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| {{Pancreatic cancer}} | | {{Pancreatic cancer}} |
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| {{CMG}} | | {{CMG}}{{AE}}{{PSD}} |
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| ==Types== | | ==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: |
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| 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>
| | ::* Malignant |
| [[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.]]
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| ===Exocrine cancers===
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| 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).
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| 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.
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| [[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>
| | :::* 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.[1,2] |
| | :::* Papillary mucinous carcinoma. |
| | :::* Signet ring carcinoma. |
| | :::* Small cell carcinoma. |
| | :::* Unclassified. |
| | :::* Undifferentiated carcinoma. |
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| [[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>
| | ::* Borderline Malignancies |
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| [[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> | | :::* Intraductal papillary mucinous tumor with dysplasia.[3] |
| | :::* Mucinous cystic tumor with dysplasia. |
| | :::* Pseudopapillary solid tumor |
| | ==Refrences== |
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| ===Neuroendocrine===
| | {{Reflist|2}} |
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| 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"/>
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| 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>
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| ==References==
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| {{Reflist|2}}
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| [[Category:Needs content]]
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| [[Category:Disease]] | | [[Category:Disease]] |
| [[Category:Types of cancer]] | | [[Category:Types of cancer]] |