Pancreatic cancer classification: Difference between revisions

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| style="background:#F5F5F5; + " |  
| style="background:#F5F5F5; + " |  
*Vasoactive intestinal peptide releasing tumour (VIPoma)
*Vasoactive intestinal peptide releasing tumour (VIPoma)
|-
|}
<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, sweating, tachycardia, tremulousness, confusion, seizure
| style="background:#F5F5F5; + " |
*CgA and CgB, insulin inappropriate for blood glucose level, proinsulin, C-peptide
|-
| style="background:#DCDCDC; + " | '''Gastrinoma (Zollinger–Ellison)'''
| style="background:#F5F5F5; + " |
*Gastrinoma triangle Often extrapancreatic (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; + " |
*Watery diarrhea, hypokalemia, achlorhydria (or acidosis)
| style="background:#F5F5F5; + " |
*CgA, 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, ampullary, periampullary
| style="background:#F5F5F5; + " |
*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
|-
|-
|}
|}
Line 161: Line 222:
| style="background:#DCDCDC; + | M1  
| style="background:#DCDCDC; + | M1  
| style="background:#F5F5F5; + | Distant metastasis  
| style="background:#F5F5F5; + | Distant metastasis  
|-
|}
<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, sweating, tachycardia, tremulousness, confusion, seizure
| style="background:#F5F5F5; + " |
*CgA and CgB, insulin inappropriate for blood glucose level, proinsulin, C-peptide
|-
| style="background:#DCDCDC; + " | '''Gastrinoma (Zollinger–Ellison)'''
| style="background:#F5F5F5; + " |
*Gastrinoma triangle Often extrapancreatic (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; + " |
*Watery diarrhea, hypokalemia, achlorhydria (or acidosis)
| style="background:#F5F5F5; + " |
*CgA, 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, ampullary, periampullary
| style="background:#F5F5F5; + " |
*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
|-
|-
|}
|}

Revision as of 18:06, 14 November 2017

Pancreatic cancer Microchapters

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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

Classification


  • Types of Pancreatic Cancers:[1]
Types of Pancreatic Cancers
Pancreatic Exocrine Cancers
  • Adenocarcinoma
  • Acinar cell carcinoma
  • Adenosquamous carcinoma
  • Giant cell tumour
  • Intraductal papillary mucinous neoplasm (IPMN)
  • Mucinous cystadenocarcinoma
  • Pancreatoblastoma
  • Serous cystadenocarcinoma
  • Solid and pseudopapillary tumours
Pancreatic Endocrine Cancers (Pancreatic Neuroendocrine Tumours)
  • Gastrinoma
  • Glucagonoma
  • Insulinoma
  • Nonfunctional islet cell tumour
  • Somatostatinoma
  • Vasoactive intestinal peptide releasing tumour (VIPoma)


  • 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


  • 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
  • Mitoses are rarely seen
PanIN 3 (high grade/carcinoma in situ)
  • Severe atypia, with varying degrees of cribriforming, luminal necrosis, and atypical mitoses
  • Contained within the basement membrane


  • 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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