Pancreatic cancer classification: Difference between revisions

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==Overview==
==Overview==


 
[[Pancreatic cancer|Pancreatic cancers]] can be classified based on the production of [[Hormone|hormones]] into [[Exocrine gland|exocrine]] and [[Endocrine system|endocrine]] [[Cancer|cancers]]. [[Pancreas|Pancreatic]] [[Exocrine gland|exocrine]] [[Tumor|tumors]] include different types such as [[Adenocarcinoma]], [[Acinic cell carcinoma|acinar cell carcinoma]], [[Adenosquamous carcinoma|adenosquamous]] [[carcinoma]] and [[Pancreatoblastoma|pancreatoblastomas]]. [[Pancreas|Pancreatic]] [[endocrine tumors]] include [[Insulinoma|insulinomas]], [[Glucagonoma|glucagonomas]], [[VIPoma|VIPomas]], [[Neuroendocrine tumors|somatostatinomas]] and Ppomas.
==Classification==
==Classification==


<br />
[[Pancreatic cancer|Pancreatic cancers]] can be classified based on the production of [[Hormone|hormones]] into [[Exocrine gland|exocrine]] and [[Endocrine system|endocrine]] [[Cancer|cancers]]:<br />
*'''Types of Pancreatic Cancers:'''<ref name="pmid22592847">{{cite journal| author=Bond-Smith G, Banga N, Hammond TM, Imber CJ| title=Pancreatic adenocarcinoma. | journal=BMJ | year= 2012 | volume= 344 | issue=  | pages= e2476 | pmid=22592847 | doi=10.1136/bmj.e2476 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22592847  }} </ref>
*'''Types of Pancreatic Cancers:'''<ref name="pmid22592847">{{cite journal| author=Bond-Smith G, Banga N, Hammond TM, Imber CJ| title=Pancreatic adenocarcinoma. | journal=BMJ | year= 2012 | volume= 344 | issue=  | pages= e2476 | pmid=22592847 | doi=10.1136/bmj.e2476 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22592847  }} </ref>


{|
{|
! colspan="1" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" + | '''Types of Pancreatic Cancers'''
! colspan="2" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" + | '''Types of Pancreatic Cancers'''
|+  
|+  
| colspan="1" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" + |'''Pancreatic Exocrine Cancers'''
| colspan="1" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" + |'''Pancreatic Exocrine Cancers'''
| colspan="1" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" + |'''Pancreatic Endocrine Cancers (Pancreatic Neuroendocrine Tumours)'''
|-
|-
| style="background:#F5F5F5; + " |  
| style="background:#F5F5F5; + " |  
*Adenocarcinoma
*[[Adenocarcinoma]]
| style="background:#F5F5F5; + " |
*[[Gastrinoma (patient information)|Gastrinoma]]
|-
|-
| style="background:#F5F5F5; + " |  
| style="background:#F5F5F5; + " |  
*Acinar cell carcinoma
*[[Acinic cell carcinoma|Acinar cell carcinoma]]
| style="background:#F5F5F5; + " |
*[[Glucagonoma]]
|-
|-
| style="background:#F5F5F5; + " |  
| style="background:#F5F5F5; + " |  
*Adenosquamous carcinoma
*[[Adenosquamous carcinoma]]
| style="background:#F5F5F5; + " |
*[[Insulinoma]]
|-
|-
| style="background:#F5F5F5; + " |  
| style="background:#F5F5F5; + " |  
*Giant cell tumour
*Giant cell tumor
| style="background:#F5F5F5; + " |
*Nonfunctional islet cell tumor
|-
|-
| style="background:#F5F5F5; + " |  
| style="background:#F5F5F5; + " |  
*Intraductal papillary mucinous neoplasm (IPMN)
*[[Intraductal papillary mucinous neoplasm]] (IPMN)
| style="background:#F5F5F5; + " |
*[[Neuroendocrine tumors|Somatostatinoma]]
|-
|-
| style="background:#F5F5F5; + " |  
| style="background:#F5F5F5; + " |  
*Mucinous cystadenocarcinoma
*[[Mucinous cystadenocarcinoma]]
| style="background:#F5F5F5; + " |
*[[VIPoma|Vasoactive intestinal peptide releasing tumor (VIPoma)]]
|-
|-
| style="background:#F5F5F5; + " |  
| style="background:#F5F5F5; + " |  
*Pancreatoblastoma
*[[Pancreatoblastoma]]
| style="background:#F5F5F5; + " |
|-
|-
| style="background:#F5F5F5; + " |  
| style="background:#F5F5F5; + " |  
*Serous cystadenocarcinoma
*Serous [[cystadenocarcinoma]]
| style="background:#F5F5F5; + " |
|-
|-
| style="background:#F5F5F5; + " |  
| style="background:#F5F5F5; + " |  
*Solid and pseudopapillary tumours
*Solid and pseudopapillary tumours
| style="background:#F5F5F5; + " |
|-
|-
|+
|+
| colspan="1" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" + | '''Pancreatic Endocrine Cancers (Pancreatic Neuroendocrine Tumours)'''
 
|+
|+
|-
| style="background:#F5F5F5; + " |
*Gastrinoma
|-
| style="background:#F5F5F5; + " |
*Glucagonoma
|-
| style="background:#F5F5F5; + " |
*Insulinoma
|-
| style="background:#F5F5F5; + " |
*Nonfunctional islet cell tumour
|-
| style="background:#F5F5F5; + " |
*Somatostatinoma
|-
| style="background:#F5F5F5; + " |
*Vasoactive intestinal peptide releasing tumour (VIPoma)
|-
|-
|}
|}
Line 75: Line 73:
|-
|-
| style="background:#F5F5F5; + " |  
| style="background:#F5F5F5; + " |  
*Minimal degree of atypia
*Minimal degree of [[atypia]]
|-
|-
| style="background:#F5F5F5; + " |  
| style="background:#F5F5F5; + " |  
*Subclassified into PanIN 1A: absence of micropapillary infoldings of the epithelium; and 1B, presence of micropapillary infoldings of the epithelium
*Subclassified into PanIN 1A: absence of micropapillary infoldings of the [[epithelium]]; and 1B, presence of micropapillary infoldings of the [[epithelium]]
|-
|-
|+
|+
Line 85: Line 83:
|-
|-
| style="background:#F5F5F5; + " |  
| style="background:#F5F5F5; + " |  
*Moderate degree of atypia, including loss of polarity, nuclear crowding, enlarged nuclei, pseudostratification, and hyperchromatism
*Moderate degree of [[atypia]], including loss of [[Chemical polarity|polarity]], nuclear crowding, enlarged [[Cell nucleus|nuclei]], pseudostratification, and hyperchromatism
|-
|-
| style="background:#F5F5F5; + " |  
| style="background:#F5F5F5; + " |  
*Mitoses are rarely seen
*[[Mitosis]] is rarely seen
|-
|-
|+
|+
Line 95: Line 93:
|-
|-
| style="background:#F5F5F5; + " |  
| style="background:#F5F5F5; + " |  
*Severe atypia, with varying degrees of cribriforming, luminal necrosis, and atypical mitoses
*Severe [[atypia]], with varying degrees of [[Cribriform|cribriforming]], [[Lumen|luminal]] [[necrosis]], and atypical [[mitosis]]
|-
|-
| style="background:#F5F5F5; + " |  
| style="background:#F5F5F5; + " |  
*Contained within the basement membrane
*Contained within the [[basement membrane]]
|-
|}
 
<br/>
*'''TNM classification for pancreatic cancer:'''<ref name="pmid22592847">{{cite journal| author=Bond-Smith G, Banga N, Hammond TM, Imber CJ| title=Pancreatic adenocarcinoma. | journal=BMJ | year= 2012 | volume= 344 | issue=  | pages= e2476 | pmid=22592847 | doi=10.1136/bmj.e2476 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22592847  }} </ref> <ref name="pmid22997452">{{cite journal| author=Seufferlein T, Bachet JB, Van Cutsem E, Rougier P, ESMO Guidelines Working Group| title=Pancreatic adenocarcinoma: ESMO-ESDO Clinical Practice Guidelines for diagnosis, treatment and follow-up. | journal=Ann Oncol | year= 2012 | volume= 23 Suppl 7 | issue=  | pages= vii33-40 | pmid=22997452 | doi=10.1093/annonc/mds224 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22997452  }} </ref>
 
{|
! rowspan="1" colspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" + | '''TNM Classification for Pancreatic Cancer:'''
|+
| rowspan="1" colspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" + |'''Primary tumor'''
|+
| rowspan="1" colspan="2" style="background:#4479BA; color: #FFFFFF;" + |
| rowspan="1" colspan="2" style="background:#4479BA; color: #FFFFFF;" + |
|-
| style="background:#DCDCDC; + | TX
| style="background:#F5F5F5; + | Primary tumor cannot be assessed
|-
| style="background:#DCDCDC; + | T0
| style="background:#F5F5F5; + | No evidence of primary tumor
|-
| style="background:#DCDCDC; + | Tis
| style="background:#F5F5F5; + | Carcinoma ''in situ''
|-
| style="background:#DCDCDC; + | T1
| style="background:#F5F5F5; + | Tumor limited to the pancreas, ≤2 cm in greatest dimension
|-
| style="background:#DCDCDC; + | T2
| style="background:#F5F5F5; + | Tumor limited to the pancreas, >2 cm in greatest dimension
|-
| style="background:#DCDCDC; + | T3
| style="background:#F5F5F5; + | Tumor extends beyond the pancreas but without involvement of the celiac axis or the superior mesenteric artery
|-
| style="background:#DCDCDC; + | T4
| style="background:#F5F5F5; + | Tumor involves the celiac axis or the superior mesenteric artery (unresectable primary tumor)
|+
| rowspan="1" colspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" + |'''Regional lymph nodes'''
|+
| rowspan="1" colspan="2" style="background:#4479BA; color: #FFFFFF;" + |
| rowspan="1" colspan="2" style="background:#4479BA; color: #FFFFFF;" + |
|-
| style="background:#DCDCDC; + | NX
| style="background:#F5F5F5; + | Regional lymph nodes cannot be assessed
|-
| style="background:#DCDCDC; + | N0
| style="background:#F5F5F5; + | No regional lymph node metastasis
|-
| style="background:#DCDCDC; + | N1
| style="background:#F5F5F5; + | Regional lymph node metastasis
|+
| rowspan="1" colspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" + |'''Distant metastases'''
|+
| rowspan="1" colspan="2" style="background:#4479BA; color: #FFFFFF;" + |
| rowspan="1" colspan="2" style="background:#4479BA; color: #FFFFFF;" + |
|-
| style="background:#DCDCDC; + | MX
| style="background:#F5F5F5; + | Distant metastasis cannot be assessed
|-
| style="background:#DCDCDC; + | M0
| style="background:#F5F5F5; + | No distant metastasis
|-
| style="background:#DCDCDC; + | M1
| style="background:#F5F5F5; + | Distant metastasis
|-
|-
|}
|}
Line 179: Line 115:
*Head, body, tail (evenly distributed)
*Head, body, tail (evenly distributed)
| style="background:#F5F5F5; + " |  
| style="background:#F5F5F5; + " |  
*Hypoglycemia, dizziness, sweating, tachycardia, tremulousness, confusion, seizure
*[[Hypoglycemia]], [[dizziness]], [[Perspiration|sweating]], [[tachycardia]], tremulousness, [[confusion]], [[seizure]]
| style="background:#F5F5F5; + " |  
| style="background:#F5F5F5; + " |  
*CgA and CgB, insulin inappropriate for blood glucose level, proinsulin, C-peptide
*CgA and CgB, [[insulin]] inappropriate for [[Blood sugar|blood glucose]] level, [[proinsulin]], [[C-peptide]]
|-
|-
| style="background:#DCDCDC; + " | '''Gastrinoma (Zollinger–Ellison)'''
| style="background:#DCDCDC; + " | '''Gastrinoma (Zollinger–Ellison)'''
| style="background:#F5F5F5; + " |  
| style="background:#F5F5F5; + " |  
*Gastrinoma triangle Often extrapancreatic (duodenal); can be found anywhere in gland
*[[Gastrinoma (patient information)|Gastrinoma]] triangle
*Often extrapancreatic ([[Duodenum|duodenal]]); can be found anywhere in [[gland]]
| style="background:#F5F5F5; + " |  
| style="background:#F5F5F5; + " |  
*Gastric acid hypersecretion, peptic ulcer, diarrhea, esophagitis, epigastric pain
*[[Gastric acid]] hypersecretion, [[peptic ulcer]], [[diarrhea]], [[esophagitis]], [[epigastric]] [[pain]]
| style="background:#F5F5F5; + " |  
| style="background:#F5F5F5; + " |  
*CgA, gastrin, PP (35%)
*CgA, [[gastrin]], PP (35%)
|-
|-
| style="background:#DCDCDC; + " | '''VIPoma (Verner– Morrison syndrome, WDHA)'''
| style="background:#DCDCDC; + " | '''VIPoma (Verner– Morrison syndrome, WDHA)'''
| style="background:#F5F5F5; + " |  
| style="background:#F5F5F5; + " |  
*Distal pancreas (body and tail) Often spread outside pancreas
*Distal [[pancreas]] (body and tail)  
*Often spread outside [[pancreas]]
| style="background:#F5F5F5; + " |  
| style="background:#F5F5F5; + " |  
*Watery diarrhea, hypokalemia, achlorhydria (or acidosis)
*[[Diarrhea|Watery diarrhea]], [[hypokalemia]], [[achlorhydria]] (or acidosis)
| style="background:#F5F5F5; + " |  
| style="background:#F5F5F5; + " |  
*CgA, VIP
*CgA, [[Vasoactive intestinal peptide|VIP]]
|-
|-
| style="background:#DCDCDC; + " | '''Glucagonoma'''
| style="background:#DCDCDC; + " | '''Glucagonoma'''
| style="background:#F5F5F5; + " |  
| style="background:#F5F5F5; + " |  
*Body and tail of pancreas Often large and spread outside pancreas
*Body and tail of [[pancreas]]
*Often large and spread outside [[pancreas]]
| style="background:#F5F5F5; + " |  
| style="background:#F5F5F5; + " |  
*Diabetes (hyperglycemia), necrolytic migratory erythema, stomatitis, glossitis, angular cheilitis
*[[Diabetes]] ([[hyperglycemia]]), [[necrolytic migratory erythema]], [[stomatitis]], [[glossitis]], [[angular cheilitis]]
| style="background:#F5F5F5; + " |  
| style="background:#F5F5F5; + " |  
*CgA, glucagon, glycentin
*CgA, [[glucagon]], glycentin
|-
|-
| style="background:#DCDCDC; + " | '''Somatostatinoma'''
| style="background:#DCDCDC; + " | '''Somatostatinoma'''
| style="background:#F5F5F5; + " |
*Pancreatoduodenal groove, [[Ampulla of Vater|ampullary]], periampullary
| style="background:#F5F5F5; + " |  
| style="background:#F5F5F5; + " |  
*Pancreatoduodenal groove, ampullary, periampullary
*[[Gallstone disease|Gallstones]], [[diabetes]] (hyperglycemia), [[steatorrhea]]
| style="background:#F5F5F5; + " |  
| style="background:#F5F5F5; + " |  
*Gallstones, diabetes (hyperglycemia), steatorrhea
*CgA, [[somatostatin]]
| style="background:#F5F5F5; + " |
*CgA, somatostatin
|-
|-
| style="background:#DCDCDC; + " | '''Ppoma'''
| style="background:#DCDCDC; + " | '''Ppoma'''
| style="background:#F5F5F5; + " |  
| style="background:#F5F5F5; + " |  
*Head of pancreas
*Head of [[pancreas]]
| style="background:#F5F5F5; + " |  
| style="background:#F5F5F5; + " |  
*None
*None
| style="background:#F5F5F5; + " |  
| style="background:#F5F5F5; + " |  
*CgA, PP
*CgA, PP
|-
|}
<nowiki>**</nowiki>Key
CgA- Chromogranin A
CgB- Chromogranin B
PP- Pancreatic polypeptide
*'''TNM classification for pancreatic cancer:'''<ref name="pmid22592847">{{cite journal| author=Bond-Smith G, Banga N, Hammond TM, Imber CJ| title=Pancreatic adenocarcinoma. | journal=BMJ | year= 2012 | volume= 344 | issue=  | pages= e2476 | pmid=22592847 | doi=10.1136/bmj.e2476 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22592847  }} </ref> <ref name="pmid22997452">{{cite journal| author=Seufferlein T, Bachet JB, Van Cutsem E, Rougier P, ESMO Guidelines Working Group| title=Pancreatic adenocarcinoma: ESMO-ESDO Clinical Practice Guidelines for diagnosis, treatment and follow-up. | journal=Ann Oncol | year= 2012 | volume= 23 Suppl 7 | issue=  | pages= vii33-40 | pmid=22997452 | doi=10.1093/annonc/mds224 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22997452  }} </ref>
{|
! colspan="2" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" + | '''TNM Classification for Pancreatic Cancer:'''
|+
| colspan="2" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" + |'''Primary tumor'''
|+
|-
| style="background:#DCDCDC; + " | TX
| style="background:#F5F5F5; + " | Primary [[tumor]] cannot be assessed
|-
| style="background:#DCDCDC; + " | T0
| style="background:#F5F5F5; + " | No evidence of primary [[tumor]]
|-
| style="background:#DCDCDC; + " | Tis
| style="background:#F5F5F5; + " | [[Carcinoma]] ''in situ''
|-
| style="background:#DCDCDC; + " | T1
| style="background:#F5F5F5; + " | [[Tumor]] limited to the [[pancreas]], ≤2 cm in greatest dimension
|-
| style="background:#DCDCDC; + " | T2
| style="background:#F5F5F5; + " | [[Tumor]] limited to the [[pancreas]], >2 cm in greatest dimension
|-
| style="background:#DCDCDC; + " | T3
| style="background:#F5F5F5; + " | [[Tumor]] extends beyond the [[pancreas]] but without involvement of the [[Celiac artery|celiac]] axis or the [[superior mesenteric artery]]
|-
| style="background:#DCDCDC; + " | T4
| style="background:#F5F5F5; + " | Tumor involves the [[Celiac artery|celiac]] axis or the [[superior mesenteric artery]] (unresectable primary [[tumor]])
|+
| colspan="2" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" + |'''Regional lymph nodes'''
|+
|-
| style="background:#DCDCDC; + " | NX
| style="background:#F5F5F5; + " | Regional [[Lymph node|lymph nodes]] cannot be assessed
|-
| style="background:#DCDCDC; + " | N0
| style="background:#F5F5F5; + " | No regional [[lymph node]] metastasis
|-
| style="background:#DCDCDC; + " | N1
| style="background:#F5F5F5; + " | Regional [[lymph node]] metastasis
|+
| colspan="2" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" + |'''Distant metastases'''
|+
|-
| style="background:#DCDCDC; + " | MX
| style="background:#F5F5F5; + " | Distant [[metastasis]] cannot be assessed
|-
| style="background:#DCDCDC; + " | M0
| style="background:#F5F5F5; + " | No distant [[metastasis]]
|-
| style="background:#DCDCDC; + " | M1
| style="background:#F5F5F5; + " | Distant [[metastasis]]
|-
|-
|}
|}


==Refrences==
==Refrences==
{{Reflist|2}}


{{Reflist|2}}
{{WH}}
{{WS}}
[[Category:Gastroenterology]]
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Surgery]]
[[Category:Gastroenterology]]
[[Category:Gastroenterology]]

Latest revision as of 15:02, 27 November 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aravind Reddy Kothagadi M.B.B.S[2]

Overview

Pancreatic cancers can be classified based on the production of hormones into exocrine and endocrine cancers. Pancreatic exocrine tumors include different types such as Adenocarcinoma, acinar cell carcinoma, adenosquamous carcinoma and pancreatoblastomas. Pancreatic endocrine tumors include insulinomas, glucagonomas, VIPomas, somatostatinomas and Ppomas.

Classification

Pancreatic cancers can be classified based on the production of hormones into exocrine and endocrine cancers:

  • Types of Pancreatic Cancers:[1]
Types of Pancreatic Cancers
Pancreatic Exocrine Cancers Pancreatic Endocrine Cancers (Pancreatic Neuroendocrine Tumours)
  • Giant cell tumor
  • Nonfunctional islet cell tumor
  • Solid and pseudopapillary tumours


  • Types of Pancreatic Intraepithelial Neoplasia (PanIN):[1]
Types of Pancreatic Intraepithelial Neoplasia (PanIN)
PanIN 1 (low grade)
  • Subclassified into PanIN 1A: absence of micropapillary infoldings of the epithelium; and 1B, presence of micropapillary infoldings of the epithelium
PanIN 2 (intermediate grade)
  • Moderate degree of atypia, including loss of polarity, nuclear crowding, enlarged nuclei, pseudostratification, and hyperchromatism
PanIN 3 (high grade/carcinoma in situ)


  • Functional Pancreatic Neuroendocrine Tumors and their Characteristics are mentioned in the following table:[2]
Functional Pancreatic Neuroendocrine Tumors and their Characteristics
Tumor type and syndrome Location in pancreas Signs and symptoms Circulating biomarkers
Insulinoma (Whipple’s triad)
  • Head, body, tail (evenly distributed)
Gastrinoma (Zollinger–Ellison)
VIPoma (Verner– Morrison syndrome, WDHA)
Glucagonoma
Somatostatinoma
  • Pancreatoduodenal groove, ampullary, periampullary
Ppoma
  • None
  • CgA, PP

**Key

CgA- Chromogranin A

CgB- Chromogranin B

PP- Pancreatic polypeptide

  • TNM classification for pancreatic cancer:[1] [3]
TNM Classification for Pancreatic Cancer:
Primary tumor
TX Primary tumor cannot be assessed
T0 No evidence of primary tumor
Tis Carcinoma in situ
T1 Tumor limited to the pancreas, ≤2 cm in greatest dimension
T2 Tumor limited to the pancreas, >2 cm in greatest dimension
T3 Tumor extends beyond the pancreas but without involvement of the celiac axis or the superior mesenteric artery
T4 Tumor involves the celiac axis or the superior mesenteric artery (unresectable primary tumor)
Regional lymph nodes
NX Regional lymph nodes cannot be assessed
N0 No regional lymph node metastasis
N1 Regional lymph node metastasis
Distant metastases
MX Distant metastasis cannot be assessed
M0 No distant metastasis
M1 Distant metastasis

Refrences

  1. ↑ 1.0 1.1 1.2 Bond-Smith G, Banga N, Hammond TM, Imber CJ (2012). "Pancreatic adenocarcinoma". BMJ. 344: e2476. doi:10.1136/bmj.e2476. PMID 22592847.
  2. ↑ Ryan DP, Hong TS, Bardeesy N (2014). "Pancreatic adenocarcinoma". N Engl J Med. 371 (11): 1039–49. doi:10.1056/NEJMra1404198. PMID 25207767.
  3. ↑ Seufferlein T, Bachet JB, Van Cutsem E, Rougier P, ESMO Guidelines Working Group (2012). "Pancreatic adenocarcinoma: ESMO-ESDO Clinical Practice Guidelines for diagnosis, treatment and follow-up". Ann Oncol. 23 Suppl 7: vii33–40. doi:10.1093/annonc/mds224. PMID 22997452.

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