[Pancreatic cancer. Molecular and surgical pathology]

The incidence of ductal adenocarcinoma of the pancreas shows a slight upward trend, while the prognosis for patients with pancreatic cancer remains poor. Little progress has been made in early diagnosis due to accompanying chronic pancreatitis and the histopathologically well known "desmoplastic stroma reaction". The cancer originates in the ductal epithelium, while the cell of origin is the "centroacinar" cell. Up to 20% of patients with pancreatic cancer have a family history of the disease. In about 10%, a hereditary tumor syndrome could be identified. At initial diagnosis, only 20% of patients with pancreatic cancer present with localized, potentially curable tumors. To ensure accurate staging of resected pancreatic cancer, care has to be taken in applying the correct R (residual tumor) classification, whereby the circumferential resection margins require particular attention. Tumor size as well as the number of resected (and examined) lymph nodes is of prognostic significance. Standardized protocols for uniform histopathological work-up are strongly recommended.