**5. Pancreatic metastases from colorectal cancer**

Colorectal cancer represents one of the most common reported malignancies worldwide, being the third cause of death following breast and lung cancer and the second cause of death among non-smokers [28]. When it comes to the most common patterns of spread in colorectal cancers, they are represented by the peritoneal, lymphatic and hematogenous spread; the hematogenous route is usually related to the apparition of parenchymatous lesions located in liver, lung or brain. In certain cases, pancreatic metastases from colorectal malignancies can occur, the estimated incidence being of 2%; these types of lesions are usually associated with peritoneal carcinomatosis and less often as single lesions [29]. When it comes to the most appropriate imagistic study in order to confirm the presence of such lesions, CT has been proposed, followed by PET-CT (in cases in which although the clinical symptoms are highly suggestive for a pancreatic lesion but standard CT failed to diagnose it). It has been reported that PET-CT is a highly sensitive method of diagnostic in such cases (with an estimated sensitivity of 90–95%) while the specificity ranges between 65 and 85%; therefore performing a PET-CT in such cases seems to be responsible for the change of the therapeutic approach in up to half per cent of cases [6].

Isolated pancreatic metastases from colorectal cancer suitable for resections are scarce eventualities, only few cases being reported so far. Therefore is difficult to establish whether surgical resections of such lesions is superior to the conservative treatment such chemotherapy, due to the small number of cases submitted to surgery. However, it seems that surgery is especially useful in patients with symptomatic lesions, a satisfactory symptom relief being reported [10].
