obsolete secondary malignant neoplasm to the pancreas

Secondary Malignant Neoplasm of Pancreas: An Obsolete Term

A secondary malignant neoplasm of the pancreas, also referred to as a metastatic tumor to the pancreas, is a type of cancer that originates from another part of the body and spreads to the pancreas. This term was previously used to describe such tumors, but it has since been replaced by more specific and accurate terminology.

Current Understanding

According to recent studies [3], pancreatic adenocarcinoma is the second most common cause of death from cancer in the gastrointestinal tract. The majority of pancreatic cancers arise in the head of the pancreas, with a smaller percentage occurring in the body and tail [4]. These tumors can be primary or secondary, with the latter originating from other parts of the body.

Common Primary Sites

Research has shown that lung cancer is the most common source of metastasis to the pancreas, followed by gastrointestinal carcinomas and lymphomas [10]. These secondary tumors are usually detected in patients with disseminated disease and are often found during autopsies. The incidence of pancreatic secondary tumors was reported to be around 15% in autopsy cases of malignant tumors [11].

Clinical Implications

The presence of a secondary malignant neoplasm in the pancreas can have significant clinical implications, including changes in treatment approaches and outcomes. A study on secondary neoplasms of the pancreas found that these tumors can manifest different clinicopathological characteristics and outcomes compared to primary pancreatic carcinomas [15].

References:

[3] M Ducreux (2024) - Of all the GI malignancies, pancreatic adenocarcinoma is the second most common cause of death from cancer. [4] M Ducreux (2015) - Approximately 60%–70% of pancreatic cancer arises in the head of the

Diagnostic Tests for Secondary Malignant Neoplasms to the Pancreas

Secondary malignant neoplasms (SMNs) to the pancreas are a type of cancer that originates from another part of the body and metastasizes to the pancreas. Diagnosing SMNs to the pancreas can be challenging, but various diagnostic tests can help confirm the presence of these tumors.

• Imaging studies: Imaging techniques such as computed tomography (CT) scans, magnetic resonance imaging (MRI), and positron emission tomography (PET)/CT scans can help identify masses in the pancreas [8]. These tests can also provide information on the size and extent of lymph node metastases [3].
• Endoscopic ultrasonography (EUS): EUS-guided fine-needle aspiration (FNA) is a safe and accurate method for diagnosing pancreatic metastases from different primary carcinomas [4]. This test can determine tumor size, assess lymph node involvement, and evaluate portal venous invasion.
• Blood tests: A pancreas blood test can detect tumor markers such as CA19-9, which may indicate the presence of cancer [9].
• Immunohistochemical stains: If the differential diagnosis includes a nonductal malignant tumor or metastatic adenocarcinoma, immunohistochemical stains on a cell block can be used to confirm that a malignant tumor is likely a pancreatic ductal adenocarcinoma (PDAC) [10].

It's essential to note that diagnosing SMNs to the pancreas often requires a combination of these tests and careful evaluation by a healthcare professional. The diagnostic accuracy of these tests may vary, and additional testing may be necessary to confirm the diagnosis.

References:

[4] C Triantopoulou · 2012 · Cited by 68 — EUS-guided FNA is safe and accurate for the diagnosis of pancreatic metastases from different primary carcinomas. [8] B PAN · 2012 · Cited by 36 — Besides imaging studies, such as computed tomography (CT) scan, bone scan and positron emission tomography (PET)/CT scan, endoscopic ultrasound (EUS)-guided ... [9] A pancreas blood test can detect tumor markers. A tumor marker is a substance that may indicate the presence of cancer. For pancreatic cancer, high levels of ... [10] Because PDAC accounts for the majority of malignancies in the pancreas, immunohistochemical stains on a cell block can be used to confirm that a malignant tumor is likely a PDAC.

Treatment Options for Recurrent Pancreatic Cancer

Recurrent pancreatic cancer, also known as metastatic pancreatic cancer, is a challenging condition to treat. When the disease progresses or recurs after initial treatment, various drug options are available to manage the symptoms and slow down the progression of the disease.

• Gemcitabine-based chemotherapy: This remains a common treatment option for recurrent pancreatic cancer, particularly when the disease has spread to other parts of the body (metastasized). Gemcitabine is often used in combination with other drugs like 5-fluorouracil (5-FU) or leucovorin.
• FOLFIRINOX: This is a combination chemotherapy regimen that includes 5-FU, leucovorin, irinotecan, and oxaliplatin. FOLFIRINOX has been shown to be effective in treating metastatic pancreatic cancer, especially in patients who have not received prior treatment.
• Liposomal irinotecan: This is a newer drug that has been approved for use in combination with 5-FU/LV (leucovorin) for the treatment of metastatic pancreatic cancer. Liposomal irinotecan works by targeting and killing cancer cells, while also reducing side effects.
• Targeted therapy: Targeted therapies, such as Lynparza (olaparib), are designed to specifically target cancer cells with genetic mutations. In the case of Lynparza, it is approved for use in patients with metastatic pancreatic adenocarcinoma who have inherited BRCA mutations and whose tumors did not progress after treatment with a first-line platinum-based chemotherapy.

Other Treatment Options

In addition to these drug treatments, other options may be considered depending on individual patient needs. These include:

• Surgery: In some cases, surgery may be an option for patients with recurrent pancreatic cancer.
• Radiation therapy: Radiation therapy can also be used to manage symptoms and slow down the progression of the disease.

References

1. [2] by R Imperial · 2024 — Upon progression of disease or recurrence, subsequent second-line treatment is still gemcitabine or 5-fluorouracil based chemotherapy, depending ...
2. [10] For the first-line treatment of metastatic pancreatic cancer, ...
3. [11] Drug development in pancreatic cancers is challenging. The overall success rate for drugs in phase 3 clinical trials of patients with solid tumors is approximately 40%. ... as well as the toxicity profile of the therapeutic regimen.
4. [13] The Food and Drug Administration (FDA) recently approved the treatment Lynparza® (olaparib) for use in a group of pancreatic cancer patients: those with stage IV pancreatic adenocarcinoma who have germline (inherited) BRCA mutations and whose tumors did not progress after treatment with a first-line platinum-based chemotherapy.

The differential diagnosis of an obsolete secondary malignant neoplasm to the pancreas involves considering various types of tumors that may have metastasized to the pancreas. According to the available information, the most common sources of metastasis to the pancreas are:

• Lung cancer [10]
• Gastrointestinal carcinomas [10]
• Lymphomas [10]

These tumors are usually seen in patients with disseminated disease and are detected mainly in autopsies. Secondary tumors constitute about 4% of pancreatic specimens in surgical databases [10].

In addition to these, other types of malignant neoplasms that may metastasize to the pancreas include:

• Malignant melanoma [13]
• Other extrapancreatic tumors [15]

It's worth noting that the differential diagnosis of a pancreatic cancer should always consider the possibility of a secondary neoplasm [11].

References: [10] Intraductal papillary mucinous neoplasms (IPMNs) represent approximately 1% of all pancreatic neoplasms and 25% of cystic neoplasms. They are divided into three types: main duct-IPMN (MD-IPPMN), branch duct-IPMN (BD-IPMN), and mixed type-IPMN. ... Hsiao et al evaluated the utility of the 2006 Sendai and 2012 Fukuoka guidelines in the ... [11] In principle, the possibility of a secondary neoplasm should always be considered as a differential when diagnosing a pancreatic cancer. This chapter focuses on the more common malignant neoplasms that metastasize to the pancreas, and provides detailed information on the differential diagnosis, including a table with useful immunohistochemical ... [13] A further important differential diagnosis of poorly or undifferentiated pancreatic carcinoma is malignant melanoma. Diffuse sheets of non-cohesive tumor cell growth, marked cellular atypia, and prominent nucleoli may be seen in both lesions. Up to 10 % of patients with malignant melanoma metastatic to the pancreas may not have a known ­primary. [15] The vast majority of pancreatic carcinomas are primary, and, among these, more than 90% are of ductal origin. However, a variety of extrapancreatic tumors may involve the pancreas secondarily and may manifest different clinicopathological characteristics and outcomes. In this study, pathology material from 973 surgical specimens and 4955 adult autopsy cases was reviewed to identify the tumors ...