Loading
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.
MCN-associated carcinoma is pancreatic cancer that has developed inside a mucinous cystic neoplasm, a thick-walled cyst with ovary-like tissue in its wall that occurs almost only in women, usually in the tail of the pancreas. Most such cysts are benign when removed; the minority with invasive cancer are larger, carry nodules and occur in older women, and about six in ten survive five years.
What it is. A mucinous cystic neoplasm is defined by ovarian-type stroma in the cyst wall and by the absence of communication with the pancreatic duct; the 2019 WHO classification grades it as MCN with low- or high-grade dysplasia or MCN with associated invasive carcinoma (Nagtegaal 2020). The invasive component is usually a tubular ductal adenocarcinoma and occasionally colloid or undifferentiated with osteoclast-like giant cells (Adsay 2001; Muraki 2016).
How it differs from its parent. In 163 resected MCNs defined by ovarian stroma, 95 percent were in women and 97 percent in the distal pancreas; 72 percent were adenomas, 10.5 percent borderline, 5.5 percent carcinoma in situ and 12 percent invasive carcinoma; patients with invasive cancer were older (55 against 44 years); every cancer was 40 mm or larger or had nodules; five-year disease-specific survival was 100 percent for non-invasive and 57 percent for invasive MCNs, and only invasive tumours recurred (Crippa 2008). In 156 Japanese cases, 82.7 percent were adenomas, 13.4 percent non-invasive carcinomas and 3.9 percent invasive; 98.1 percent were women with a mean age of 48, mean size 65 mm, and five- and ten-year survival were 96.6 percent overall, with cyst diameter and mural nodules predicting malignancy (Yamao 2011).
| Setting | Approach | Guideline |
|---|---|---|
| Resectable | Distal pancreatectomy with splenectomy (minimally invasive where expertise exists, DIPLOMA), pancreatoduodenectomy for the rare head lesion; adjuvant chemotherapy as for ductal adenocarcinoma when invasive carcinoma is found. | 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 |