Teaching staging case highlighting advanced presentation of locally advanced disease with vascular invasion involving upper abdominal arteries and veins with vascular narrowing. Note how the primary tumor is difficult to confidently measure, however with such characteristic vascular involvement, the diagnosis of pancreas cancer can be made confidently in this case. In particular, note how there is severe narrowing of the portal vein and also mild narrowing and irregularity of the common hepatic artery with poststenotic dilation of the proper hepatic artery. Also noted borderline/suspicious peripancreatic lymph nodes. This is unfortunately unresectable disease.