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{{Pancreatic cancer}}
{{Pancreatic cancer}}
{{CMG}}; {{AE}} {{ARK}}
==Overview==


{{CMG}}
[[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==


==Types==
[[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>


The many types of pancreatic cancer can be divided into two general groups. The vast majority of cases (about 99%) occur in the part of the pancreas which produces [[digestive enzymes]], known as the [[Exocrine component of pancreas|exocrine component]]. There are several sub-types of exocrine pancreatic cancers, but their diagnosis and treatment have much in common. The small minority of cancers that arise in the [[hormone]]-producing ([[endocrine]]) tissue of the pancreas have different clinical characteristics.  Both groups occur mainly (but not exclusively) in people over 40, and are slightly more common in men, but some rare sub-types mainly occur in women or children.<ref name=Harris-2013>{{cite book| last=Harris| first=RE| title=Epidemiology of Chronic Disease|url=https://books.google.com/books?id=KJLEIvX4wzoC&pg=PA182| year=2013| publisher=Jones & Bartlett |isbn=978-0-7637-8047-0 |pages=181–190| chapter=Epidemiology of pancreatic cancer}}</ref><ref name=pmid22997445>{{cite journal | author = Öberg K, Knigge U, Kwekkeboom D, Perren A | title = Neuroendocrine gastro-entero-pancreatic tumors: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up | journal = Annals of Oncology: Official Journal of the European Society for Medical Oncology / ESMO | volume = 23 Suppl 7 | issue = | pages = vii124–30 | date = October  2012 | pmid = 22997445 | doi = 10.1093/annonc/mds295 | url = http://annonc.oxfordjournals.org/content/23/suppl_7/vii124.long }} ([http://annonc.oxfordjournals.org/content/23/suppl_7/vii124/T5.expansion.html Table 5] outlines the proposed TNM staging system for PanNETs.)</ref>
{|
[[File:Pancreatic_cancer_classification.jpg|thumb|320px|The pancreas has multiple functions, served by the endocrine cells in the [[islets of Langerhans]] and the exocrine [[acinar cell]]s. Pancreatic cancer may arise from any of these and disrupt any of their functions.]]
! colspan="2" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" + | '''Types of Pancreatic Cancers'''
===Exocrine cancers===
|+
The exocrine group is dominated by pancreatic [[adenocarcinoma]] (variations of this name may add "invasive" and "ductal"), which is by far the most common type, representing about 85% of all pancreatic cancers. This is despite the fact that the tissue from which it arises - the pancreatic ductal [[epithelium]] - represents less than 10% of the pancreas by cell volume.<ref name="DeVita2011">{{cite book|author= Govindan R |title=DeVita, Hellman, and Rosenberg's Cancer: Cancer: Principles & Practice of Oncology |edition=9th |date=2011|publisher=Lippincott Williams & Wilkins|isbn=978-1-4511-0545-2|at= Chapter 35: Cancer of the Pancreas: Surgical Management}} Online edition, with updates to 2014</ref>  This cancer originates in the ducts that carry secretions (such as [[enzymes]] and [[bicarbonate]]) away from the pancreas. About 60–70% of adenocarcinomas occur in the 'head' of the pancreas (see diagram, right).
| colspan="1" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" + |'''Pancreatic Exocrine Cancers'''
The next most common type, [[acinar cell carcinoma of the pancreas]], arises in the [[Acinus|clusters of cells]] that produce these enzymes, and represents 5% of exocrine pancreas cancers. Like the 'functioning' endocrine cancers described below, acinar cell carcinomas may cause over-production of certain molecules, in this case digestive enzymes, which may cause symptoms such as skin rashes and joint pain.
| 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; + " |
|-
|+


[[Cystadenocarcinoma]]s account for 1% of pancreatic cancers, and they have a better prognosis than the other exocrine types.<ref name="Tobias">{{cite book |author= Tobias JS, Hochhauser D |title= Cancer and its Management |pages=276–7 |year= 2010 |edition= 6th |isbn=  978-1-1187-1325-9}}</ref>
|+
|-
|}


[[Pancreatoblastoma]] is a rare form, mostly occurring in childhood, and with a relatively good prognosis.  Other exocrine cancers include [[adenosquamous carcinoma]]s, [[signet ring cell carcinoma]]s, [[hepatoid carcinoma]]s, colloid carcinomas, [[Anaplasia|undifferentiated]] carcinomas, and undifferentiated carcinomas with [[osteoclast]]-like [[giant cell]]s.  [[Solid pseudopapillary tumor]] is a rare low-[[Grading (tumors)|grade]] neoplasm that mainly affects younger women, and generally has a very good prognosis.<ref name="JHM-SGPCRC">{{cite web | publisher= Johns Hopkins Medicine |website= The Sol Goldman Pancreas Cancer Research Center |url= http://pathology.jhu.edu/pancreas/BasicTypes2.php?area=ba |title= Types of Pancreas Tumors |date= 2012 |accessdate= 18 November 2014}}</ref>
<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>


[[Pancreatic mucinous cystic neoplasm]]s are a broad group of pancreas tumors that have varying malignant potential. They are being detected at a greatly increased rate as CT scans become more powerful and common, and discussion continues as how best to assess and treat them, given that many are benign.<ref>{{cite journal | author = Farrell JJ, Fernández-del Castillo C | title = Pancreatic cystic neoplasms: management and unanswered questions | journal = Gastroenterology | volume = 144 | issue = 6 | pages = 1303–15 | date = June 2013 | pmid = 23622140 | doi = 10.1053/j.gastro.2013.01.073 }}</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]]
|-
|}


===Neuroendocrine===
<br />
{{main|Pancreatic neuroendocrine tumor}}
*'''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>
The small minority of tumors that arise elsewhere in the pancreas are mainly pancreatic [[neuroendocrine tumor]]s (PanNETs).<ref name=nomenclature>The PanNET denomination is in line with [[WHO]] guidelines for the classification of tumors of the digestive system [http://www.ncbi.nlm.nih.gov/nlmcatalog/101553728] published in 2010. Historically, PanNETs have also been referred to by a variety of terms, and are still commonly called "pancreatic endocrine tumors". See: {{cite journal | author = Klimstra DS, Modlin IR, Coppola D, Lloyd RV, Suster S | title = The pathologic classification of neuroendocrine tumors: a review of nomenclature, grading, and staging systems | journal = Pancreas | volume = 39 | issue = 6 | pages = 707–12 | date = August  2010 | pmid = 20664470 | doi = 10.1097/MPA.0b013e3181ec124e | url = http://www.seen.es/docs/apartados/470/The_Pathologic_Classification_of_Neuroendocrine.2.pdf }}<!-- likely to remain a valid source for nomenclature until the 2010 WHO classification of digestive system tumors is superseded --></ref>  Neuroendocrine tumors (NETs) are a diverse group of [[Benign tumor#Benign vs malignant|benign or malignant]] tumors that arise from the body's [[neuroendocrine cell]]s, which are responsible for integrating the [[Nervous system|nervous]] and endocrine systems. NETs can start in most organs of the body, including the pancreas, where the various malignant types are all considered to be [[Rare disease|rare]].  PanNETs are grouped into 'functioning' and 'non-functioning' types, depending on the degree to which they produce hormones. The functioning types secrete hormones such as [[insulin]], [[gastrin]], and [[glucagon]] into the bloodstream, often in large quantities, giving rise to serious symptoms such as [[low blood sugar]], but also favoring relatively early detection. The most common functioning PanNETs are [[insulinoma]]s and [[gastrinoma]]s, named after the hormones they secrete. The non-functioning types do not secrete hormones in a sufficient quantity to give rise to overt clinical symptoms. For this reason, non-functioning PanNETs are often diagnosed only after the cancer has spread to other parts of the body.<ref name="Burns2012"/>


As with other neuroendocrine tumors, the history of the terminology and classification of PanNETs is complex.<ref name=nomenclature/> PanNETs are sometimes called "islet cell cancers",<ref>The [[Medical Subject Headings]] indexing system refers to "islet cell carcinoma", which is subdivided into gastrinoma, [[glucagonoma]], [[somatostatinoma]] and [[VIPoma]]. See: 2014 MeSH tree at [https://www.nlm.nih.gov/cgi/mesh/2014/MB_cgi?mode=&term=Carcinoma,+Islet+Cell&field=entry#TreeC04.588.322.475.500 "Pancreatic Neoplasms [C04.588.322.475<nowiki>]</nowiki>"] 16 October 2014</ref> even though it is now known that they do not actually arise from [[islet cell]]s as previously thought.<ref name="Burns2012">{{cite journal | author = Burns WR, Edil BH | title = Neuroendocrine pancreatic tumors: guidelines for management and update | journal = Current treatment options in oncology | volume = 13 | issue = 1 | pages = 24–34 | date = March 2012 | pmid = 22198808 | doi = 10.1007/s11864-011-0172-2 }}</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


==References==
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==
{{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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