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2) What exactly is pancreatic cancer? (continued)

Pathologist examine histological slides (slides of tissue samples) microscopically to diagnose pancreatic cancer. To make the cells visible the tissues are stained with various dyes. A change in color from one slide to another does not indicate any disease or abnormality. The different colors indicate that a different dye has been used or a different part of the cells is stained. Pathologists identify abnormalities by changes in the size, shape or arrangement of cells.

Types of Pancreas Tumors

Non-Endocrine
Adenocarcinomas   Most Common Click to view	This is the form of cancer that most people are talking about when they refer to "cancer of the pancreas." These tumors account for 75% of all pancreas cancers. Microscopically, adenocarcinomas form glands (collections of cells surrounding an empty space.) These tumors can grow large enough to invade nerves which can cause back pain. They also frequently spread (metastasize) to the liver or lymph nodes. If this happens the tumor may be considered unresectable.
The following rare non-endocrine tumors are listed alphabetically.
Acinar Cell Carcinomas Click to view	These rare cancerous tumors may produce excess amounts of the digestive enzymes normally produced by the pancreas.This increase in enzymes causes distinct symptoms in 20% of acninar cell carcinoma cases. Symptoms may include unusual skin rashes, joint pain and an increased level of eosinophils, a type of white blood cell. Microscopically, these tumors have a characteristic grainy appearance. Special tests, including electron microscopy, can often be used to diagnose this type of tumor.
Adenosquamous Carcinomas Click to view	This rare variant of pancreatic cancer is similar to adenocarcinoma because it also forms glands. These tumors also show "squamous differentiation." This means that the cells tend to flatten out as they grow. This variant is important to recognize because it may mimic other types of cancer that often show squamous differentiation. For example, cancer of the esophagus.
Giant Cell Tumors Click to view	These tumors are extremely rare and are important to identify because they may not be as aggressive as the more common adenocarcinomas. As the name indicates, these tumors have unusually large "giant" cells. This does not mean that the tumor itself is larger than other types of tumors.
Intraductal Papillary-Mucinous Neoplasms Click to view	These rare but very distinctive tumors were first described in Japan in the 1980's. The tumors characteristically grow along the ducts of the pancreas that drain the pancreatic fluid into the small intestine. Microscopically, they usually appear as finger-like projections (papillae) into the duct. Some of these tumors are benign and some are malignant (cancerous). Naturally, this distinction is extremely important to make and can only be determined by a microscopic examination of the tissue.
Mucinous Cystadenocarcinomas Click to view	This is a rare, cystic, fluid containing, tumor of the pancreas. The spaces within this spongy tumor are filled with a thick fluid called mucin. Unlike the serous cystadenomas, these tumors can develop into cancer over time. These tumors may be benign or fully cancerous. Even in cases where cancer is found the prognoses for these tumors are better than for the common adenocarcinomas.
Pancreatoblastomas Click to view	These rare malignant tumors primarily occur in children. The reason for this is unknown. These tumors are referred to as the "pancreatic cancer of infancy." Microscopically, these tumors appear as nests of flat (squamoid cells) floating in a sea of more uniform cells. The survival rate for patients with these tumors is better than for those with adenocarcinomas.
Serous Cystadenomas Click to view	These rare tumors are usually benign (non-cancerous) growths. They are cystic, fluid containing, tumors with a sponge-like appearance. However, they can grow to be quite large and may need to be surgically removed if symptoms such as pain and weight loss occur. The vast majority of patients with this type of tumor are cured by its removal.
Solid and Pseudopapillary Tumors Click to view	These rare tumors occur primarily in women in their 30's. As the name implies some parts of the tumors are solid and some are papillary. These benign tumors have a very good prognosis although the tumors can spread so they should be removed completely.
Endocrine
Endocrine (Islet Cell) Tumors Click to view	These tumors are far less common than the non-endocrine tumors listed above. They account for about 1% of pancreatic cancers. It is very important that endocrine tumors be distinguished from non-endocrine because the treatments for the two types are very different. The endocrine tumors may produce highly active hormones and therefore have very dramatic symptoms. There are different kinds: Insulinomas produce large amounts of insulin which can result in hypoglycemia ( low blood sugar). Glucagonomas produce glucagon which can result in a very striking skin rash (necrolytic migratory erythema.) While most endocrine tumors of the pancreas behave in a benign fashion, it can be very difficult to predict the behavior of these tumors. A complete list and discussion of endocrine tumors can be found in the endocrine section of this web site.

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