Pancreatic cancer is the sixth most common cancer and the fourth leading cause of cancer-related death, carrying one of the poorest prognoses of any major cancer type. While surgical resection remains the only potential curative treatment, 85–90% of patients present with surgically unresectable disease. Vascular invasion—found in up to 64% of cases—plays a critical role in determining treatment options and assessing resectability.
During the March 2025 Oncology Coding Break, Patricia Fordham, ODS-C, reviewed:
- Key signs and symptoms of pancreatic cancer, including jaundice, abdominal or back pain, unexplained weight loss, nausea, and liver/gallbladder enlargement.
- Definitions of vessel abutment and encasement and their impact on staging and surgical planning:
- Abutment: tumor touching a blood vessel ≤180° (≈40% probability of invasion).
- Encasement: tumor involving >180° of the vessel circumference (≈80% probability of invasion).
- Abutment: tumor touching a blood vessel ≤180° (≈40% probability of invasion).
- Arteries commonly affected by encasement, such as the superior mesenteric, celiac, and hepatic arteries.
- Staging considerations: SEER Summary Stage interprets abutment or encasement as regional direct extension (code 2), while AJCC cT4 includes both abutment and encasement.
This session highlighted how accurate identification of vessel involvement is critical for staging in both SEER Summary Stage and AJCC 8th Edition and directly influences treatment pathways.
