Fact-sheet: Pancreatic adenocarcinoma
Updated on 04/23/2019 at 9:50 AM
View all RADEOS cases associated with this fact-sheet
Definition
The most common malignant tumor of the pancreas (85%).
Risk factors: smoking, alcohol, chronic pancreatitis, diabetes, obesity
Familial forms (hereditary pancreatitis, Von Hippel-Lindau disease, or HNPCC syndrome).
A cancer with a very poor prognosis: 5-year survival is 6%.
This cancer tends to extend into the posterior retroperitoneal fat and become unresectable.
80% of patients are unresectable at diagnosis.
The preferred sites of metastasis are the liver, peritoneum, and lung
Clinical features
- Severe abdominal pain radiating to the back and/or posteriorly.
- Jaundice (head tumor obstructing the common bile duct)
- Diabetes
- Acute pancreatitis, bowel obstruction, gastrointestinal bleeding, thromboembolic event, ascites, diarrhea due to maldigestion, anxiety/depression, panniculitis (Weber-Christian syndrome)
Ultrasound
Pancreatic mass syndrome. Search for lymphadenopathy and metastases.
CT
Pancreatic mass syndrome
Usually isodense on unenhanced images
Usually hypovascular - hypodense after contrast injection, and best seen at 30-40 seconds post IV
Contributes to locoregional staging including vascular involvement, and metastatic workup
3 scenarios:
- resectable cancer: surgery is certain to achieve R0
- locally advanced cancer: surgery will be at best R1
- borderline resectable cancer: uncertain
Criteria for unresectable cancers:
- distant metastases
- involvement of the superior mesenteric artery >180° and/or of the celiac trunk
- involvement of the aorta
- Unreconstructable thrombosis of the superior mesenteric vein and/or portal vein.
Criteria for borderline resectable tumors (limited and reconstructable vascular involvement):
- no distant metastases
- involvement of the superior mesenteric artery <180°
- unilateral or bilateral involvement of the superior mesenteric vein or portal vein >180°
- Short-segment, reconstructable thrombosis of the superior mesenteric vein
Classification
T - Primary tumor.
T0 No evidence of primary tumor
Tis Carcinoma in situ
T1 Tumor <=2 cm in greatest dimension
T2 Tumor >2 cm and <=4 cm in greatest dimension
T3 Tumor >4 cm
T4 Tumor involving the superior mesenteric artery or the common hepatic artery
N - Regional lymph nodes
N0 No regional lymph node metastasis
N1 Metastasis in 1 to 3 regional lymph nodes
N2: Metastasis in >=4 regional lymph nodes
M - Distant metastasis
M0 No distant metastasis
M1 Distant metastasis present