From the Guidelines
Pancreatic cancers can be ranked from most to least aggressive as follows: Pancreatic ductal adenocarcinoma (PDAC) is generally the most aggressive type, followed by acinar cell carcinoma, poorly differentiated pancreatic neuroendocrine tumors (PNETs), well-differentiated PNETs, solid pseudopapillary neoplasms, mucinous cystic neoplasms, and serous cystadenomas being the least aggressive. The aggressiveness of pancreatic cancer is determined by factors including cell differentiation, location within the pancreas, stage at diagnosis, and molecular characteristics 1.
Key Factors Influencing Aggressiveness
- Cell differentiation: Well-differentiated tumors tend to have a better prognosis than poorly differentiated ones 1.
- Location within the pancreas: Tumors located in the head of the pancreas may have a worse prognosis due to earlier involvement of major vessels and surrounding structures.
- Stage at diagnosis: Early detection significantly impacts treatment outcomes, but pancreatic cancer is often diagnosed at advanced stages due to vague initial symptoms 1.
- Molecular characteristics: Certain molecular markers, such as Ki-67 index, can help predict the aggressiveness of pancreatic neuroendocrine tumors 1.
Ranking of Pancreatic Cancers by Aggressiveness
- Pancreatic ductal adenocarcinoma (PDAC): Most aggressive, with a 5-year survival rate of less than 10% 1.
- Acinar cell carcinoma: Highly aggressive, with a slightly better prognosis than PDAC.
- Poorly differentiated pancreatic neuroendocrine tumors (PNETs): Aggressive, with a worse prognosis than well-differentiated PNETs 1.
- Well-differentiated PNETs: Less aggressive, with a better prognosis than poorly differentiated PNETs 1.
- Solid pseudopapillary neoplasms: Low-grade malignancies with good prognosis.
- Mucinous cystic neoplasms: Malignant potential, but less aggressive when detected early.
- Serous cystadenomas: Typically benign and the least aggressive. It is essential to note that the ranking of pancreatic cancers by aggressiveness can vary depending on individual patient factors and the specific characteristics of the tumor 1.
From the Research
Pancreatic Cancers in Order of Aggressiveness
The following list outlines pancreatic cancers in order of aggressiveness, from most aggressive to least aggressive, based on available evidence:
- Adenosquamous carcinomas: These are recently recognized under the "basal" like category in profiling studies and are actually even worse prognostically than PDACs 2
- Pancreatic ductal adenocarcinoma (PDAC): This is the most common and most important cancer of the pancreas, with rapid mortality and poor five-year survival rates of 2%-9% 2, 3, 4
- Poorly differentiated (neuro)endocrine carcinoma: This type of tumor is high grade and has a poor prognosis 5
- Medullary carcinomas: These appear to have different biology and are more aggressive than some other types of pancreatic cancer 2
- Acinar cell carcinomas: These are non-ductal cancers with their respective clinicopathologic and molecular associations 2
- Ampullary adenocarcinoma: This type of cancer has a variable prognosis based on factors such as patient age, TNM classification, differentiation grade, and treatment modality received 6
- Colloid carcinoma: This type of cancer has a much better behavior than PDAC and may require an entirely different treatment approach 2
- Well differentiated (neuro)endocrine carcinoma: This type of tumor is low grade and has a better prognosis than poorly differentiated (neuro)endocrine carcinoma 5
- Neuroendocrine tumors of the ampulla: These are distinct entities presenting clinically with jaundice and have a good outcome with pancreaticoduodenectomy 5