Cancer Dissemination Pathways

Abstract

Pancreatic adenocarcinoma is a disease with a dismal prognosis. To improve patient outcome and plan the best treatment for each tumor, accurate staging is mandatory, especially to avoid inappropriate surgery. Knowledge of the preferential pathways of tumor spread for adenocarcinomas located in the different portions of the organ can significantly aid the radiologist in searching for signs, even subtle, of disease spread which might modify the therapeutic approach. Vascular invasion and other organ involvement are obviously related to tumor location. Also lymph node involvement, extrapancreatic nerve plexus infiltration and distribution of metastases in the liver show differences based on the site of the primary tumor, with different patterns for tumors located in the head or in the body–tail of the pancreas. In this chapter, we will review these pathways of tumoral spread and the concepts of unresectability, resectability, and the increasingly important concept of “borderline resectable pancreatic cancer.”