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Invasive ductal carcinoma of the pancreas (view source)
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'''Invasive ductal carcinoma of the pancreas''' is the most common type of [[ | {{ Infobox diagnosis | ||
| Name = {{PAGENAME}} | |||
| Image = Pancreas_adenocarcinoma_(2)_Case_01.jpg | |||
| Width = | |||
| Caption = Pancreatic adenocarcinoma. [[H&E stain]]. | |||
| Synonyms = | |||
| Micro = | |||
| Subtypes = | |||
| LMDDx = [[chronic pancreatitis]], [[cholangiocarcinoma]] | |||
| Stains = | |||
| IHC = | |||
| EM = | |||
| Molecular = +/-[[BRCA2]] carrier | |||
| IF = | |||
| Gross = | |||
| Grossing = | |||
| Site = [[pancreas]], typically head of pancreas | |||
| Assdx = [[pancreatic intraepithelial neoplasia]], +/-[[diabetes mellitus]] | |||
| Syndromes = | |||
| Clinicalhx = +/-[[smoking]] | |||
| Signs = | |||
| Symptoms = | |||
| Prevalence = common for site | |||
| Bloodwork = elevated CA19-9 | |||
| Rads = pancreatic mass | |||
| Endoscopy = | |||
| Prognosis = very poor | |||
| Other = | |||
| ClinDDx = [[chronic pancreatitis]], other pancreatic tumours | |||
| Tx = surgery if possible | |||
}} | |||
'''Invasive ductal carcinoma of the pancreas''' is the most common type of [[pancreatic cancer]]. | |||
It is typically gland forming and thus also referred to as | It is typically gland forming and thus also referred to as '''pancreatic ductal adenocarcinoma''' and '''pancreatic adenocarcinoma'''. | ||
Less specific terms that are used when the context is clear include '''[[ductal adenocarcinoma]]''' and '''[[invasive ductal carcinoma]]'''. | |||
==General== | ==General== | ||
*Most common type of pancreatic cancer.<ref name=Ref_WMSP>{{Ref WMSP|237}}</ref> | *Most common type of pancreatic cancer.<ref name=Ref_WMSP>{{Ref WMSP|237}}</ref> | ||
*Location: usually in the head ~60%. | *Location: usually in the head ~60%. | ||
**15% in the body, 5% tail, 20% diffuse (head, body & tail).<ref name=Ref_PBoD950>{{Ref PBoD|950}}</ref> | **15% in the body, 5% tail, 20% diffuse (head, body & tail).<ref name=Ref_PBoD950>{{Ref PBoD|950}}</ref> | ||
**The vast majority of pancreatic cancers are solitary, but multifocal disease can occur. | |||
*Abysmal prognosis. | *Abysmal prognosis. | ||
| Line 12: | Line 45: | ||
*Smoking (RR ~ 2). | *Smoking (RR ~ 2). | ||
*Pancreatitis. | *Pancreatitis. | ||
*Family history, esp. BRCA2. | *Family history, esp. [[BRCA2]]. | ||
*[[Diabetes mellitus]] - modest risk increase. | *[[Diabetes mellitus]] - modest risk increase (RR ~ 1.5-2). | ||
*Previous gastrectomy. | |||
*Heavy drinking of alcohol may weakly increase risk. | |||
Molecular characteristics:<ref name=Ref_PCPBoD8_470-1>{{Ref PCPBoD8|470-1}}</ref><ref name=pmid19896096>{{Cite journal | last1 = Furukawa | first1 = T. | title = Molecular pathology of pancreatic cancer: implications for molecular targeting therapy. | journal = Clin Gastroenterol Hepatol | volume = 7 | issue = 11 Suppl | pages = S35-9 | month = Nov | year = 2009 | doi = 10.1016/j.cgh.2009.07.035 | PMID = 19896096 }}</ref> | Molecular characteristics:<ref name=Ref_PCPBoD8_470-1>{{Ref PCPBoD8|470-1}}</ref><ref name=pmid19896096>{{Cite journal | last1 = Furukawa | first1 = T. | title = Molecular pathology of pancreatic cancer: implications for molecular targeting therapy. | journal = Clin Gastroenterol Hepatol | volume = 7 | issue = 11 Suppl | pages = S35-9 | month = Nov | year = 2009 | doi = 10.1016/j.cgh.2009.07.035 | PMID = 19896096 }}</ref> | ||
| Line 20: | Line 55: | ||
#TP53 (AKA p53). | #TP53 (AKA p53). | ||
#SMAD4. | #SMAD4. | ||
Clinical: | |||
*Serum CA19-9 - >2504 U/ml predicts outcome.<ref name=pmid28924968>{{Cite journal | last1 = Usón Junior | first1 = PLS. | last2 = Callegaro-Filho | first2 = D. | last3 = Bugano | first3 = DDG. | last4 = Moura | first4 = F. | last5 = Maluf | first5 = FC. | title = Predictive Value of Serum Carbohydrate Antigen 19-9 (CA19-9) for Early Mortality in Advanced Pancreatic Cancer. | journal = J Gastrointest Cancer | volume = 49 | issue = 4 | pages = 481-486 | month = Dec | year = 2018 | doi = 10.1007/s12029-017-0007-x | PMID = 28924968 }}</ref> | |||
==Gross== | |||
Features:<ref name="pmid2015921">{{Cite journal | last1 = Hermanek | first1 = P. | title = Staging of exocrine pancreatic carcinoma. | journal = Eur J Surg Oncol | volume = 17 | issue = 2 | pages = 167-72 | month = Apr | year = 1991 | doi = | PMID = 2015921 }}</ref> | |||
*Firm, sclerotic and poorly defined masses that replace the normal lobular architecture of the gland. | |||
*Cut surface are yellow to white. | |||
*The mean diameter of pancreatic head tumor is between 2.5-3.5cm. | |||
==Microscopic== | ==Microscopic== | ||
| Line 40: | Line 84: | ||
*[[Chronic pancreatitis]].<ref name=pmid16273946>{{Cite journal | last1 = Adsay | first1 = NV. | last2 = Bandyopadhyay | first2 = S. | last3 = Basturk | first3 = O. | last4 = Othman | first4 = M. | last5 = Cheng | first5 = JD. | last6 = Klöppel | first6 = G. | last7 = Klimstra | first7 = DS. | title = Chronic pancreatitis or pancreatic ductal adenocarcinoma? | journal = Semin Diagn Pathol | volume = 21 | issue = 4 | pages = 268-76 | month = Nov | year = 2004 | doi = | PMID = 16273946 }}</ref> | *[[Chronic pancreatitis]].<ref name=pmid16273946>{{Cite journal | last1 = Adsay | first1 = NV. | last2 = Bandyopadhyay | first2 = S. | last3 = Basturk | first3 = O. | last4 = Othman | first4 = M. | last5 = Cheng | first5 = JD. | last6 = Klöppel | first6 = G. | last7 = Klimstra | first7 = DS. | title = Chronic pancreatitis or pancreatic ductal adenocarcinoma? | journal = Semin Diagn Pathol | volume = 21 | issue = 4 | pages = 268-76 | month = Nov | year = 2004 | doi = | PMID = 16273946 }}</ref> | ||
*[[Cholangiocarcinoma]]. | *[[Cholangiocarcinoma]]. | ||
*[[Pancreatic intraepithelial neoplasia]] (PanIN). | |||
===Images=== | ===Images=== | ||