The Sol Goldman Pancreatic Cancer Research Center

Metastasis

A major concern when diagnosing a pancreatic cancer is whether or not the cancer has already spread (metastasized) outside of the pancreas. The location of the metastases will determine whether the patient has locoregional or metastatic disease.The location of the metastases will also determine whether the cancer is able to be surgically removed (resectable) or unable to be surgically removed (unresectable).

There are certain sites that pancreatic cancer may spread to that usually, but not always, eliminate surgery as a treatment option. They are:


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Lymph nodes:
Metastases (mets) to lymph nodes does not automatically eliminate surgery as a treatment option. There are lymph nodes scattered throughout the body. The location of the affected lymph nodes makes a big difference.
For example, the lymph nodes in the groove between the duodenum and the pancreas are a very common site of metastases. These are considered locoregional and are routinely removed during the Whipple surgical procedure. However, the spread of cancer to more distant lymph nodes, such as lymph nodes closer to the liver, may mean the tumor is unresectable.

Liver:
Metastases to the liver are a common finding especially with tumors in the tail and the body of the pancreas. Usually, if there is evidence of liver "mets," surgery will not be an option.

Celiac plexus:
This is a network of many nerves that are grouped around the aorta where it passes through opening in the diaphragm.
It is these nerves that cause back pain when pressed upon by a growing tumor. Therefore, this is where an alcohol is injected during an alcohol nerve block to stop the sensation of pain.

Superior mesenteric vessels:
This artery and vein carry blood to and from the bowels and are closely associated with the pancreas. Therefore, they may become involved by the spreading of the tumor. These blood vessels run between the uncinate process and head of the pancreas. The artery is a branch off of the aorta and carries oxygen-rich blood to abdominal organs. The vein carries oxygen-poor blood to the portal vein which enters the liver.

Ligament of Treitz:
This is actually a thin muscle that wraps around the small intestine where the duodenum and jejunum meet. It passes behind the pancreas and is attached above to the spine and the diaphragm.

Portal vein:
This is another important blood vessel that runs right next to the pancreas. It carries oxygen poor blood to the liver where the blood is filtered. If the cancer has spread to involve the portal vein, the cancer may be considered unresectable. The surgeon may decide that surgery can proceed. If so, they can remove the affected portion of the portal vein and replace it with an artificial graft.


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