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Ca Παγκρέατος – Εξωκρινής μοίρα
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AJCC Stages
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Stages
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T
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N
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M
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0
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Tis
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N0
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M0
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IA
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T1
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N0
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M0
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IB
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T2
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N0
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M0
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IIA
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T3
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N0
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M0
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IIB
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T1
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N1
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M0
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T2
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N1
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M0
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T3
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N1
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M0
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III
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T4
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Any N
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M0
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IV
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Any T
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Any N
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M1
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(T) Primary Tumor
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TX
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Primary tumor cannot be assessed
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T0
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No evidence of primary tumor
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Tis
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Carcinoma in situ*
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T1
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Tumor limited to the pancreas, ≤ 2 cm in greatest dimension
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T2
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Tumor limited to the pancreas, > 2 cm in greatest dimension
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T3
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Tumor extends beyond the pancreas but without involvement of the celiac axis or the superior mesenteric artery
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T4
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Tumor involves the celiac axis or the superior mesenteric artery (unresectable primary tumor)
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*This also includes the "PanInIII" classification.
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(N) Regional Lymph Nodes
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NX
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Regional lymph nodes cannot be assessed
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N0
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No regional lymph node metastasis
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N1
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Regional lymph node metastasis
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(M) Distant Metastasis
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M0
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No distant metastasis
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M1
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Distant metastasis
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Χαρακτηριστικά Επέκτασης
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Local invasion
- Vascular invasion
- Celiac trunk
- Superior mesenteric artery (SMA)
- Common and proper hepatic artery
- Gastroduodenal artery (GDA)
- Splenic artery
- Portal vein
- Superior mesenteric vein (SMV)
- Splenic vein
- Primary tumor in pancreatic head &/or uncinate
- Duodenum
- Stomach
- Inferior vena cava
- Aorta
- Right renal artery
- Primary tumor in pancreatic body &/or tail
- Transverse colon and mesocolon
- Stomach
- Left renal vein
- Left adrenal gland
- Superior pole of left kidney
- Spleen
- Splenic flexure of colon
- Inferior vena cava
- Aorta
Lymphatic spread
- Pancreatic head and uncinate tumors
- Anterior and superior pancreatic head
- Drain along anterior superior pancreaticoduodenal vessels to pyloric and celiac axis nodes
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- Posterior and superior pancreatic head
- Drain along posterior superior pancreaticoduodenal vessels to pyloric and celiac axis nodes or along common bile duct to portal vein and to hepatic hilar nodes
- Inferior pancreatic head and uncinate
- Drain along inferior pancreaticoduodenal vessels to superior mesenteric and paraaortic nodes
- Pancreatic body and tail tumors
- Drain either along splenic artery to celiac axis nodes or splenic hilar nodes
Perineural/perivascular spread
- Pathways similar to lymphatic spread of tumor
- 80% of pancreatic carcinomas demonstrate perineural invasion on pathology
Hematogenous spread
- Occurs late in disease, but common for patients to have hematogenous metastases at time of presentation
- Hepatic metastases are common
- Pancreas drained by portal venous structures
- Hepatic sinusoids lack basement membrane and are relatively porous, which is thought to allow metastases to permeate into space of Disse
- Distant hematogenous metastases are less common and generally only seen in advanced disease (lung, pleura, adrenal glands, brain, bone, other)
Peritoneal spread
- Common location of metastatic disease
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Κατηγοριοποίηση (Ιστολογικοί Τύποι)
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Ductal origin (> 95%)
- Ductal adenocarcinoma (> 85%)
- Cystic mucinous carcinoma
- Noncystic mucinous carcinoma (colloid Ca)
- Associated with more protracted course
- Undifferentiated carcinoma
- Sarcomatoid (spindle cell)
- Anaplastic giant cell
- Carcinosarcoma
- Undifferentiated carcinoma with osteoclast-like giant cells
- Adenosquamous carcinoma
- Intraductal papillary mucinous carcinoma
- Signet ring cell carcinoma
- Serous cystadenocarcinoma (very rare)
- Medullary carcinoma (very rare)
Acinar origin (1-2%)
Mixed origin
- Mixed ductal-endocrine carcinoma (rare)
- Behaves similar to ductal carcinoma
- Mixed ductal-acinar carcinoma (rare)
- Behaves similar to ductal carcinoma
- Mixed acinar-endocrine carcinoma
- Behaves similar to acinar carcinoma
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- Pancreatoblastoma
- Typically includes all 3 cell types (endocrine, ductal, acinar) but composed of cells of acinar origin
- Typically in children (peak age: 4 years) with small 2nd peak in 4th decade of life
Supportive element origin
- Squamous cell carcinoma (very rare)
Unknown origin
- Solid pseudopapillary carcinoma
Borderline, indolent, or premalignant neoplasms
(up to 2% of exocrine pancreatic Ca arise from these)
- Intraductal papillary mucinous neoplasm (IPMN)
- Pancreatic intraepithelial neoplasia III (PanInIII)
- Mucinous cystadenoma
- Intraductal oncocytic papillary neoplasm (rare)
- Solid pseudopapillary tumor
According to 2010 AJCC staging guidelines, pancreatic exocrine and endocrine tumors now utilize same staging system, which was previously reserved for exocrine pancreatic carcinoma
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