Table 2 Summary table of local, nodal and haematogenous spread in pancreatic cancer

Local spread

•Tumour spreads by direct perivascular and perineural invasion;

•Local invasion can involve the stomach, duodenum and retroperitoneum;

•Head/uncinate process tumours: these usually extend along the SMA and mesenteric root;

•Body/tail tumours: these usually infiltrate the celiac, hepatic or splenic arteries

Lymph node spread

•Primary drainage: superior, inferior, anterior, posterior and splenic lymph nodes;

•Secondary drainage: porta hepatis, common hepatic, coeliac, mesenteric root lymph nodes;

•Tertiary drainage: peri-aortic and distal superior mesenteric lymph nodes

Haematogenous spread

•These usually involve the liver and peritoneal surfaces

Note

•Early lymphatic and haematogenous micrometastases at presentation are common