival in the circulation, and colonization of distant sites.
Carcinogenesis is the process of cancer development and in involves several distinct phases. It begins with initiation phase, during which normal cells undergo genetic or epigenetic alterations that confer them with the potential to become cancerous. Following initiation, the initiate cells are exposed to promoting factors that drive their clonal expansion and further malignant transformation. Promotion leads to the expansion of initiated cell populations and the formation of preneoplastic lesions. These preneoplastic lesions goes to the next phase, the progression phase. They acquire additional genetic or epigenetic alterations that confer them with invasive and metastatic properties. Malignant cells within the primary tumor acquire the ability to invade surrounding tissues and penetrate through the basement membrane. This invasive behavior is facilitated by alterations in cell adhesion molecules, degrading enzymes (such as MMPs). Once they go past basement membrane and invade surrounding tissues, they may enter nearby blood vessels or lymphatic channels through a process known as intravasation. Intravasated tumor cells gain access to the circulation and are transported to distant sites in the body, where they can extravasate into the surrounding tissue and establish metastatic colonies. Upon reaching a distant organ, extravasated tumor cells must adhere to the endothelial lining of blood vessels and invade the surrounding tissue to establish metastatic colonies through a process known as extravasation and colonization.
The tissue level primarily affected is epithelial tissue. In the case of pancreatic ductal adenocarcinoma, the primary tumor arises from the epithelial cells lining the ducts of the pancreas. The diagnostic test, an Endoscopic Ultrasound of the Pancreas, revealed a solid mass in the head of the pancreas, infiltrating the Wirsung duct. Additionally, the fine needle aspiration (FNA) biopsy confirmed ductal adenocarcinoma, indicating that the malignant cells originate from the epithelial lining of the pancreatic ducts.

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Based on the case study described, proceed to classify the tumor based on the TNM Stage classification. Why is this classification important?
The TNM Stage classification system is used to determine the extent of cancer based on the size of the tumor, the involvement of adjacent lymph nodes, and the metastatic process. The classification of a tumor is essential in delivering patient care. These tumor characteristics have a major impact on prognosis and therapeutic options. Based on the case study, J.C’s TNM Stage classification would be T (tumor) 4, N (lymph node involvement) 1, and M (metastasis) 1. This classification will indicate the extent of the disease’s manifestation as T4N1M1 or stage III (Rosen & Sapra, 2023).
Discussed characteristic of malignant tumors regarding it cells, growth and ability to spread.
Malignant tumors are different from normal cells in size, shape, number, differentiation, purpose, and function (Dlugasch & Story, 2021). Malignant tumors vary in size and shape. They reproduce and invade at a fast speed. Examples of malignant tumors include sarcoma, carcinoma, and leukemia.
Describe the carcinogenesis phase when a tumor metastasizes.
The third carcinogenesis phase is called progression. In the progression phase of carcinogenesis, a tumor increases in size, mutates, multiples, and invades. For the tumor to progress to the final stage it must enter, navigate, and survive the bloodstream or the lymphatic system (Dlugasch & Story, 2021).




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