Pancreatic cancer classification

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Parminder Dhingra, M.D. [2]

Overview

Pancreatic cancer can be classified into malignant and borderline malignant. Duct cell carcinoma is the most common type of pancreatic cancer.

Classification

• Cellular Classification of Pancreatic Cancer

• 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

• Intraductal papillary mucinous tumor with dysplasia
• Mucinous cystic tumor with dysplasia
• Pseudopapillary solid tumor

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)	Hypoglycemia, dizziness, sweating, tachycardia, tremulousness, confusion, seizure	CgA and CgB, insulin inappropriate for blood glucose level, proinsulin, C-peptide
Gastrinoma (Zollinger–Ellison)	Gastrinoma triangle Often extrapancreatic (duodenal); can be found anywhere in gland	Gastric acid hypersecretion, peptic ulcer, diarrhea, esophagitis, epigastric pain	CgA, gastrin, PP (35%)
VIPoma (Verner– Morrison syndrome, WDHA)	Distal pancreas (body and tail) Often spread outside pancreas	Watery diarrhea, hypokalemia, achlorhydria (or acidosis)	CgA, VIP
Glucagonoma	Body and tail of pancreas Often large and spread outside pancreas	Diabetes (hyperglycemia), necrolytic migratory erythema, stomatitis, glossitis, angular cheilitis	CgA, glucagon, glycentin
Somatostatinoma	Pancreatoduodenal groove, ampullary, periampullary	Gallstones, diabetes (hyperglycemia), steatorrhea	CgA, somatostatin
Ppoma	Head of pancreas	None	CgA, PP