Pancreas: neoplasia of the exocrine pancreas (adenocarcinoma)

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• Cause : rare as primary (<0.5% of all cancers) neoplasia of acinar or duct cells in central portion of pancreas. Usually occur in older animals, specifically Airdale terriers .
• Signs : non-specific - vomiting, fever, weakness, variable abdominal pain.
• Diagnosis : radiography, ultrasound, laparotomy and tissue biopsy.
• Treatment : symptomatic, not curative.
• Prognosis : very poor - often locally invasive and metastasized at presentation. If diagnosed at exploratory laparotomy; intra-operative euthanasia should be considered.

• Non-specific signs of gastrointestinal disease:
  • Weight loss .
  • Lethargy.
  • Inappetance.
  • Vomiting  
  • Dehydration.
  • Abdominal pain.

  May mimic pancreatitis .

• Weakness.
• Diarrhea.
• Icterus.

Extrahepatic bile duct obstruction may cause:

• Ascites.
• Jaundice.
• Abdominal effusion.

• Collapse.
• Peritonitis .
• Intestinal obstruction.
• Severe pain, localizable to anterior abdominal segment on palpation.

• Average age 9 years.

• Females.

• Airedale Terriers .

• Spaniels                     .

• Moderately expensive diagnostic procedures necessary for definitive diagnosis.

Pathogenesis

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• Adenocarcinoma of pancreatic duct or acinar cells.

• Malignant tumor arising from cells of ducts or acinae  pancreatic enlargement (  abdominal mass +/- pain, intestinal obstruction); abnormal function (  maldigestion, anorexia, weight loss); biliary obstruction (  jaundice).
• Metastasis  bone (  pathological fractures) and/or soft tissues.
• Some tumors  increased gastrin secretion  inappropriate acid secretion by stomach  gastroduodenitis.

• Rapid metastasis - usually already occurred at time of presentation.

Diagnosis

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• Vomiting  
• Jaundice.
• Abdominal mass.
• Weight loss .

• Anorexia.

• Vomiting  
• Weight loss .
• Chronic diarrhea  (exocrine pancreatic failure).

• Weakness.
• Polydipsia/polyuria (associated with diabetes mellitus  ).

• Abdominal pain.

• Icterus.
• Pyrexia.

• Anterior abdominal mass.
• Signs referable to metastasis to other organs.
• Wasting.
• Ascites.

• Biopsy via laparotomy, possibly ultrasound-guided:
  • Malignant pancreatic cells .

Abdominal radiography  :

• Pancreatic mass or loss of contrast (localized peritonitis) .
• Caudal displacement of colon .
• Mass lesion displacements of duodenum (laterally), greater curvature of stomach (cranially) viewed in right cranial abdomen on ventrodorsal view.
• Loss of serosal detail .
• Hepatic metastasis.
• Possibly no radiographic changes.

Thoracic radiography  :

• For detection of pulmonary metastasis.

• Pancreatic mass     or evidence of pancreatitis .
• More sensitive than radiography at detecting small amounts of peritoneal fluid around pancreas.
• Examination of local organs, eg liver and lymph nodes for detection of invasion or metastatic spread.
• Biliary obstruction may be evident.

• Non-specific changes, eg mild anemia, neutrophilia.

• Elevated hepatic enzymes particularly ALP and bilirubin due to bile duct obstruction.
• Hyperlipidemia .
• Lipase   and amylase  may be affected to varying degrees.
• Glucose   levels may oscillate widely if serially sampled.
• TLI measurement may be low (if functional pancreatic tissue destroyed), normal or high.
• Dehydration and electrolyte inbalance reflected in blood results.

• Advanced imaging techniques, eg MRI and CT give detailed information about size and extent of tumor.
• Evidence of disseminated disease and metastatic spread indicative of neoplasia as opposed to pancreatitis .

• Radiography/ultrasonography.

• Laparotomy and biopsy/histopathology.
• Biopsy differentiates chronic pancreatitis   from neoplasia.
• Laparotomy allows search of local lymph nodes, liver, mesentery for metastatic disease. Presence of metastatis prompts strong consideration of intra-operative euthanasia.

• Enlarged pancreas/pancreatic mass.
• Pancreatitis.

• Peritonitis.

• Malignant cells of pancreatic ducts or acinae.

• Primary pancreatitis .
• Other pancreatic neoplasia .

• Pancreatic abscess.
• Peritonitis .
• Other abdominal masses.

Treatment

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• Palliative therapy, eg anti-inflammatories, analgesia.
• No effective treatment for disease.

• Symptomatic treatment of digestive symptoms, pain, etc .

• Partial pancreatectomy.
• Gastrointestinal bypass if obstructed.

• Control of symptoms, eg digestive symptoms, pain.

Sequelae

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• Very poor: metastasis is rapid - usually by time of diagnosis.
• Survival time rare beyond 1 year, usually less.

• Control of symptoms, eg pain and vomiting.

• Locally invasive, non-excisable.
• Rapid metastasis.

Sources

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• Recent references from PubMed.
• Lamb C R, Simpson K W, Boswood A & Mathewman L A (1995) Ultrasonography of pancreatic neoplasia in the dog: a retrospective review of 16 cases. Vet Rec 137, 65 - 68.
• Withrow S J (1989) Tumours of the gastrointestinal system: exocrine pancreas. In: Clinical Veterinary Oncology. Eds S J Withrow and E G MacEwen. Lippincott, Philadelphia. p 192.
• Anderson N V & Johnson K K (1967) Pancreatic carcinoma in the dog. JAVMA 150 , 286.

• Williams D A (1996) The Pancreas. In: Strombeck's Small Animal Gastroenterology.W Guildford et al(eds), Saunders W B, Philadelphia, pp 381-411.
• Bunch S E (1992) Diseases of the exocrine pancreas. In: Handbook of Small Animal Practice.Ed: R V Morgan. 2nd edn. Churchill: Livingstone, NY, USA.

• Dr Laura Garrett DVM DipACVIM , School of Veterinary Medicine, Kansas State University, Manhattan, KS 66506-5606, USA.
• Dr James W Simpson SDA BVM&S MPhil MRCVS , Department of Veterinary Clinical Studies, Royal (Dick) School of Veterinary Studies, Easter Bush Veterinary Centre, Nr Roslin, Midlothian EH25 9RG, UK.
• Andrew Gardiner DVM&S CertSAS MRCVS, 8/6 Hermit's Croft, St Leonards, Edinburgh EH8 9RF, UK.

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