Pancreatic Ductal Adenocarcinoma is one of the most lethal of the gastrointestinal tumors. Surgical cure is possible in some cases, but only if the disease is found in the early stages.
In general, cancer of the pancreas has a low cure rate if nodal metastasis are found, and is unresectable if metastatic disease is discovered. In addition, this cancer is not resectable if it involves major vascular structures. A familiarity with local vascular anatomy surrounding the pancreas is important in understanding the surgical therapy of pancreatic cancer.
The pancreas sits in the retroperitoneum, behind the stomach. The pancreatic head is tucked into the c-loop of the duodenum.
The pancreas is intimately associated with the portal vein, the superior mesenteric vein and the splenic vein. Important arterial structures include the celiac artery, which branches into the hepatic and splenic and left gastric arteries, as well as the superior mesenteric artery, which gives off the pancreaticoduodenal arteries.
Pancreas cancer is usually staged using the TNM system, in which T stands for tumor, N for nodes and M for metastatic disease.
The size and extent of the main tumor is an important factor in determining whether or not a complete surgical resection can be accomplished. The T-stage reflects this.
T1 disease is a tumor less than 2 cm in size and is confined to the pancreas. T2 disease is more than 2 cm in size but is still confined to the pancreas. T1 and T2 tumors are amenable to surgical removal if there is no evidence of spread away from the main tumor.
T3 disease is outside of the pancreas but not involving the celiac trunk or superior mesenteric artery. It can involve surrounding structures including the portal vein and the superior mesenteric vein, the bile duct, stomach or the duodenum. In some instances, T3 lesions can be removed if they are not too extensive.
T4 disease involves the celiac trunk or the superior mesenteric artery. T4 disease is currently considered unresectable.
A video clip is shown here of an EUS procedure in which a T4 pancreatic cancer was found. The label celiac is over the celiac artery and the letter T is over the tumor. In this instance, the tumor is wrapped around the celiac artery. The location of the tumor is approximated in the cross sectional image of the VH Dissector.