Pancreatic cancer

Pancreatic cancer

Updated: 03/02/2021

© Jun Wang, MD, PhD

General features
  • Classification based on differentiation: ductal, endocrine, acinar, etc
  • Majority are ductal carcinoma
  • Fourth leading cause of death
  • More common in population older than 50
  • 3 recognized precursors of invasive disease: PanIN, IPMN and mucinous cystic neoplasm
  • Most common in head and body
  • Overall poor prognosis
Clinical presentations
  • Non specific: Anorexia, malaise, nausea, fatigue, and midepigastric or back pain
  • Painless obstructive jaundice: Most characteristic sign of cancer of head of the pancreas
Risk factors
Molecular abnormality
  • KRAS, CDKN2A, p53, SMAD4, BRCA2, SMAD4, etc
  • Inherited
Ductal adenocarcinoma
  • Most common pancreatic cancer
  • Non specific presentation including pain, weight loss, anorexia, malaise, weakness
  • Trousseau sign: Migratory thrombophlebitis, due to tumor or tumor necrosis producing platelet-aggregating factors and procoagulants; causes arterial and venous thrombi, including pulmonary thromboemboli
  •  Poorly circumscribed, gritty, gray-white, hard masses
  • Malignant tubular glands infiltrating desmoplastic stroma
  • Loss of nuclear SMAD4 expression
  • Serum tests: CEA, CA19-9
Acinar cell carcinoma
  • Morphological resemblance to acinar cells
  • Produce pancreatic exocrine enzymes (trypsin, chymotrypsin, lipase, etc)
  • Resembles similar tumor in salivary gland morphologically
  • 1-2% of pancreatic malignancies
  • More common in men
  • May present with lipase hypersecretion syndrome (subcutaneous fat necrosis)
  • Well circumscribed, soft/fleshy with fibrous septa
  • Highly cellular with minimal stroma and no desmoplasia
Pancreatoblastoma
Pancreatic intraepithelial neoplasia
Management
  • Surgery: Whipple procedure
  • Chemotherapy, radiation therapy


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