Pancreatic cancer classification: Difference between revisions

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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 1: / Line 1: @@
 __NOTOC__
 {{Pancreatic cancer}}
+{{CMG}}; {{AE}} {{ARK}}
-{{CMG}}{{AE}}{{PSD}}
 ==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==
-*'''Cellular Classification of Pancreeratic 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
+[[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>
+{|
+! 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
-:::* Duct cell carcinoma (90% of all cases).
+PP- Pancreatic polypeptide
-:::* Acinar cell carcinoma.
+*'''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>
-:::* 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.[1,2]
-:::* Papillary mucinous carcinoma.
-:::* Signet ring carcinoma.
-:::* Small cell carcinoma.
-:::* Unclassified.
-:::* Undifferentiated carcinoma.
-::* Borderline Malignancies
+{|
+! 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]]
+|-
+|}
-:::* Intraductal papillary mucinous tumor with dysplasia.[3]
-:::* Mucinous cystic tumor with dysplasia.
-:::* Pseudopapillary solid tumor
 ==Refrences==
 {{Reflist|2}}
+{{WH}}
-[[Category:Disease]]
+{{WS}}
-[[Category:Types of cancer]]
+[[Category:Gastroenterology]]
+ [[Category:Up-To-Date]]
 [[Category:Oncology]]
-[[Category:Mature chapter]]
+[[Category:Medicine]]
-[[Category:Primary care]]
+[[Category:Surgery]]
+[[Category:Gastroenterology]]

Pancreatic cancer classification: Difference between revisions

Latest revision as of 15:02, 27 November 2017

Overview

Classification

Refrences

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