Table 3.1.

A brief summary of classification, characteristics and current treatments of exocrine and endocrine tumors of the pancreas

Origin	Types	Characteristics	Treatments
Pancreatic exocrine tumors	Adenocarcinoma	The most common type of pancreatic cancer, accounting for 75% of all pancreas cancer; nearly all of these are ductal adenocarcinoma; cause back pain when tumor grow large and invade nerves	Surgical resection: pancreaticoduodenectom, total pancreatectomy and distal pancreatectomy
	Acinar cell carcinoma	Rare cancerous tumor produces excessive amounts of digestive enzymes. Unusual skin rashes, joint pain and increased increased eosinophils level	First-line chemotherapy: Gemcitabine
	Adenosquamous carcinoma	Similar to adenocarcinoma that it forms glands, but it flattens as it grows. It can mimic other types of cancer that show squamous differentiation	Second line chemotherapy: 5-flourouracil (5-Fu), irinotecan, celecoxib, cisplatin and oxaliplatin
	Giant cell tumor	Extremely rare and is not aggressive as adenocarcinomas. It has unusually large cells	Combined therapy: ICM-C225 + Gem, erlotinib + Gem
	Intraductal papillary-mucinous neoplasm (IPMN)	Rare but very distinctive tumor. It grows along the pancreatic duct and appears to be a fingerlike projection into the duct
	Mucinous cystadenocarcinoma	Rare, cystic, fluid-containing pancreas tumor and can develop into cancer over time. The space within the spongy tumor is filled with a think fluid called mucin	Radiation therapy and chemoradiotherapy
	Pancreatoblastoma	Rare malignant tumor occurs primarily in children, and called pancreatic cancer of infancy
Pancreatic endocrine tumor	Insulinoma	Produce large amounts of insulin which result in hypoglycemia	Surgical resection Chemotherapy: Streptozocin, dacarbazine, doxorubicin and 5-Fu Combination therapy
	Glucagonoma	Produce excessive amounts of glucagon which result in severe dermatitis, mild diabetes, stomatitis, anemia, and weight loss	Distal pancreatectomy Standard chemotherapy: streptozocin and dacarbazine Octreotide: Reduce elevated glucagon levels, and control the hyperglycemia and dermatitis
	Gastrinoma	Release large quantities of the hormone gastrin into the blood stream leading to severe duodenal ulcers and persistent diarrhea	Surgical resection Chemotherapy: Proton pump inhibitors, like lansoprazole, pantoprazole esomeprasole, in high doses to control hypersecretion of gastric acid
	VIPoma	Releasing large amounts of the hormone VIP into the blood stream. Symptoms include watery diarrhea, hypokalemia, and either achlorhydria or hypochlorhydria.	Surgical excision Chemotherapy: Octreotide to reduce circulating VIP levels and control diarrhea No specific chemotherapy for VIPoma patients
	Somatostatinoma	Less common, releasing large quantities of the hormone somatostatin into the blood stream	Combination treatment with intravenous 5-FU and streptozotocin or doxorubicin and 5-FU