Biologic Behaviour

•pancreatic ADC is a tumor of the exocrine pancreas originating in either the acinar cells or ductular epithelium

•very rare in cats and rare in dogs accounting for < 0.05% of all cancers

•75% of feline pancreatic carcinomas are diffuse

•75% of pancreatic carcinomas in humans are located in the head of the pancreas with invasion of the duodenum, stomach, and bile duct common

•N-ethyl-N'-nitro-N-nitrosoguanidine induces pancreatic ADC in dogs with intraductal administration

•exocrine pancreatic carcinoma has been diagnosed concurrently with diabetes mellitus and hyperadrenocorticism in 3 cats and diabetes mellitus in 22% (8/37) cats suggesting a possible association between these disease

•metastasis to regional lymph nodes and distant sites is frequent with 50%-78% metastatic rate at diagnosis

•metastatic sites: liver, small intestine, and lungs in cats and dogs, and mesenteric lymph nodes, mesentery ± skull and vertebrae in dogs

Signalment

•breed predisposition: Labrador Retriever, Boxer, Cocker Spaniel, and Airedale Terrier

•sex predilection: female dogs

•median age 12 years in cats and 10 years in dogs

Clinical Signs

•clinical signs are non-specific and include vomiting, anorexia, weakness, weight loss, maldigestion, exocrine pancreatic insufficient, icterus with obstruction of the common bile duct ± abdominal effusion secondary to peritoneal metastasis, carcinomatosis, or compression of the caudal vena cava

•clinical signs are similar to pancreatitis

Diagnosis

•blood test abnormalities are non-specific and include mild anemia, neutrophilia, and bilirubinemia

•serum amylase and lipase are inconsistently elevated

•barium studies may reveal slow intestinal transit time or invasion or compression of the duodenum

•pancreatic mass detected with either survey radiographs or abdominal ultrasonography in 50% cases

•ultrasound-guided aspirate cytology sensitive with correct diagnosis in 92%

•DDx: pancreatic nodular hyperplasia and pancreatic pseudocyst

Treatment

General Considerations

•treatment is complicated by frequent and extensive local invasiveness and metastasis

Surgery

•surgical techniques: complete pancreatectomy or pancreaticoduodenectomy (Whipple's procedure)

•high morbidity and mortality (5%-30% in humans) without significant improvement in survival

•palliative surgical techniques include duodenal by-pass (i.e., gastrojejunostomy) and biliary diversion

Chemotherapy

•unknown effect in animals and limited value in humans with pancreatic ADC

•taxols and gemcitabine have been used with some improvement in survival time in humans

Prognosis

•poor prognosis due to location, local invasiveness, and metastasis

•survival time < 7 days in all cats