| 1. 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.
|
| 2. 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. |
| 3. 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. |
| 4.
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. |
| 5. 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. |
| 6. 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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