[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [General pathology](https://durgical.com/en/general-pathology/) › [Pancreas](https://durgical.com/en/general-pathology/areas/pancreas/) › Pancreatic ductal adenocarcinoma # Pancreatic ductal adenocarcinoma - Lesion Pancreatic cancer is hard, invasive and found late; in the head it blocks the bile duct and causes painless jaundice. Updated Nov 12, 2026 ## Key points - Location: head in most, then body and tail; head tumours cause obstructive jaundice and a palpable gallbladder (Courvoisier sign). - Risks: smoking, chronic pancreatitis (including hereditary), obesity, diabetes, family history; germline BRCA2, PALB2, ATM, Lynch, CDKN2A, PRSS1. - Histology: atypical glands in dense desmoplastic stroma; perineural, lymphatic and vascular invasion common. - Migratory thrombophlebitis (Trousseau sign) from tumour procoagulants. - CA 19-9 used for follow-up, not screening. - Body and tail tumours present late with pain and weight loss; metastasis to liver and peritoneum is frequent. ## What it is Pancreatic ductal adenocarcinoma is one of the deadliest cancers: most patients are diagnosed with locally advanced or metastatic disease. Smoking is the strongest environmental risk factor, followed by chronic pancreatitis, obesity and long-standing diabetes; inherited syndromes explain a minority. Most tumours arise in the head of the pancreas. The tumour is very infiltrative, with dense desmoplastic stroma, and spreads along nerves and vessels early. ## Structure - Gross: hard, stellate, grey-white mass with poorly defined edges; obstructs the common bile and pancreatic ducts in the head. - Micro: moderately to poorly differentiated glands of mucin-producing cells in abundant collagen; perineural invasion; variants include adenosquamous, colloid (with IPMN), medullary and undifferentiated with osteoclast-like giant cells. ## Step by step - Precursor lesions accumulate KRAS, CDKN2A, TP53 and SMAD4 changes. - Invasive cells recruit and activate stellate cells that build a dense desmoplastic stroma. - The stroma is hypovascular and immunosuppressive, which limits drug delivery and immune attack. - Cancer cells track along nerves (pain) and vessels. - Head tumours block bile flow (jaundice); spread to liver, peritoneum and lungs follows. - Tumour mucins and tissue factor activate coagulation: migratory thrombophlebitis. ## Markers - CA 19-9 (serum) - Keratin 7 - Loss of SMAD4 (DPC4) - CEA ## Clinical notes - Painless jaundice, weight loss, epigastric pain radiating to the back, new-onset diabetes in an older adult. - Only a minority are resectable at diagnosis; pancreaticoduodenectomy (Whipple) for head tumours. ## Memory aid Head blocks bile, tail grows silent; the stroma is a hard wall and nerves are its highway. ## Test yourself Think of the answer, then tap the question to see it. ## What is the strongest environmental risk factor for pancreatic adenocarcinoma? Cigarette smoking. ## What is the Trousseau sign of malignancy? Migratory superficial thrombophlebitis caused by tumour-derived procoagulants, classically with pancreatic cancer. ## Why do carcinomas of the pancreatic head often present earlier than tail tumours? They compress the common bile duct and cause obstructive jaundice; body and tail tumours grow silently. ## What is the role of CA 19-9 in pancreatic cancer? Monitoring response and recurrence; it is not specific or sensitive enough for screening. [Add to my cards (4)](https://durgical.app/estudiar/?add=/en/general-pathology/pancreatic-ductal-adenocarcinoma/) [More Pathology questions →](https://durgical.com/en/practice/?f=pathology) ## Connections ## Related 8 - [Precursors of pancreatic cancer: PanIN, IPMN, MCN](https://durgical.com/en/general-pathology/precursors-of-pancreatic-cancer-panin-ipmn-mcn/) - [Chronic pancreatitis: fibrosis, ductal stones and lost acini](https://durgical.com/en/general-pathology/chronic-pancreatitis-fibrosis-ductal-stones-and-lost-acini/) - [Metastases to the liver: the most common liver malignancy](https://durgical.com/en/general-pathology/metastases-to-the-liver-the-most-common-liver-malignancy/) - [Tobacco: how smoking injures tissue](https://durgical.com/en/general-pathology/tobacco-how-smoking-injures-tissue/) - [Paraneoplastic syndromes: the table to know](https://durgical.com/en/general-pathology/paraneoplastic-syndromes-the-table-to-know/) - [Hypercoagulable states: inherited and acquired](https://durgical.com/en/general-pathology/hypercoagulable-states-inherited-and-acquired/) - [Tumour markers: serum and tissue, and what each one is for](https://durgical.com/en/general-pathology/tumour-markers-serum-and-tissue-and-what-each-one-is-for/) - [Hereditary cancer syndromes: the table to know](https://durgical.com/en/general-pathology/hereditary-cancer-syndromes-the-table-to-know/) ## Related conditions 7 - [Pancreatic cancer](https://durgical.com/en/conditions/pancreatic-cancer/) - [Chronic pancreatitis](https://durgical.com/en/conditions/chronic-pancreatitis/) - [Hereditary breast and ovarian cancer syndrome (BRCA1/BRCA2)](https://durgical.com/en/conditions/hereditary-breast-and-ovarian-cancer-syndrome/) - [Lynch syndrome (hereditary non-polyposis colorectal cancer)](https://durgical.com/en/conditions/lynch-syndrome/) - [Type 2 diabetes mellitus](https://durgical.com/en/conditions/type-2-diabetes-mellitus/) - [Obesity](https://durgical.com/en/conditions/obesity/) - [Paraneoplastic syndromes](https://durgical.com/en/conditions/paraneoplastic-syndromes/) [← All of general pathology](https://durgical.com/en/general-pathology/) Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given. Sources: [Pancreatic Cancer](https://www.ncbi.nlm.nih.gov/books/NBK518996/) (StatPearls (NCBI Bookshelf), 2024); [Pancreatic Cancer and Pancreatic Neuroendocrine Tumor - NCI](https://www.cancer.gov/types/pancreatic) (National Cancer Institute, 2026). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/general-pathology/pancreatic-ductal-adenocarcinoma/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/general-pathology/pancreatic-ductal-adenocarcinoma/