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Types of Pancreatic CancerThere are several types of pancreatic cancer, although the large majority are considered exocrine tumors because they arise from the exocrine pancreas, the ducts and glands in the pancreas which produce digestive juices and enzymes. However, these can vary in their presentation depending on their location and specific type. Much more rarely, endocrine pancreatic cancers can occur in the pancreas as well, arising from the endocrine cells in the Islets of Langerhans, the small islands of cells which produce endocrine hormones such as insulin and glucagon.
Exocrine TumorsExocrine tumors are the most common types of pancreatic cancer, by a long shot. Most of these tumors arise from the ducts, small tubes that carry secretions, of the pancreas and are called ductal carcinomas. Occasionally, they can also arise from the actual gland cells that make the pancreatic digestive secretions and are called acinar cell carcinomas.The pathologic type of these tumors is generally adenocarcinoma, a general term for cancers arising from glandular cells. Less commonly, other pathological types of pancreatic cancer, such as adenosquamous carcinoma, squamous cell carcinoma and giant cell carcinoma, can occur as well. These are distinguished from each other by a pathologist who studies biopsy tissue from the tumor under a microscope. Endocrine TumorsEndocrine tumors of the pancreas are much less common than exocrine tumors, making up only about 1% of all pancreatic cancers. They have several names. In general, they can be known as endocrine tumors of the pancreas, pancreatic neuroendocrine tumors (NETs), or islet cell tumors, since they arise from the islets of Langerhans.The more specific names depend on which cells in the endocrine pancreas they develop from. For example, tumors that arise from the cells that secrete insulin are called insulinomas, those that arise from cells that produce glucagon are called glucagonomas, and so on. Other examples include gastrinomas, somatostatinomas, VIPomas (vasoactive intestinal peptide) and PPomas (pancreatic polypeptide). Some, but not all, endocrine tumors secrete hormones into the blood. These are called functional or functioning tumors. Those that do not produce hormones are called non-functional or non-functioning. All these tumors can be benign or malignant. Generally, these tumors have a better prognosis than those of the more common exocrine cancers. The most common types are insulinomas and gastrinomas. Locations of Pancreatic CancerTumors of the pancreas can arise in any portion of the gland including the head, body and tail. However, tumors of the head and body are the most common. The location the cancer affects can have implications for the patient's symptoms, treatment and prognosis. For example, which a cancer in the head of the pancreas may obstruct (block) the larger ducts in the gland and cause symptoms earlier, tumors of the distal body or tail may not present symptoms until they are very large or have already spread (metastasized) to other organs. There are better treatment options and prognosis if pancreatic cancer is caught very early.
One particular subtype of pancreatic cancers are what are termed ampullary cancer or carcinoma of the ampulla of Vater. The ampulla of Vater is the place where the bile duct (from the liver) and the main pancreatic duct (which carries pancreatic juices) join together and empty their secretions into the small intestine to aid in digestion. This is a small area but cancers that start in this location deserve special mention. Because they arise directly from where all the bile and pancreatic duct flow empties, they can cause obstruction (blockage) of these ducts very quickly as the tumor grows. Blockage can lead to symptoms quickly, including pain, jaundice (yellowing of skin, eyes and other tissues), dark urine, pancreatitis, etc. For this reason, these tumors often come to medical attention early, while they are still very small. Therefore, the treatment and ultimate prognosis of these tumors tends to be better than other types of pancreatic cancers which grow large and invasive before causing obvious symptoms.
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