Pancreatic cancer classification: Difference between revisions

	Pancreatic cancer Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Pancreatic Cancer from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Staging
Diagnostic study of choice
History and Symptoms
Physical Examination
Laboratory Findings
Chest X Ray
CT
MRI
Ultrasound
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Pancreatic cancer classification On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Pancreatic cancer classification All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Pancreatic cancer classification
CDC on Pancreatic cancer classification
Pancreatic cancer classification in the news
Blogs on Pancreatic cancer classification
Directions to Hospitals Treating Pancreatic cancer
Risk calculators and risk factors for Pancreatic cancer classification

VisualWikitext

Latest revision as of 15:02, 27 November 2017

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)
Adenocarcinoma	Gastrinoma
Acinar cell carcinoma	Glucagonoma
Adenosquamous carcinoma	Insulinoma
Giant cell tumor	Nonfunctional islet cell tumor
Intraductal papillary mucinous neoplasm (IPMN)	Somatostatinoma
Mucinous cystadenocarcinoma	Vasoactive intestinal peptide releasing tumor (VIPoma)
Pancreatoblastoma
Serous cystadenocarcinoma
Solid and pseudopapillary tumours

Types of Pancreatic Intraepithelial Neoplasia (PanIN):^[1]


Types of Pancreatic Intraepithelial Neoplasia (PanIN)
PanIN 1 (low grade)
Minimal degree of atypia
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
Mitosis is rarely seen
PanIN 3 (high grade/carcinoma in situ)
Severe atypia, with varying degrees of cribriforming, luminal necrosis, and atypical mitosis
Contained within the basement membrane

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)	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

**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

↑ ^1.0 ^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.
↑ Ryan DP, Hong TS, Bardeesy N (2014). "Pancreatic adenocarcinoma". N Engl J Med. 371 (11): 1039–49. doi:10.1056/NEJMra1404198. PMID 25207767.
↑ 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.

Template:WH Template:WS

[pmid22592847-1] 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.

[pmid25207767-2] Ryan DP, Hong TS, Bardeesy N (2014). "Pancreatic adenocarcinoma". N Engl J Med. 371 (11): 1039–49. doi:10.1056/NEJMra1404198. PMID 25207767.

[pmid22997452-3] 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.

[1]

[2]

[3]

@@ Line 4: / Line 4: @@
 ==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.
+[[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==
@@ Line 11: / Line 11: @@
 {|
-! 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 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; + " |
 |-
 |+
-| colspan="1" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" + | '''Pancreatic Endocrine Cancers (Pancreatic Neuroendocrine Tumours)'''
 |+
-|-
-| style="background:#F5F5F5; + " |
-*[[Gastrinoma (patient information)|Gastrinoma]]
-|-
-| style="background:#F5F5F5; + " |
-*[[Glucagonoma]]
-|-
-| style="background:#F5F5F5; + " |
-*[[Insulinoma]]
-|-
-| style="background:#F5F5F5; + " |
-*Nonfunctional islet cell tumor
-|-
-| style="background:#F5F5F5; + " |
-*[[Neuroendocrine tumors|Somatostatinoma]]
-|-
-| style="background:#F5F5F5; + " |
-*[[VIPoma|Vasoactive intestinal peptide releasing tumor (VIPoma)]]
 |-
 |}
@@ Line 123: / Line 121: @@
 | style="background:#DCDCDC; + " | '''Gastrinoma (Zollinger–Ellison)'''
 | style="background:#F5F5F5; + " |
-*[[Gastrinoma (patient information)|Gastrinoma]] triangle Often extrapancreatic ([[Duodenum|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; + " |
 *[[Gastric acid]] hypersecretion, [[peptic ulcer]], [[diarrhea]], [[esophagitis]], [[epigastric]] [[pain]]
@@ Line 131: / Line 130: @@
 | style="background:#DCDCDC; + " | '''VIPoma (Verner– Morrison syndrome, WDHA)'''
 | style="background:#F5F5F5; + " |
-*Distal [[pancreas]] (body and tail) Often spread outside [[pancreas]]
+*Distal [[pancreas]] (body and tail)
+*Often spread outside [[pancreas]]
 | style="background:#F5F5F5; + " |
 *[[Diarrhea|Watery diarrhea]], [[hypokalemia]], [[achlorhydria]] (or acidosis)
@@ Line 139: / Line 139: @@
 | style="background:#DCDCDC; + " | '''Glucagonoma'''
 | 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; + " |
 *[[Diabetes]] ([[hyperglycemia]]), [[necrolytic migratory erythema]], [[stomatitis]], [[glossitis]], [[angular cheilitis]]
@@ Line 163: / Line 164: @@
 |}
-<br />
+<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>
@@ Line 171: / Line 178: @@
 | colspan="2" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" + |'''Primary tumor'''
 |+
-| colspan="2" rowspan="1" style="background:#4479BA; color: #FFFFFF;" + |
-| colspan="2" rowspan="1" style="background:#4479BA; color: #FFFFFF;" + |
 |-
 | style="background:#DCDCDC; + " | TX
@@ Line 197: / Line 202: @@
 | colspan="2" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" + |'''Regional lymph nodes'''
 |+
-| colspan="2" rowspan="1" style="background:#4479BA; color: #FFFFFF;" + |
-| colspan="2" rowspan="1" style="background:#4479BA; color: #FFFFFF;" + |
 |-
 | style="background:#DCDCDC; + " | NX
@@ Line 211: / Line 214: @@
 | colspan="2" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" + |'''Distant metastases'''
 |+
-| colspan="2" rowspan="1" style="background:#4479BA; color: #FFFFFF;" + |
-| colspan="2" rowspan="1" style="background:#4479BA; color: #FFFFFF;" + |
 |-
 | style="background:#DCDCDC; + " | MX
@@ Line 230: / Line 231: @@
 {{WH}}
 {{WS}}
+[[Category:Gastroenterology]]
+ [[Category:Up-To-Date]]
+[[Category:Oncology]]
+[[Category:Medicine]]
+[[Category:Surgery]]
 [[Category:Gastroenterology]]

Pancreatic cancer classification: Difference between revisions

Latest revision as of 15:02, 27 November 2017

Overview

Classification

Refrences

Navigation menu