Pancreatic cancer classification: Difference between revisions

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==Overview==
==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==
==Classification==


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*[[Pancreatoblastoma]]
*[[Pancreatoblastoma]]
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|-
|-
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*Serous [[cystadenocarcinoma]]
*Serous [[cystadenocarcinoma]]
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|-
|-
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*Solid and pseudopapillary tumours
*Solid and pseudopapillary tumours
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| style="background:#F5F5F5; + " |
|-
|-
|+
|+
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| style="background:#DCDCDC; + " | '''Gastrinoma (Zollinger–Ellison)'''
| style="background:#DCDCDC; + " | '''Gastrinoma (Zollinger–Ellison)'''
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| 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; + " |  
| style="background:#F5F5F5; + " |  
*[[Gastric acid]] hypersecretion, [[peptic ulcer]], [[diarrhea]], [[esophagitis]], [[epigastric]] [[pain]]
*[[Gastric acid]] hypersecretion, [[peptic ulcer]], [[diarrhea]], [[esophagitis]], [[epigastric]] [[pain]]
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| style="background:#DCDCDC; + " | '''VIPoma (Verner– Morrison syndrome, WDHA)'''
| style="background:#DCDCDC; + " | '''VIPoma (Verner– Morrison syndrome, WDHA)'''
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*Distal [[pancreas]] (body and tail) Often spread outside [[pancreas]]
*Distal [[pancreas]] (body and tail)  
*Often spread outside [[pancreas]]
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| style="background:#F5F5F5; + " |  
*[[Diarrhea|Watery diarrhea]], [[hypokalemia]], [[achlorhydria]] (or acidosis)
*[[Diarrhea|Watery diarrhea]], [[hypokalemia]], [[achlorhydria]] (or acidosis)
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| style="background:#DCDCDC; + " | '''Glucagonoma'''
| style="background:#DCDCDC; + " | '''Glucagonoma'''
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*Body and tail of [[pancreas]] Often large and spread outside [[pancreas]]
*Body and tail of [[pancreas]]  
*Often large and spread outside [[pancreas]]
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| style="background:#F5F5F5; + " |  
*[[Diabetes]] ([[hyperglycemia]]), [[necrolytic migratory erythema]], [[stomatitis]], [[glossitis]], [[angular cheilitis]]
*[[Diabetes]] ([[hyperglycemia]]), [[necrolytic migratory erythema]], [[stomatitis]], [[glossitis]], [[angular cheilitis]]
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| colspan="2" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" + |'''Primary tumor'''
| 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  
| style="background:#DCDCDC; + " | TX  
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| colspan="2" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" + |'''Regional lymph nodes'''
| 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  
| style="background:#DCDCDC; + " | NX  
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| colspan="2" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" + |'''Distant metastases'''
| 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
| style="background:#DCDCDC; + " | MX

Revision as of 21:42, 20 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


  • 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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