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IPMN-associated carcinoma is pancreatic cancer that has grown out of a mucus-producing cyst in the pancreatic duct. Because the cyst is often being watched, the cancer is found smaller and earlier, and about four in ten patients are alive five years after surgery against two in ten for ordinary pancreatic cancer; the advantage belongs to the colloid type, not the tubular type.
What it is. Intraductal papillary mucinous neoplasms progress through low- and high-grade dysplasia to invasive carcinoma of two main types, tubular (which looks like ordinary ductal adenocarcinoma) and colloid (mucin pools), with a rarer oncocytic type; the 2015 Baltimore consensus asks pathologists to measure the distance between the IPMN and the invasive cancer and to sample the tissue between, because a carcinoma that is merely concomitant (arising separately in the same gland) should be genetically distinct from one associated with the IPMN (Basturk 2015). The parent cyst page carries the Fukuoka and Kyoto surveillance rules; this page is the cancer that surveillance is trying to pre-empt.
How it differs from its parent. In 1,260 consecutive resections for pancreatic adenocarcinoma, 132 (10 percent) were IPMN-associated and their five-year survival was 42 percent against 19 percent, explained by lower T stage, fewer node metastases, lower grade, fewer positive margins and less perineural and vascular invasion; when any one of those adverse features was present, survival fell to that of ordinary disease (Poultsides 2010). In 61 invasive IPMNs against 570 ductal adenocarcinomas, 62 percent were tubular, 26 percent colloid and 12 percent oncocytic; the favourable outcome (hazard ratio 0.58 after stage matching) held only for colloid and oncocytic carcinomas, while tubular carcinoma was no better than ordinary ductal cancer; colloid carcinomas arose from intestinal-type, mostly main-duct IPMNs and tubular carcinomas from gastric-type, often branch-duct IPMNs (Mino-Kenudson 2011). In a matched comparison of 59 patients, three- and five-year survival were 76 and 68 percent, and tubular histology carried 3.7 times the hazard of death of colloid histology (Yopp 2011).
How common it is. About 10 percent of resected adenocarcinomas in the Johns Hopkins series; no population count is published.
How it is treated. Staged by TNM and treated as pancreatic ductal adenocarcinoma: resection (pancreatoduodenectomy or distal pancreatectomy, sometimes total pancreatectomy for main-duct disease throughout the gland) with adjuvant chemotherapy, and lifelong surveillance of any remaining pancreas because IPMN is a field disease (the parent cyst page cites the Kyoto 2024 guideline). Whether colloid-type cancers need the same adjuvant treatment as tubular cancers has not been tested.
Averages across everyone diagnosed, often years ago. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.
About 10 percent of resected pancreatic adenocarcinomas at a high-volume US centre (132 of 1,260, 1995 to 2006); the share of all pancreatic cancers is lower because many are unresectable at diagnosis and the precursor is not always recognisable.
Most pancreatic cancers arise in the head next to the bile duct, which is why jaundice is the presenting sign; bile duct cancers are named by where along the tree they sit.
Same organ: Glucagonoma, VIPoma, Somatostatinoma, Pancreatic ductal adenocarcinoma, Biliary tract cancer (cholangiocarcinoma), Intrahepatic cholangiocarcinoma, Extrahepatic cholangiocarcinoma (perihilar and distal), Biliary tract cancer (all types), Neuroendocrine tumours, Pancreatic neuroendocrine tumours, Grade 3 well-differentiated neuroendocrine tumour, Extrapulmonary neuroendocrine carcinoma, Gallbladder cancer, Gallbladder adenocarcinoma, Papillary carcinoma of the gallbladder, Mucinous carcinoma of the gallbladder, Adenosquamous and squamous carcinoma of the gallbladder, Neuroendocrine carcinoma of the gallbladder, Incidental gallbladder cancer (found after cholecystectomy), Carcinoma in situ and dysplasia of the gallbladder, Cystic duct carcinoma, Ampullary cancer (ampulla of Vater), Resectable pancreatic ductal adenocarcinoma, Borderline resectable pancreatic ductal adenocarcinoma, Locally advanced unresectable pancreatic ductal adenocarcinoma, Metastatic pancreatic ductal adenocarcinoma, KRAS G12C-mutant pancreatic ductal adenocarcinoma, KRAS wild-type pancreatic ductal adenocarcinoma, BRCA or PALB2-mutant pancreatic ductal adenocarcinoma, Mismatch repair deficient (MSI-high) pancreatic ductal adenocarcinoma, Pancreatic acinar cell carcinoma, Intraductal papillary mucinous neoplasm and other pancreatic cystic precursors, Pancreatoblastoma, Adenosquamous carcinoma of the pancreas, Colloid (mucinous non-cystic) carcinoma of the pancreas, Undifferentiated carcinoma of the pancreas with osteoclast-like giant cells, Mucinous cystic neoplasm of the pancreas with associated invasive carcinoma (MCN-associated carcinoma), Solid pseudopapillary neoplasm of the pancreas
Nothing recorded yet.
Nothing recorded yet.
Also on OnCo: Symptoms and red flags · Early detection roadmap.
Pancreatoduodenectomy, distal pancreatectomy or total pancreatectomy according to the extent of duct involvement, with regional lymphadenectomy and adjuvant chemotherapy as for ductal adenocarcinoma; surveillance of the remnant gland.
Treated as pancreatic ductal adenocarcinoma: resection with adjuvant chemotherapy when removable, the chemotherapy rows of the parent page when not; the parent record carries the trials.
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Query for this cancer: (TITLE:"Invasive carcinoma arising in an intraductal papillary mucinous neoplasm" OR ABSTRACT:"Invasive carcinoma arising in an intraductal papillary mucinous neoplasm" OR TITLE:"IPMN-associated carcinoma" OR ABSTRACT:"IPMN-associated carcinoma" OR TITLE:"Invasive carcinoma arising in an IPMN tubular or colloid type; treated as ductal PDAC" OR ABSTRACT:"Invasive carcinoma arising in an IPMN tubular or colloid type; treated as ductal PDAC" OR TITLE:"Invasive carcinoma arising in an IPMN tubular or colloid type; 10 percent of resections; staged and treated as ductal adenocarcinoma" OR ABSTRACT:"Invasive carcinoma arising in an IPMN tubular or colloid type; 10 percent of resections; staged and treated as ductal adenocarcinoma" OR TITLE:"IPMN with associated invasive carcinoma" OR ABSTRACT:"IPMN with associated invasive carcinoma" OR TITLE:"Invasive IPMN" OR ABSTRACT:"Invasive IPMN") AND (treatment OR therapy OR trial OR survival OR diagnosis). Results are unfiltered search hits about Invasive carcinoma arising in an intraductal papillary mucinous neoplasm (IPMN-associated carcinoma), not a curated reading list.
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Bleeding that will not stop, black or bloody stools, or unexplained bruising when platelets are expected to be low.
The three main regimens share low blood counts, tiredness, sickness and sore mouth; FOLFIRINOX and NALIRIFOX add irinotecan diarrhoea and oxaliplatin's cold-triggered tingling and rare throat spasm, gemcitabine with nab-paclitaxel adds hair loss and neuropathy, and every regimen comes with the same temperature rule for ringing the 24-hour line.
See all on the product pages:FOLFIRINOX / mFOLFIRINOXGemcitabine + nab-paclitaxelNALIRIFOX (liposomal irinotecan + oxaliplatin + 5-FU/LV)·Printable cards in the navigator
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