Pancreatic Cancer Awareness Month 2025

Pancreatic Cancer Awareness Month

Pancreatic cancer is a spectrum disease of pancreatic cancer, which majorly include pancreatic ductal adenocarcinoma (one of the exorcrine carcinomas) and neuroendocrine neoplasms. Due to the anatomical location of the pancreas, the mass lesions of the pancreas could be very difficult to be detected until the patients show late stage of the cancers. Approximately 60%-70% of pancreatic ductal adenocarcinoma (PDAC) are found in the head of the pancreas, 60 – 70%; in the body, 5 – 15%; and in the tail, 10 – 15%. About 50% of the head tumors have distention of biliary tree and progressive jaundice; around 85% of the head tumors have extension beyond pancreas at diagnosis. In the body / tail locations, the carcinomas are typically larger at diagnosis since these tumors do not cause symptoms until late. Approximately 25% of pancreatic ductal adenocarcinoma have peripheral venous thrombi and metastases are common at diagnosis. Fine needle aspiration guided by ultrasound (EUS-FNA) has been a very popular tool for making diagnosis when pancreatic carcinoma is suspected. EUS-FNA has sensitivity and specificity of > 90% and 100%; sensitivity being increased with ThinPrep. FNA brushings are 50% sensitive. Duodenal secretions are 80% sensitive in head tumors, 33% sensitive in tail tumors and endoscopic retrograde cholangiopancreatography (ERCP) juice is 50 – 85% sensitive. (Arch Pathol Lab Med 2000;124:387) Immunohistochemistry (IHC) plays an essential and important role in diagnostic pathology. FNA can present broken architectures of the malignant tumors although the cytology reveal the features of malignancy, IHC can be applied to raise the confidence to make an accurate diagnosis for pathologists. By using multiple antibodies, the IHC assays can show the following: Carcinoma cells could be positive stains in maspin, placental S100 (S100P), IMP3 (all positive in > 90% PDACs); p53 expressed in most cases; CK7, CK8, CK18, CK19, MUC1, MUC3, MUC4, MUC5AC, CEA, B72.3, CA19-9, CA125 (48%). (Arch Pathol Lab Med 2012;136:601, Hum Pathol 2013;44:503) Tumor cells can be negative stains in pVHL negative / loss seen in > 90% PDACs (Arch Pathol Lab Med 2012;136:601, Hum Pathol 2013;44:503); in loss of SMAD4 / DPC4 seen in 55%; specific for malignancy (in situ or invasive) (Am J Clin Pathol 2001;116:831) and tumor cells can be negative in CK20, MUC2, vimentin, synaptophysin, chromogranin, trypsin, chymotrypsin, lipase.