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7 slides generated from the cancer page, with a quiz from the open benchmark and speaker notes that cite the sources. Arrow keys move between slides; Print gives one slide per page.
IPMN-associated carcinoma is pancreatic cancer that has grown out of a mucus-producing cyst in the pancreatic duct. Because the cyst is often being watched, the cancer is found smaller and earlier, and about four in ten patients are alive five years after surgery against two in ten for ordinary pancreatic cancer; the advantage belongs to the colloid type, not the tubular type.
What it is. Intraductal papillary mucinous neoplasms progress through low- and high-grade dysplasia to invasive carcinoma of two main types, tubular (which looks like ordinary ductal adenocarcinoma) and colloid (mucin pools), with a rarer oncocytic type; the 2015 Baltimore consensus asks pathologists to measure the distance between the IPMN and the invasive cancer and to sample the tissue between, because a carcinoma that is merely concomitant (arising separately in the same gland) should be genetically distinct from one associated with the IPMN (Basturk 2015). The parent cyst page carries the Fukuoka and Kyoto surveillance rules; this page is the cancer that surveillance is trying to pre-empt.
How it differs from its parent. In 1,260 consecutive resections for pancreatic adenocarcinoma, 132 (10 percent) were IPMN-associated and their five-year survival was 42 percent against 19 percent, explained by lower T stage, fewer node metastases, lower grade, fewer positive margins and less perineural and vascular invasion; when any one of those adverse features was present, survival fell to that of ordinary disease (Poultsides 2010). In 61 invasive IPMNs against 570 ductal adenocarcinomas, 62 percent were tubular, 26 percent colloid and 12 percent oncocytic; the favourable outcome (hazard ratio 0.58 after stage matching) held only for colloid and oncocytic carcinomas, while tubular carcinoma was no better than ordinary ductal cancer; colloid carcinomas arose from intestinal-type, mostly main-duct IPMNs and tubular carcinomas from gastric-type, often branch-duct IPMNs (Mino-Kenudson 2011). In a matched comparison of 59 patients, three- and five-year survival were 76 and 68 percent, and tubular histology carried 3.7 times the hazard of death of colloid histology (Yopp 2011).
| Setting | Approach | Guideline |
|---|---|---|
| Resectable | Pancreatoduodenectomy, distal pancreatectomy or total pancreatectomy according to the extent of duct involvement, with regional lymphadenectomy and adjuvant chemotherapy as for ductal adenocarcinoma; surveillance of the remnant gland. | not mapped |
| Advanced | Treated as pancreatic ductal adenocarcinoma: resection with adjuvant chemotherapy when removable, the chemotherapy rows of the parent page when not; the parent record carries the trials. | not mapped |