Exocrine and endocrine malignancies of the pancreas

1. Big picture

Pancreatic malignancies are divided into two major groups:

1. Exocrine pancreatic malignancies Mostly pancreatic ductal adenocarcinoma, the classic “pancreatic cancer.” It is aggressive, often diagnosed late, and surgery is possible only in a minority of patients.

2. Endocrine pancreatic malignancies Pancreatic neuroendocrine tumours, also called pancreatic NETs or islet cell tumours. They may be functional and produce hormones, or non-functional and present as a mass/metastasis.

The surgical exam question is:

Pancreatic mass
      ↓
Exocrine adenocarcinoma or neuroendocrine tumour?
      ↓
Head/uncinate or body/tail?
      ↓
Resectable, borderline, locally advanced, or metastatic?
      ↓
Whipple / distal pancreatectomy / total pancreatectomy / enucleation / palliation

The key oral-exam sentence:

The only potentially curative treatment for most pancreatic malignancies is complete surgical resection with negative margins, but resectability depends mainly on metastatic disease, vascular involvement, tumour location, and patient fitness.

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