# Adenosquamous carcinoma of the pancreas

Source: https://onco.cc/cancers/pancreatic-adenosquamous-carcinoma/  
OnCo record `pancreatic-adenosquamous-carcinoma` (Cancer). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Adenosquamous carcinoma is a rare form of pancreatic cancer in which at least three tenths of the tumour has turned into squamous cells, the flat cells of skin-like linings. It is found more often in the body and tail, tends to be larger and poorly differentiated, and does worse after surgery than ordinary pancreatic cancer, though surgery remains the strongest predictor of survival.

## Summary

What it is. The 2019 WHO classification of digestive tumours lists adenosquamous carcinoma as a variant of pancreatic ductal adenocarcinoma in which a squamous component makes up at least 30 percent of the tumour (Nagtegaal 2020); pure squamous cell carcinoma of the pancreas is exceptional and most such tumours prove to be adenosquamous on wider sampling.

How it differs from its parent. In 415 SEER patients (1988 to 2007) compared with 45,693 with adenocarcinoma, adenosquamous tumours were more often in the body and tail, more often poorly differentiated, larger and node positive, and long-term survival after resection was significantly worse, although resection was still the strongest predictor of survival (Boyd 2012). In the National Cancer Database (2004 to 2012), 1,745 adenosquamous carcinomas (1 percent of 207,073 pancreatic cancers) were larger and more often in the body or tail (36 against 24 percent); survival was similar to adenocarcinoma when operated and unoperated patients were pooled, but worse among resected stage I and II patients (Hester 2018).

How common it is. About 1 percent of pancreatic cancers in both US series above; no UK registry count is published.

How it is treated. No trial has been run in this histology. It is staged by the same TNM 8th edition and treated as pancreatic ductal adenocarcinoma: resection with adjuvant chemotherapy when removable, the chemotherapy rows of the parent page when not, with the squamous component sometimes prompting platinum-based regimens by analogy with squamous cancers elsewhere, on case-series evidence only.

## Fields

- Kind: Cancer
- Last checked: 2026-09-24
- Also known as: Adenosquamous carcinoma of the pancreas (squamous component of at least 30 percent; about 1 percent of cases; body and tail; worse after resection); Pancreatic adenosquamous carcinoma; ASCP; Adenosquamous pancreatic cancer; Mixed adenocarcinoma and squamous cell carcinoma of the pancreas
- Tags: gi; pancreatic; subtype-page
- Group: gastrointestinal
- Burden: About 1 percent of pancreatic cancers: 415 of 46,108 pancreatic carcinomas in SEER (1988 to 2007) and 1,745 of 207,073 in the US National Cancer Database (2004 to 2012). No UK count is published.
- Subtypes: Adenosquamous carcinoma with a dominant ductal (PDAC) component; Adenosquamous carcinoma with a dominant squamous component (the 30 percent rule still applies)
- Biomarkers: Squamous component of at least 30 percent on histology (p40 and p63 immunohistochemistry mark the squamous cells); KRAS and TP53 as in ductal adenocarcinoma; CA 19-9 for monitoring, as in the parent

## Sections of this record

The page is a hub with ten sections in reading order; large sections have their own page. The same plan as JSON: https://onco.cc/api/v1/cancers/pancreatic-adenosquamous-carcinoma/sections.json

- Overview (on the hub): The TL;DR, the family this cancer belongs to, the organ, who gets it and what the state of the art is. https://onco.cc/cancers/pancreatic-adenosquamous-carcinoma/#overview [1 state-of-the-art points]
- What it is (on the hub): Anatomy, the subtypes and how they differ, how it is staged, and where advanced disease spreads. https://onco.cc/cancers/pancreatic-adenosquamous-carcinoma/#what-it-is [2 subtypes]
- Finding it (on the hub): How it shows itself, how it is confirmed, what screening exists, and the biomarkers clinicians test for. https://onco.cc/cancers/pancreatic-adenosquamous-carcinoma/#finding-it [3 biomarkers]
- Treating it (on the hub): The standard of care by setting, the medicines, surgery and radiotherapy named in it, and the regimens behind them. https://onco.cc/cancers/pancreatic-adenosquamous-carcinoma/#treating-it [2 settings, 1 decision with options]
- Evidence (on the hub): Trials recruiting now, the landmark trials, the key papers and what they mean, the latest literature, and the milestones year by year. https://onco.cc/cancers/pancreatic-adenosquamous-carcinoma/#evidence [2 milestones]
- The science (on the hub): The molecular landscape: the targets and how often each appears, the pathways, the mechanics stages and the preclinical models. https://onco.cc/cancers/pancreatic-adenosquamous-carcinoma/#science [2 targets, 2 pathways]
- Where you are (own page): Cases by country, the UK and NHS pathway and other country lenses, and the expert centres with trials on record. https://onco.cc/cancers/pancreatic-adenosquamous-carcinoma/where-you-are/
- Living with it (on the hub): The decisions you may face, the aids that walk through them, the warnings on record, the first sixty days and the questions to ask. https://onco.cc/cancers/pancreatic-adenosquamous-carcinoma/#living-with-it [12 questions, 2 red cards]
- What is coming (own page): Everything in development, the open problems and what is being done about them, the roadmaps, and what changed on this record. https://onco.cc/cancers/pancreatic-adenosquamous-carcinoma/coming/ [3 medicines, 2 open problems]
- Data (own page): Every connected record, the notes, the JSON, Markdown and RDF twins, and where the record came from and when it was checked. https://onco.cc/cancers/pancreatic-adenosquamous-carcinoma/data/ [17 connected records]

## Standard of care

- Resectable: Pancreatoduodenectomy or distal pancreatectomy with adjuvant chemotherapy as for ductal adenocarcinoma; surgery is the strongest predictor of survival in the population series. ([Whipple procedure (pancreaticoduodenectomy)](https://onco.cc/terms/whipple/), [Distal pancreatectomy (removal of the body and tail of the pancreas, usually with the spleen)](https://onco.cc/terms/distal-pancreatectomy/), [FOLFIRINOX / mFOLFIRINOX](https://onco.cc/drugs/folfirinox/), [Neoadjuvant / adjuvant / perioperative](https://onco.cc/terms/neoadjuvant-adjuvant/))
- Advanced: Chemotherapy as for metastatic pancreatic ductal adenocarcinoma; no histology-specific trial exists. ([FOLFIRINOX / mFOLFIRINOX](https://onco.cc/drugs/folfirinox/), [Gemcitabine + nab-paclitaxel](https://onco.cc/drugs/gemcitabine-nab-paclitaxel/), [NALIRIFOX (liposomal irinotecan + oxaliplatin + 5-FU/LV)](https://onco.cc/drugs/nalirifox/))

## State of the art

- Recognised as a WHO variant with a worse outcome after resection than ductal adenocarcinoma in two US population series.

## Open problems

- No prospective trial; whether platinum or squamous-directed regimens help is unknown.
- The 30 percent threshold depends on sampling, so small biopsies under-diagnose it.

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Adenosquamous_carcinoma
- Nagtegaal, Histopathology 2020: the 2019 WHO classification of tumours of the digestive system: https://doi.org/10.1111/his.13975
- Boyd, J Surg Res 2012: 415 patients with adenosquamous carcinoma of the pancreas, SEER analysis: https://doi.org/10.1016/j.jss.2011.06.015
- Hester, J Surg Oncol 2018: comparative outcomes of adenosquamous carcinoma of the pancreas, National Cancer Database: https://doi.org/10.1002/jso.25112
- NCCN Guidelines: Pancreatic Adenocarcinoma (resectability criteria): https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1455

## Connected records

- cancers: [Adenosquamous and squamous carcinoma of the gallbladder](https://onco.cc/cancers/gallbladder-adenosquamous-squamous-carcinoma/), [Adenosquamous carcinoma of the lung](https://onco.cc/cancers/lung-adenosquamous-carcinoma/), [Colloid (mucinous non-cystic) carcinoma of the pancreas](https://onco.cc/cancers/pancreatic-colloid-carcinoma/), [Pancreatic ductal adenocarcinoma](https://onco.cc/cancers/pancreatic/), [Undifferentiated carcinoma of the pancreas with osteoclast-like giant cells](https://onco.cc/cancers/pancreatic-undifferentiated-carcinoma-ogc/)
- technologies: [Cytotoxic chemotherapy](https://onco.cc/technologies/cytotoxic-chemotherapy/), [Histopathology & immunohistochemistry](https://onco.cc/technologies/histopathology-ihc/)
- targets: [KRAS](https://onco.cc/targets/kras/), [TP53](https://onco.cc/targets/tp53/)
- drugs: [FOLFIRINOX / mFOLFIRINOX](https://onco.cc/drugs/folfirinox/), [Gemcitabine + nab-paclitaxel](https://onco.cc/drugs/gemcitabine-nab-paclitaxel/), [NALIRIFOX (liposomal irinotecan + oxaliplatin + 5-FU/LV)](https://onco.cc/drugs/nalirifox/)
- pathways: [Pancreatic cancer (KEGG map)](https://onco.cc/pathways/pancreatic-cancer-signalling/), [RAS / RAF / MEK / ERK (MAPK)](https://onco.cc/pathways/ras-mapk/)
- terms: [Distal pancreatectomy (removal of the body and tail of the pancreas, usually with the spleen)](https://onco.cc/terms/distal-pancreatectomy/), [Grade](https://onco.cc/terms/tumour-grade/), [Neoadjuvant / adjuvant / perioperative](https://onco.cc/terms/neoadjuvant-adjuvant/), [Resection margins (R0 / R1 / R2)](https://onco.cc/terms/resection-margins/), [Whipple procedure (pancreaticoduodenectomy)](https://onco.cc/terms/whipple/)

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JSON: https://onco.cc/api/v1/entities/pancreatic-adenosquamous-carcinoma.json