Pancreatic tumors

Generality

Pancreatic tumors are neoplasms, benign or malignant, that originate at the level of the pancreatic gland.

There are two main types of pancreatic cancers: tumors of the endocrine pancreas and tumors of the exocrine pancreas .

The first type includes all pancreatic neoplasms that develop from a cell of the Langerhans islands; an example of endocrine pancreatic cancer is insulinoma.

The second type, on the other hand, includes all pancreatic neoplasms that originate from a pancreas cell responsible for the production of enzymes necessary for digestion; the most important example of exocrine pancreatic cancer is pancreatic cancer .

According to the doctors, some particular factors affect the appearance of pancreatic tumors, including: smoking, obesity, advanced age and chronic pancreatitis.

For a precise diagnosis, it is essential to use instrumental examinations (ultrasound, MRI, CT scan, biopsy, etc.).

Pancreatic cancer therapy may include surgery, chemotherapy and / or radiotherapy.

Brief anatomical revision of the pancreas

The pancreas is a voluminous gland, weighing 70-80 grams, about 15 centimeters long and placed transversely at the level of the first two vertebrae of the lumbar region, just behind the stomach .

In the pancreas, the anatomists identify three portions:

The so-called head, which, embraced centrally by the "C" of the duodenum, represents the right end of the gland.
The so-called body, which, located in front of the spine, constitutes the central part of the organ.
The so-called tail, which, located near the spleen, represents the left end of the organ.

The pancreas has a dual function:

produces essential enzymes for digestion ( exocrine function )
secretes hormones that it releases into the blood ( endocrine function )

To deal with the exocrine function of the pancreas are cells grouped in small roundish berries, which pour back what they produce into the "C" of the duodenum, through the excretory ducts of Wirsung and Santorini (pancreatic ducts); taken together, these cells are also called exocrine pancreas .

On the other hand, the endocrine function is performed by special agglomerates of cells, scattered throughout the pancreas and called islands of Langerhans .

Constituting the so-called endocrine pancreas, the islands of Langerhans produce hormones:

Glucagon, using pancreatic alpha cells .
Insulin, using pancreatic beta cells .
Somatostatin, via the pancreatic delta cells .
Gastrin, by pancreatic G cells .
Pancreatic peptide, using pancreatic PP cells .

Functions of hormones secreted by the islets of Langerhans of the pancreas.
Hormone	Function
Glucagon	Glucagon is the hormone that raises blood glucose levels.
Insulin	Insulin is the hormone that lowers blood glucose levels and allows it to enter cells.
Somatostatin	Somatostatin is the hormone that inhibits stomach acid secretion.
Gastrin	Gastrin is the hormone that promotes the production of essential substances for the digestive process (eg digestive enzymes).
Pancreatic peptide	The pancreatic peptide appears to have an inhibitory role against the exocrine function of the pancreas.

Pancreatic tumors

Pancreatic tumors are benign or malignant neoplasms that originate from a cell constituting the pancreatic gland.

If the cell of origin of the tumor mass belongs to the so-called endocrine pancreas, we speak more properly of tumors of the endocrine pancreas or tumors of the neuroendocrine pancreas ; if instead the cell of origin of the neoplasia belongs to the so-called exocrine pancreas, it is more correct to speak of tumors of the exocrine pancreas .

Tumors of the endocrine pancreas

At least 4 tumor types can originate from the cells that make up the islands of Langerhans:

Insulinoma . It is the tumor of the endocrine pancreas that originates from pancreatic beta cells, or insulin-secreting cells. Generally, it is an adenoma, which is a benign tumor.
Glucagonoma . It is the tumor of the endocrine pancreas that originates from the pancreatic alpha cells, or glucagon-secreting cells. Generally, it is a malignant tumor.
Gastrinoma . It is the tumor of the endocrine pancreas that originates from pancreatic G cells, that is gastrin-secreting cells. As a rule, it is a malignant tumor.
The somatostatinoma . It is the tumor of the endocrine pancreas that originates from the pancreatic delta cells, or somatostatin-secreting cells. It can be both malignant and benign and usually characterizes the condition known as multiple endocrine adenomatosis of type I or MEN1 or Wermer syndrome (which associates somatostatinoma with other tumors of the parotid and pituitary glands).

To these 4 types of endocrine pancreatic cancer, another must be added - the so-called VIPoma - even if the cells from which it originates do not properly belong to the Langerhans islands.

The VIPoma derives from the cells of the endocrine pancreas that secrete the so-called VIP or Intestinal Vasoactive Peptide .

Tumors of the exocrine pancreas

Tumors of the exocrine pancreas may be benign or malignant; however, those of a benign nature are extremely rare.

Among the tumors of the exocrine pancreas, the most known and widespread is a malignant form commonly known as pancreatic carcinoma or pancreatic ductal adenocarcinoma . This tumor is one of the most deadly malignancies for humans; to motivate most of its high mortality is the fact that, often, in its initial phases it is asymptomatic, therefore difficult to recognize.

In addition to pancreatic cancer, other malignant tumors of the exocrine pancreas, worthy of a mention, are:

Pancreatic acinar cell carcinoma,
Pseudopapillary tumor of the pancreas e
Pancreatoblastoma .

The greater spread of pancreatic cancer, compared to the newly mentioned and benign tumors, explains the common (and imprecise) tendency to recognize in the first (ie in pancreatic ductal adenocarcinoma) the entire category of tumors of the exocrine pancreas.

Deepening: what is a carcinoma and an adenocarcinoma?

Carcinomas are malignant tumors that originate from an epithelial cell .

Adenocarcinomas are particular carcinomas that develop from an epithelial cell of an exocrine gland or from an epithelial cell belonging to a tissue with secretory properties.

LOCATION OF TUMORS OF PANCREAS ESOCRINO

Tumors of the exocrine pancreas can form in any portion of the pancreatic gland. However, from the diagnostic findings it emerges that their preferred location is the pancreas head (65% of clinical cases); the second most frequent is the body of the pancreas (30% of clinical cases); finally, the least common is the pancreas tail (only 5% of clinical cases).

Epidemiology

Tumors of the exocrine pancreas are decidedly more common than tumors of the endocrine pancreas . This explains why they call for more attention, from doctors, scientific articles, ordinary people and so on.

To give an idea of the spread of tumors of the exocrine pancreas, compared to those of the endocrine pancreas, an interesting statistical datum is reported: 95 malignant neoplasms of the pancreas per 100 are malignant tumors of the exocrine pancreas .

EPIDEMIOLOGY CARCINOMA DEL PANCREAS

Pancreatic cancer accounts for about 2% of all malignant tumors and about 10% of malignant tumors in the gastrointestinal tract, second only to colon cancer.

Regarding pancreatic cancer, recent statistical studies have observed that:

Its incidence has considerably increased in recent decades, reaching a frequency of 12.5 cases per 100, 000 inhabitants in countries such as, for example, the United States (where the neoplasm in question represents the fourth cause of death from cancer);
Survival rates one year after diagnosis and five years after diagnosis are approximately 27% and approximately 6%, respectively. This means, for the first case, that 73% of patients do not survive more than a year from the detection of the disease; for the second case, instead, that 94% of patients do not survive more than 5 years since the doctors diagnosed the disease;
Worldwide, the number of new diagnoses each year is around 280, 000; of these 280, 000 new diagnoses, around 10, 000 concern people resident in Italy;
As an increase in the number of female smokers (NB: cigarette smoking is a proven risk factor for pancreatic cancer), today the number of female patients has equaled the number of male patients (who, until a few years ago, were always been definitely more).

The people most at risk of getting pancreatic ductal adenocarcinoma are those between the ages of 60 and 80 ; among individuals under the age of 40 the malignant neoplasm in question is very rare.

Pancreatic cancer affects black individuals more frequently than white individuals.

Causes

Like most cancers, pancreatic tumors are masses of particularly active cells, which - due to a series of mutations in their DNA - have acquired the anomalous ability to divide and grow in an uncontrolled way.

Currently, despite numerous research on this subject, doctors have not yet identified what exactly triggers the mutations at the origin of pancreatic tumors; however, it is their opinion that, on the appearance of the neoplasm in question, factors and circumstances such as: have a more or less important influence:

Cigarette smoke . As is known, it is a risk factor for many malignant neoplasms;
An unhealthy diet, rich in fat and meat . It seems that a healthy diet, rich in fruits and vegetables, protects against pancreatic tumors;
Obesity . Several clinical studies have shown that many sufferers of pancreatic ductal adenocarcinoma have a history of overweight or, worse, obesity;
Chronic pancreatitis . It is a type of long-term inflammation of the pancreas. It seems that from its aggravation it could depend on the onset of some malignant tumors of the pancreas;
A family history of pancreatic cancer . According to some genetic studies, those who have (or have had) blood related patients with pancreatic cancer are more likely to develop the same malignancy;
Advanced age . The confirmation of how much aging can affect the onset of pancreatic tumors comes from the particular spread of these neoplasms among people aged 60-80.

Doubtful risk factors

In the past, among the risk factors of pancreatic cancer (particularly those of a malignant nature) diabetes mellitus, alcohol abuse and excessive consumption of coffee were also included .

Today, this is no longer the case, because recent in-depth research has provided conflicting results, compared to previous studies; even, as regards the excessive consumption of coffee, it seems that the latter has absolutely no relation with the appearance of neoplasms affecting the pancreatic gland.