Pancreatic tumor

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Pancreatic tumor
Blausen 0699 PancreasAnatomy2.png
Anatomy of the pancreas
Specialty Gastroenterology, Hepatology, Oncology
Usual onsetAdults [1]

A pancreatic tumor is an abnormal growth in the pancreas. [1] In adults, almost 90% are pancreatic cancer and a few are benign. [1] Pancreatic tumors are rare in children. [1]

Contents

Classification is based on cellular differentiation (ductal, acinar, neuroendocrine, other) and gross appearance (intraductal, cystic, solid). [1] Each different type of pancreatic tumor has a different appearance when examined under a microscope. [2] These unique microscopic features and genetic markers are what allow for proper diagnosis and treatments in patients with pancreatic cancers. [1]

Types

Relative incidences of various pancreatic neoplasm. Relative incidence of pancreatic neoplasms.png
Relative incidences of various pancreatic neoplasm.

The most common type of pancreatic tumor is pancreatic adenocarcinoma, which accounts near 90% of all pancreas cancers. [1] Adenocarcinomas are exocrine tumors of the pancreas, which implies that they begin within the part of the pancreas responsible for creating digestive enzymes. Different subtypes of exocrine adenocarcinomas exist, with the most common being pancreatic ductal adenocarcinoma (PDAC). [4]

Following PDACs, acinar cell carcinomas account for 5% of exocrine pancreatic cancers and can be "functioning", and overproduce certain molecules that can lead to some of the signs and symptoms that are often encountered in pancreatic cancers. [2] [5]

The last type of exocrine tumors include pancreatic mucinous cystic neoplasms, [2] which have fluid filled cavities. These types of tumors are common and mostly benign, although certain subtypes have varying malignant potential. [6]

The second broad category of pancreatic tumor types are neuroendocrine tumors (also known as "endocrine" or "islet cell tumors"). [7] [5] These types of tumors arise from hormone-producing cells in the pancreas and account for only 1-2% of all pancreatic tumors. [5] These endocrine tumors tend to be classified into either "functioning" or "non-functioning" types [7] depending on whether the release hormones or not. For example, some of these pancreatic endocrine tumors release hormones such as insulin, gastrin and glucagon systemically. [2] [7] Often times, these large surges in hormones lead to a relatively early detection due to symptoms that arise in response. Pancreatic endocrine tumors are named after the type of hormone they release. For example, an insulin-secreting tumor is referred to as an "insulinoma". On the other end of the spectrum, non-functioning types of endocrine tumors do not secrete hormones and thus do not give rise to obvious clinical symptoms. This latter type is therefore often diagnosed after spread to other parts of the body. [8]

Symptoms and Presentation

The defining presenting symptom of patients is jaundice or a "yellowing" of the skin and eyes. [6] [4] Although this jaundice has been described as painless in textbooks, a significant number of patients present with pain in addition to jaundice, typically arising in the upper abdomen and radiating to the back. [4] Additional presenting symptoms include abdominal pain, nausea, vomiting, and generalized itching. Often, significant weight loss and loss of appetite is also present. [6]

Management

After diagnosis and proper staging of pancreatic cancer, candidacy for surgical resection is then assessed. [9]

Related Research Articles

<span class="mw-page-title-main">Pancreas</span> Organ of the digestive system and endocrine system of vertebrates

The pancreas is an organ of the digestive system and endocrine system of vertebrates. In humans, it is located in the abdomen behind the stomach and functions as a gland. The pancreas is a mixed or heterocrine gland, i.e., it has both an endocrine and a digestive exocrine function. 99% of the pancreas is exocrine and 1% is endocrine. As an endocrine gland, it functions mostly to regulate blood sugar levels, secreting the hormones insulin, glucagon, somatostatin and pancreatic polypeptide. As a part of the digestive system, it functions as an exocrine gland secreting pancreatic juice into the duodenum through the pancreatic duct. This juice contains bicarbonate, which neutralizes acid entering the duodenum from the stomach; and digestive enzymes, which break down carbohydrates, proteins and fats in food entering the duodenum from the stomach.

<span class="mw-page-title-main">Adenocarcinoma</span> Medical condition

Adenocarcinoma is a type of cancerous tumor that can occur in several parts of the body. It is defined as neoplasia of epithelial tissue that has glandular origin, glandular characteristics, or both. Adenocarcinomas are part of the larger grouping of carcinomas, but are also sometimes called by more precise terms omitting the word, where these exist. Thus invasive ductal carcinoma, the most common form of breast cancer, is adenocarcinoma but does not use the term in its name—however, esophageal adenocarcinoma does to distinguish it from the other common type of esophageal cancer, esophageal squamous cell carcinoma. Several of the most common forms of cancer are adenocarcinomas, and the various sorts of adenocarcinoma vary greatly in all their aspects, so that few useful generalizations can be made about them.

<span class="mw-page-title-main">Pancreatic cancer</span> Type of endocrine gland cancer

Pancreatic cancer arises when cells in the pancreas, a glandular organ behind the stomach, begin to multiply out of control and form a mass. These cancerous cells have the ability to invade other parts of the body. A number of types of pancreatic cancer are known.

<span class="mw-page-title-main">Insulinoma</span> Medical condition

An insulinoma is a tumour of the pancreas that is derived from beta cells and secretes insulin. It is a rare form of a neuroendocrine tumour. Most insulinomas are benign in that they grow exclusively at their origin within the pancreas, but a minority metastasize. Insulinomas are one of the functional pancreatic neuroendocrine tumour (PNET) group. In the Medical Subject Headings classification, insulinoma is the only subtype of "islet cell adenoma".

<span class="mw-page-title-main">Digestive enzyme</span> Class of enzymes

Digestive enzymes are a group of enzymes that break down polymeric macromolecules into their smaller building blocks, in order to facilitate their absorption into the cells of the body. Digestive enzymes are found in the digestive tracts of animals and in the tracts of carnivorous plants, where they aid in the digestion of food, as well as inside cells, especially in their lysosomes, where they function to maintain cellular survival. Digestive enzymes of diverse specificities are found in the saliva secreted by the salivary glands, in the secretions of cells lining the stomach, in the pancreatic juice secreted by pancreatic exocrine cells, and in the secretions of cells lining the small and large intestines.

<span class="mw-page-title-main">Pancreaticoduodenectomy</span> Major surgical procedure involving the pancreas, duodenum, and other organs

A pancreaticoduodenectomy, also known as a Whipple procedure, is a major surgical operation most often performed to remove cancerous tumours from the head of the pancreas. It is also used for the treatment of pancreatic or duodenal trauma, or chronic pancreatitis. Due to the shared blood supply of organs in the proximal gastrointestinal system, surgical removal of the head of the pancreas also necessitates removal of the duodenum, proximal jejunum, gallbladder, and, occasionally, part of the stomach.

<span class="mw-page-title-main">Pancreatectomy</span> Surgical removal of the pancreas

In medicine, a pancreatectomy is the surgical removal of all or part of the pancreas. Several types of pancreatectomy exist, including pancreaticoduodenectomy, distal pancreatectomy, segmental pancreatectomy, and total pancreatectomy. In recent years, the TP-IAT has also gained respectable traction within the medical community. These procedures are used in the management of several conditions involving the pancreas, such as benign pancreatic tumors, pancreatic cancer, and pancreatitis.

<span class="mw-page-title-main">Gastrinoma</span> Medical condition

Gastrinomas are neuroendocrine tumors (NETs), usually located in the duodenum or pancreas, that secrete gastrin and cause a clinical syndrome known as Zollinger–Ellison syndrome (ZES). A large number of gastrinomas develop in the pancreas or duodenum, with near-equal frequency, and approximately 10% arise as primary neoplasms in lymph nodes of the pancreaticoduodenal region.

<span class="mw-page-title-main">Exocrine pancreatic insufficiency</span> Human disease

Exocrine pancreatic insufficiency (EPI) is the inability to properly digest food due to a lack or reduction of digestive enzymes made by the pancreas. EPI can occur in humans and is prevalent in many conditions such as cystic fibrosis, Shwachman–Diamond syndrome, different types of pancreatitis, multiple types of diabetes mellitus, advanced renal disease, older adults, celiac disease, IBS-D, IBD, HIV, alcohol-related liver disease, Sjogren syndrome, tobacco use, and use of somatostatin analogues.

Pancreatic diseases are diseases that affect the pancreas, an organ in most vertebrates and in humans and other mammals located in the abdomen. The pancreas plays a role in the digestive and endocrine system, producing enzymes which aid the digestion process and the hormone insulin, which regulates blood sugar levels. The most common pancreatic disease is pancreatitis, an inflammation of the pancreas which could come in acute or chronic form. Other pancreatic diseases include diabetes mellitus, exocrine pancreatic insufficiency, cystic fibrosis, pseudocysts, cysts, congenital malformations, tumors including pancreatic cancer, and hemosuccus pancreaticus.

<span class="mw-page-title-main">Neuroendocrine tumor</span> Medical condition

Neuroendocrine tumors (NETs) are neoplasms that arise from cells of the endocrine (hormonal) and nervous systems. They most commonly occur in the intestine, where they are often called carcinoid tumors, but they are also found in the pancreas, lung, and the rest of the body.

Somatostatinomas are a tumor of the delta cells of the endocrine pancreas that produces somatostatin. Increased levels of somatostatin inhibit pancreatic hormones and gastrointestinal hormones. Thus, somatostatinomas are associated with mild diabetes mellitus, steatorrhoea and gallstones, and achlorhydria. Somatostatinomas are commonly found in the head of pancreas. Only ten percent of somatostatinomas are functional tumours [9], and 60–70% of tumours are malignant. Nearly two-thirds of patients with malignant somatostatinomas will present with metastatic disease.

<span class="mw-page-title-main">Acinic cell carcinoma</span> Medical condition

Acinic cell carcinoma is a malignant tumor representing 2% of all salivary tumors. 90% of the time found in the parotid gland, 10% intraorally on buccal mucosa or palate. The disease presents as a slow growing mass, associated with pain or tenderness in 50% of the cases. Often appears pseudoencapsulated.

<span class="mw-page-title-main">Enteroendocrine cell</span>

Enteroendocrine cells are specialized cells of the gastrointestinal tract and pancreas with endocrine function. They produce gastrointestinal hormones or peptides in response to various stimuli and release them into the bloodstream for systemic effect, diffuse them as local messengers, or transmit them to the enteric nervous system to activate nervous responses. Enteroendocrine cells of the intestine are the most numerous endocrine cells of the body. They constitute an enteric endocrine system as a subset of the endocrine system just as the enteric nervous system is a subset of the nervous system. In a sense they are known to act as chemoreceptors, initiating digestive actions and detecting harmful substances and initiating protective responses. Enteroendocrine cells are located in the stomach, in the intestine and in the pancreas. Microbiota play key roles in the intestinal immune and metabolic responses in these enteroendocrine cells via their fermentation product, acetate.

<span class="mw-page-title-main">Pancreatoblastoma</span> Medical condition

Pancreatoblastoma is a rare type of pancreatic cancer. It occurs mainly in childhood and has a relatively good prognosis.

<span class="mw-page-title-main">Intraductal papillary mucinous neoplasm</span> Medical condition

Intraductal papillary mucinous neoplasm (IPMN) is a type of tumor that can occur within the cells of the pancreatic duct. IPMN tumors produce mucus, and this mucus can form pancreatic cysts. Although intraductal papillary mucinous neoplasms are benign tumors, they can progress to pancreatic cancer. As such IPMN is viewed as a precancerous condition. Once an intraductal papillary mucinous neoplasm has been found, the management options include close monitoring and pre-emptive surgery.

<span class="mw-page-title-main">Ductal cells</span>

Ductal cells refer to the epithelial cell lining of the pancreatic duct that deliver enzymes from the acinar cells to the duodenum. They have the essential function of producing bicarbonate-rich (HCO3-) secretion to neutralize stomach acidity. The hormone secretin stimulates ductal cells and is responsible for maintaining the duodenal pH and preventing duodenal injury from acidic chyme. Ductal cells mix their production with acinar cells to make up the pancreatic juice.

<span class="mw-page-title-main">Acinar cell carcinoma of the pancreas</span> Medical condition

Acinar cell carcinoma of the pancreas, also acinar cell carcinoma, is a rare malignant exocrine tumour of the pancreas. It represents 5% of all exocrine tumours of the pancreas, making it the second most common type of pancreatic cancer. It is abbreviated ACC. It typically has a guarded prognosis.

<span class="mw-page-title-main">Pancreatic neuroendocrine tumor</span> Medical condition

Pancreatic neuroendocrine tumours, often referred to as "islet cell tumours", or "pancreatic endocrine tumours" are neuroendocrine neoplasms that arise from cells of the endocrine (hormonal) and nervous system within the pancreas.

Type 3c diabetes is diabetes that comes secondary to pancreatic diseases, involving the exocrine and digestive functions of the pancreas. It also occurs following surgical removal of the pancreas.

References

  1. 1 2 3 4 5 6 7 WHO Classification of Tumours Editorial Board (2019). "10. Tumours of the pancreas". Digestive System Tumours. Vol. 1 (5th ed.). Lyon (France). pp. 295–372. ISBN   978-92-832-4499-8.{{cite book}}: CS1 maint: location missing publisher (link)
  2. 1 2 3 4 Kearney, Joseph F.; Adsay, Volkan; Yeh, Jen Jen (October 2021). "Pathology and Molecular Characteristics of Pancreatic Cancer". Surgical Oncology Clinics of North America. 30 (4): 609–619. doi:10.1016/j.soc.2021.06.003. ISSN   1055-3207. PMC   8442745 . PMID   34511185.
  3. Diagram by Mikael Häggström, M.D.
    Source data: Wang Y, Miller FH, Chen ZE, Merrick L, Mortele KJ, Hoff FL; et al. (2011). "Diffusion-weighted MR imaging of solid and cystic lesions of the pancreas". Radiographics. 31 (3): E47-64. doi:10.1148/rg.313105174. PMID   21721197.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  4. 1 2 3 Ryan, David P.; Hong, Theodore S.; Bardeesy, Nabeel (2014-09-11). "Pancreatic Adenocarcinoma". New England Journal of Medicine. 371 (11): 1039–1049. doi:10.1056/nejmra1404198. PMID   25207767 . Retrieved 2022-11-12.
  5. 1 2 3 Öberg, Kjell (2010-12-01). "Pancreatic Endocrine Tumors". Seminars in Oncology. Endocrine Cancers. 37 (6): 594–618. doi:10.1053/j.seminoncol.2010.10.014. ISSN   0093-7754. PMID   21167379.
  6. 1 2 3 Vincent, Audrey; Herman, Joseph; Schulick, Rich; Hruban, Ralph H.; Goggins, Michael (2011-08-13). "Pancreatic cancer". The Lancet. 378 (9791): 607–620. doi:10.1016/S0140-6736(10)62307-0. ISSN   0140-6736. PMC   3062508 . PMID   21620466.
  7. 1 2 3 Perri, Giampaolo; Prakash, Laura R.; Katz, Matthew H. G. (September 2019). "Pancreatic neuroendocrine tumors". Current Opinion in Gastroenterology. 35 (5): 468–477. doi:10.1097/MOG.0000000000000571. ISSN   0267-1379. PMID   31306159. S2CID   196812693.
  8. Burns, William R.; Edil, Barish H. (2012-03-01). "Neuroendocrine Pancreatic Tumors: Guidelines for Management and Update". Current Treatment Options in Oncology. 13 (1): 24–34. doi:10.1007/s11864-011-0172-2. ISSN   1534-6277. PMID   22198808. S2CID   7329783.
  9. Gurusamy, Kurinchi Selvan; Kumar, Senthil; Davidson, Brian R; Fusai, Giuseppe (2014-02-27). Cochrane Upper GI and Pancreatic Diseases Group (ed.). "Resection versus other treatments for locally advanced pancreatic cancer". Cochrane Database of Systematic Reviews (2): CD010244. doi:10.1002/14651858.CD010244.pub2. PMID   24578248.