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🌱來自：pancreatic cancer

Genetics and path of pancreatic cancer

(Nat Rev Dis Primers 2016;2:16022) • Histologic types: adenocarcinoma (~85%), acinar cell carcinoma, endocrine tumors, cystic neoplasms (<10%); rarely, mets to pancreas (eg, lung, breast, renal cell) • Location: ~60% in head, 15% in body, 5% in tail; in 20% diffuse infiltration of pancreas • Adeno. mut.: KRAS (>90%), p16 (80–95%), p53 (50–75%), SMAD4 ( 55%), BRCA (10%)

• Arises from:
  • Acinar epithelial cells after acinar to ductal metaplasia
• Most common histology:
  • Adenocarcinoma
  • 70% of tumor mass is nonneoplastic desmoplastic (stromal component) composed of numerous cell types
• Sequential progression:
  • Premalignant PanIN to invasive adenocarcinoma
• PanIN:
  • Increases in histologic grade (1A/B → 2 → 3)
  • Increases in genetic complexity (KRAS mutation/overexpression → p16 loss → p53 & BRCA2 loss)
• Likely slow evolution to invasive disease, over decades:
  • Nature 2010;467:1114