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{{Pancreatic cancer}}
{{Pancreatic cancer}}
 
{{CMG}}; {{AE}} {{ARK}}
{{CMG}}{{AE}}{{PSD}}
==Overview==
==Overview==
Pancreatic cancer can be classified into malignant and borderline malignant. Duct cell carcinoma is the most common type of pancreatic cancer.


[[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==
*'''Cellular Classification of Pancreatic Cancer'''<ref name="cancergov">National Cancer Institute. Physician Data Query Database 2015. http://www.cancer.gov/publiciation/pdq</ref>
:* Pancreatic cancer includes the following carcinomas:
::* Malignant
:::* [[Duct cell carcinoma]] (90% of all cases)
:::* [[Acinar cell carcinoma]]
:::* [[Adenosquamous carcinoma]]
:::* [[Cystadenocarcinoma]] (serous and mucinous types)
:::* [[Giant cell carcinoma]]
:::* [[Invasive adenocarcinoma]] associated with cystic mucinous neoplasm or intraductal papillary mucinous neoplasm
:::* Mixed type (ductal-endocrine or acinar-endocrine)
:::* [[Mucinous carcinoma]]
:::* [[Pancreatoblastoma]]
:::* [[Papillary-cystic neoplasm]] (Frantz tumor). This tumor has lower malignant potential and may be cured with surgery alone
:::* [[Papillary mucinous carcinoma]]
:::* [[Signet ring carcinoma]]
:::* [[Small cell carcinoma]]
:::* Unclassified
:::* [[Undifferentiated carcinoma]]


::* Borderline Malignancies
[[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 />
:::* Intraductal papillary mucinous tumor with dysplasia
*'''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>
:::* Mucinous cystic tumor with dysplasia
 
:::* Pseudopapillary solid tumor
{|
! 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 Endocrine Cancers (Pancreatic Neuroendocrine Tumours)'''
|-
| style="background:#F5F5F5; + " |
*[[Adenocarcinoma]]
| style="background:#F5F5F5; + " |
*[[Gastrinoma (patient information)|Gastrinoma]]
|-
| style="background:#F5F5F5; + " |
*[[Acinic cell carcinoma|Acinar cell carcinoma]]
| style="background:#F5F5F5; + " |
*[[Glucagonoma]]
|-
| style="background:#F5F5F5; + " |
*[[Adenosquamous carcinoma]]
| style="background:#F5F5F5; + " |
*[[Insulinoma]]
|-
| style="background:#F5F5F5; + " |
*Giant cell tumor
| style="background:#F5F5F5; + " |
*Nonfunctional islet cell tumor
|-
| style="background:#F5F5F5; + " |
*[[Intraductal papillary mucinous neoplasm]] (IPMN)
| style="background:#F5F5F5; + " |
*[[Neuroendocrine tumors|Somatostatinoma]]
|-
| style="background:#F5F5F5; + " |
*[[Mucinous cystadenocarcinoma]]
| style="background:#F5F5F5; + " |
*[[VIPoma|Vasoactive intestinal peptide releasing tumor (VIPoma)]]
|-
| style="background:#F5F5F5; + " |
*[[Pancreatoblastoma]]
| style="background:#F5F5F5; + " |
|-
| style="background:#F5F5F5; + " |
*Serous [[cystadenocarcinoma]]
| style="background:#F5F5F5; + " |
|-
| style="background:#F5F5F5; + " |
*Solid and pseudopapillary tumours
| style="background:#F5F5F5; + " |
|-
|+
 
|+
|-
|}
 
<br />
*'''Types of Pancreatic Intraepithelial Neoplasia (PanIN):'''<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 Intraepithelial Neoplasia (PanIN)'''
|+
| colspan="1" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" + |'''PanIN 1 (low grade)'''
|-
| style="background:#F5F5F5; + " |
*Minimal degree of [[atypia]]
|-
| style="background:#F5F5F5; + " |
*Subclassified into PanIN 1A: absence of micropapillary infoldings of the [[epithelium]]; and 1B, presence of micropapillary infoldings of the [[epithelium]]
|-
|+
| colspan="1" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" + | '''PanIN 2 (intermediate grade)'''
|+
|-
| style="background:#F5F5F5; + " |
*Moderate degree of [[atypia]], including loss of [[Chemical polarity|polarity]], nuclear crowding, enlarged [[Cell nucleus|nuclei]], pseudostratification, and hyperchromatism
|-
| style="background:#F5F5F5; + " |
*[[Mitosis]] is rarely seen
|-
|+
| colspan="1" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" + | '''PanIN 3 (high grade/carcinoma in situ)'''
|+
|-
| style="background:#F5F5F5; + " |
*Severe [[atypia]], with varying degrees of [[Cribriform|cribriforming]], [[Lumen|luminal]] [[necrosis]], and atypical [[mitosis]]
|-
| style="background:#F5F5F5; + " |
*Contained within the [[basement membrane]]
|-
|}
 
<br />
*'''Functional Pancreatic Neuroendocrine Tumors and their Characteristics are mentioned in the following table:'''<ref name="pmid25207767">{{cite journal| author=Ryan DP, Hong TS, Bardeesy N| title=Pancreatic adenocarcinoma. | journal=N Engl J Med | year= 2014 | volume= 371 | issue= 11 | pages= 1039-49 | pmid=25207767 | doi=10.1056/NEJMra1404198 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25207767  }} </ref>
 
{|
! colspan="4" style="background:#4479BA; color: #FFFFFF;" align="center" + | '''Functional Pancreatic Neuroendocrine Tumors and their Characteristics'''
|+
| colspan="1" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" + | '''Tumor type and syndrome'''
| colspan="1" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" + | '''Location in pancreas'''
| colspan="1" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" + | '''Signs and symptoms'''
| colspan="1" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" + | '''Circulating biomarkers'''
|-
| style="background:#DCDCDC; + " | '''Insulinoma (Whipple’s triad)'''
| style="background:#F5F5F5; + " |
*Head, body, tail (evenly distributed)
| style="background:#F5F5F5; + " |
*[[Hypoglycemia]], [[dizziness]], [[Perspiration|sweating]], [[tachycardia]], tremulousness, [[confusion]], [[seizure]]
| style="background:#F5F5F5; + " |
*CgA and CgB, [[insulin]] inappropriate for [[Blood sugar|blood glucose]] level, [[proinsulin]], [[C-peptide]]
|-
| style="background:#DCDCDC; + " | '''Gastrinoma (Zollinger–Ellison)'''
| style="background:#F5F5F5; + " |
*[[Gastrinoma (patient information)|Gastrinoma]] triangle
*Often extrapancreatic ([[Duodenum|duodenal]]); can be found anywhere in [[gland]]
| style="background:#F5F5F5; + " |
*[[Gastric acid]] hypersecretion, [[peptic ulcer]], [[diarrhea]], [[esophagitis]], [[epigastric]] [[pain]]
| style="background:#F5F5F5; + " |
*CgA, [[gastrin]], PP (35%)
|-
| style="background:#DCDCDC; + " | '''VIPoma (Verner– Morrison syndrome, WDHA)'''
| style="background:#F5F5F5; + " |
*Distal [[pancreas]] (body and tail)
*Often spread outside [[pancreas]]
| style="background:#F5F5F5; + " |
*[[Diarrhea|Watery diarrhea]], [[hypokalemia]], [[achlorhydria]] (or acidosis)
| style="background:#F5F5F5; + " |
*CgA, [[Vasoactive intestinal peptide|VIP]]
|-
| style="background:#DCDCDC; + " | '''Glucagonoma'''
| style="background:#F5F5F5; + " |
*Body and tail of [[pancreas]]
*Often large and spread outside [[pancreas]]
| style="background:#F5F5F5; + " |
*[[Diabetes]] ([[hyperglycemia]]), [[necrolytic migratory erythema]], [[stomatitis]], [[glossitis]], [[angular cheilitis]]
| style="background:#F5F5F5; + " |
*CgA, [[glucagon]], glycentin
|-
| style="background:#DCDCDC; + " | '''Somatostatinoma'''
| style="background:#F5F5F5; + " |
*Pancreatoduodenal groove, [[Ampulla of Vater|ampullary]], periampullary
| style="background:#F5F5F5; + " |
*[[Gallstone disease|Gallstones]], [[diabetes]] (hyperglycemia), [[steatorrhea]]
| style="background:#F5F5F5; + " |
*CgA, [[somatostatin]]
|-
| style="background:#DCDCDC; + " | '''Ppoma'''
| style="background:#F5F5F5; + " |
*Head of [[pancreas]]
| style="background:#F5F5F5; + " |
*None
| style="background:#F5F5F5; + " |
*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}}


 
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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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