It is generally believed that once “liver metastasis” occurs in “pancreatic cancer”, life is not much, but this is not the case in my clinical practice. The main reasons for this are poor diagnosis, inappropriate treatment and loss of confidence. Due to the limitation of imaging knowledge of most clinicians, the clinical diagnosis of “pancreatic cancer + liver metastasis” may have the following types of cases, which have different treatment and efficacy due to different etiologies: I. Malignant lesions in the pancreatic region (intrapancreatic + paracreatic) + malignant lesions in the liver Malignant tumors in the pancreatic region and liver are homologous 1. Metastasis A, highly malignant pancreatic tumor (mainly refers to pancreatic adenocarcinoma) + liver metastasis: some patients have stage efficacy of chemotherapy. B. Low malignant pancreatic tumor (neuroendocrine tumor, solid pseudopapillary tumor, IPMN, etc.) + liver metastasis: due to the slow evolution, coupled with the effectiveness of intervention, chemotherapy and surgery, we should not give up lightly, I have patients who have survived more than 20 years with conservative treatment (please see my article “The miracle of hope for pancreatic cancer patients”). I have patients who have survived for more than 20 years with conservative treatment (please see my article “Miracle of hope for pancreatic cancer patients”). 2. Regional metastases of liver and pancreas: The primary focus is located in other parts of the body (usually the digestive tract) and there are local lymph nodes in the liver and pancreas at the same time: in my practice, this is quite common. 3.Lymphoma involving liver and pancreas area: As long as the diagnosis is clear, most lymphoma chemotherapy has significant effect. 4. Malignant tumor of liver with peri-pancreatic lymph node metastasis: treated as primary hepatocellular liver cancer and cholangiocarcinoma. Different sources of malignant tumors in the pancreas region and liver 1. Double primary malignant tumors in the pancreas region and liver: rare, if both are isolated lesions and in good physical condition and economic condition can afford, interventional or radiotherapy can be performed respectively. The total incidence of benign liver masses is not low. Due to improper examination techniques or low film reading ability, it is not uncommon to mistakenly treat benign liver lesions as liver metastases when pancreatic masses are found (please see my article ” What diseases are included in pancreatic masses”). 2. Pancreatic regional malignant tumor + liver abscess: It is common after surgery and operation of pancreatic head and bile duct (pancreatic head resection, bile-intestinal anastomosis, ERCP operation, bile duct stent implantation, etc.), because the bile duct is open to the digestive tract and the contents of the digestive tract reflux, it is very easy to form peribiliary liver abscess, which is often mistaken for liver metastasis because of the clear history of tumor. Most liver abscesses can be dissipated after 2 weeks of review with active anti-inflammatory and biliary treatment and intravenous antibiotics. Benign lesions in the pancreatic region (intrapancreatic + paracreatic) + malignant lesions in the liver 1. Benign masses in the pancreatic region: see my “What diseases are included in pancreatic masses” for details. 2. Malignant tumors of the liver: primary hepatocellular hepatocellular carcinoma, primary cholangiocarcinoma, hepatic metastases, cholangiocarcinoma of the hilar region, etc. Benign lesions in the pancreatic region (intrapancreatic + paracreatic) + benign lesions in the liver 1. Benign masses in the pancreatic region: see my “What diseases are included in pancreatic masses” for details. 2. Benign hepatic masses: hepatic hemangioma, focal nodular hyperplasia of the liver (FNH), complex liver cyst, liver abscess, inflammatory pseudotumor of the liver, etc. In conclusion, even if the clinical diagnosis is “pancreatic cancer + liver metastasis”, don’t give up lightly, with careful analysis, many patients can still have a chance to delay their lives or even be cured (please read my “Hope for pancreatic cancer – a series of scientific articles”). “). The main reason why so many patients are not treated properly is that, in addition to the current medical system, the lack of knowledge of the above mentioned lesion imaging features is also the main reason. Which doctors are comfortable to carefully identify, and have considerable academic knowledge to grasp, these imaging features?