Cancer cell metastasis involves a process of cells in a primary location undergo

Question

Cancer cell metastasis involves a process of cells in a primary location undergoing epithelial to mesenchymal transition (EMT), traveling through the blood stream to a secondary location, and undergoing mesenchymal to epithelial transition (MET) in order to colonize in the new location. Two samples have been obtained from a cancer patient. One from the suspected primary tumor site in the pancreas and one from a suspected secondary metastatic site in the liver. As a pathologist, what can you do to verify that primary tumor site was indeed the pancreas and not in the liver? Further, what other cytoskeletal markers would you expect these two samples to have in common? How would these samples differ in expression from circulating tumor cells in the bloodstream?

Explanation / Answer

The metastatic cancer cells are proved to be lethal. EMT is a conserved cellular program that alter the adhesion, shape, and movement of the cell. EMT is the process that allow the intravasation of tumor cells into the surrounding blood vessels and new organs. The process of metastasis need MET essentially as it is important for the colonization. Transformed epithelial cells secrete several autocrine growth factors like HGF, TGF-beta, and EGF.

The verification of primary tumor site can be done by several markers. If the tumor is of pancreatic origin than it must contain the specific markers like CA19-9. Also as the cells undergo EMT so, they will contain the several other markers like integrin beta 4 and desmoplakin etc on their surface. These markers are visible only after EMT. So, if the tumors primary origin is pancreas than it will not be having the EMT marker when the sample will be taken from the pancreas.

There are several tumor markers that will be found common in both the samples. The common cytoskeleton markers are EpCAM, CK8, 18 and 19.

There are certain markers that down regulate after EMT. Circulating tumor cells are frequently subjected to EMT. So, these cells will be differ in the several tumor markers like CK markers and EpCAM.

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