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Malignant Neoplasm of the Pancreas B001

Document
Last amended 
17 January 2018
Current RMA Instruments
Reasonable Hypothesis
73 of 2013
Balance of Probabilities
74 of 2013
Changes from previous Instruments

SOP Bulletin 169

ICD Coding
  • ICD-9-CM Codes: 157.0-3, 157.8
  • ICD-10-AM Codes: C25.0, C25.1, C25.2, C25.3, C25.7 or C25.8.
Brief description

This is a primary malignant neoplasm of the exocrine pancreas. This does not include benign neoplasms or secondary neoplasms arising from other sources.

The pancreas is composed of exocrine glands which supply enzymes to the gastrointestinal tract via the pancreatic ducts, but also include islands (islets) of endocrine tissue scattered through the pancreas which secrete hormones (insulin, glucagon, somatostatin) into the blood stream. This SOP only applies to a cancer of the exocrine tissue and not the endocrine tissue.

The diagnostic label should refer to the part of the pancreas affected by the neoplasm, being the head, body or tail of the pancreas.

Confirming the diagnosis

This diagnosis is made on histopathology of the pancreas. Imaging will also assist but is not definitive on its own.

The relevant medical specialist is a gastroenterologist or oncologist.

Additional diagnoses covered by SOP
  • Adenocarcinoma of the pancreas
  • Mucinous cystadenocarcinoma of the pancreas
  • Pancreatoblastoma
Conditions not covered by SOP
  • Adenocarcinoma of the ampulla of vater* - malignant neoplasm of the bile duct SOP
  • Carcinoid of the pancreas#
  • Endocrine tumours of the pancreas#
  • gastrinoma#
  • glucagonoma#
  • insulinoma#
  • islet cell tumour#
  • VIPoma#
  • Hodgkin’s lymphoma of the pancreas*
  • medullary carcinoma of the pancreas#
  • Non-Hodgkin’s lymphoma of the pancreas*
  • Soft tissue sarcoma of the pancreas*

* another SOP applies

# non-SOP condition

Clinical onset

The condition most commonly presents clinically, with symptoms of pain (abdominal or epigastric), jaundice, and weight loss.  A range of other non-specific symptoms may also occur.  Pain is usually of insidious onset and has been present for around one or two months at the time of first presentation.  The condition is occassionally first uncovered as an incidental finding on CT or MRI scan.

Clinical worsening

The only SOP worsening factor is for inability to obtain appropriate clinical management.  The condition often presents late and has a poor prognosis.  Surgical resection is not possible in most cases.