Solid Pancreatic Tumors: Staging and Resectability, Criteria for Evaluation of Tumor Progression after Surgical Treatment (Lecture, Part 2)

Diagnosis of the pancreatic lesions and the estimation of its staging very important, since the results have influence on the choice of treatment.

Aim: understanding tumor staging and assessment of operability of pancreatic cancer; consideration of the factors affecting the resectability of pancreatic tumors, vascular involvement, and assessment of the concept of “locally advanced cancer”; estimate survival following surgical resection and recurrent pancreatic tumors.

Methods of radiological diagnostics. Different radiological methods can be used. However, all of them need answering the most important questions – involving vessels in the tumor process and the presence of metastasis.

Results. All stages of pancreatic tumors can be represented as follows: Stage 0 (TisN0M0), 1a (T1N0M0) step, step 1b (T2N0M0), step 2a (T3N0M0), 2b (T1–3N1M0) step, step 3 (T4N0–1M0), stage 4 (T1–4N0–1M1). The rate of tumor growth (T category) is quite difficult to predict. But, even invisible tumor can be transformed into inoperable/unresectable after 2–3 months. Newly diagnosed small tumors of the pancreas, actively accumulating contrast agent during the arterial phase, most often is neuroendocrine neoplasias. The combination of two signs – tumor size less than 2 cm in diameter and high intensity contrast enhancement in the arterial phase – suggests a tumor with a minimal number of mitosis (Grade 1), and the ability to robotic assisted enucleation of the tumor.

Conclusions. The only treatment for pancreatic ductal adenocarcinoma cancer is surgery. Radiation methods can identify operable and inoperable tumors and to evaluate their resectability in most cases. Border resectability are the most unpredictable. This group of the pancreatic tumors should be subject to special vigilance and to maximize the attention of the radiologist. Modern methods of radiology is not possible to identify paravasal and perineural spreading of tumors. The only criterion of tumoral invasion is parapancreatic infiltration of adipose tissue. The inhomogeneous structure of the adipose tissue with a higher intensity density is a poor prognostic factor after surgery. Distant metastases, local recurrence of the tumor, paravasal and perineural spreading of the tumor can be most easily identified on diffusion-weighted images (high signal intensity on images with high b-factor) or by ultrasound (narrowing of the contours of the arteries and veins, changes in blood flow parameters), or as a darkening paravasal adipose tissue on CT scans.

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