The stages of pancreatic cancer are used to describe how advanced the cancer is in your body. The higher the stage number, the more widespread the cancer is. These stages are important when choosing the best treatments for you. Your doctor might not be able to tell how far your cancer has spread (especially to the lymph nodes, which are tiny bean-shaped organs throughout the body that help fight infections) unless and until surgery is performed. For this reason, doctors often use a simple staging system for pancreatic cancer that divides cancers into groups based on whether or not they can be removed by surgery.
* Resectable – The surgeon can remove the entire tumor. These tumors may be in the pancreas or beyond it, but they have not spread to the critical arteries or veins in the area. There is no evidence of any spread to areas outside of the pancreas. * Locally advanced (unresectable) – The cancer cannot be removed (resected) by surgery because it has spread to critical arteries, veins, or surrounding organs. However, the cancer has not yet spread to distant organs. Surgery is only done on unresectable cancer to relieve symptoms or problems, such as a blocked bile duct or intestinal tract.
* Metastatic – The cancer has spread to organs beyond the pancreas, such as the liver. Surgery is only done for metastatic cancer to relieve symptoms or problems, such as a blocked bile duct or intestinal tract. The TNM staging system described below is more precise and doctors often use it to figure out whether surgery is possible. TNM System One way to describe the stages of pancreatic cancer is to use the TNM system.
This system uses three different codes to describe the size and location of the tumor, whether it has spread to the lymph nodes around the tumor, and whether it can be found in other parts of the body. Because doctors usually classify tumors during surgery and many patients with pancreatic cancer do not have surgery, the TNM system is not used as much with pancreatic cancer as it is for other diseases. In the TNM system, “T” plus a letter or number (0 to 4) is used to describe the size and location of the tumor. The tumor stages are: TX – The primary, or original, tumor cannot be evaluated because of incomplete information.
TO – There is no evidence of the primary site. Tis (carcinoma in situ) – The cancer is present only in the lining of the pancreatic ducts. T1 – The cancer has not spread beyond the pancreas and is smaller than 2 centimeters (about ? inch). T2 – The cancer has not spread beyond the pancreas, but is larger than 2 centimeters (about ? inch). T3 – The cancer has spread from the pancreas to surrounding tissues near the pancreas but not blood vessels. T4 – The cancer has spread from the pancreas into nearby large blood vessels. The “N” in the TNM system stands for node.
Lymph nodes are tiny organs shaped like beans that can be found throughout the body. Lymph nodes help the body fight infections. Regional lymph nodes are near the cervix, while distant lymph nodes are in other parts of the body. Lymph node stages are: NX – The regional lymph nodes cannot be evaluated because of incomplete information. N0 – The cancer has not spread into the regional lymph nodes. N1 – The cancer has spread into the regional lymph nodes. The “M” in the TNM system is used for cancer that has spread, or metastasized, to other parts of the body.
The stages for metastatic pancreatic cancer are: MX – Distant metastasis cannot be evaluated because of incomplete information. M0 – The cancer has not metastasized, or spread, to distant lymph nodes (those not near the pancreas) or distant organs. M1 – The cancer has spread to other parts of the body beyond the pancreas, such as the liver, lungs, or brain. Cancer Stages 0 to IV After the T, N, and M categories of your cancer have been identified, your doctor will combine this information to assign a stage (I to IV) to your cancer.
The higher the number, the more serious (advanced) the cancer is. * Stage 0 (carcinoma in situ) – Cancer is found only in the lining of the pancreas (Tis, N0, M0). * Stage 1 – Cancer is found only in the pancreas. * Stage IA – The tumor is 2 centimeters or smaller (T1, N0, M0). * Stage IB – The tumor is larger than 2 centimeters (T2, N0, M0). * Stage II – Cancer has spread to nearby tissue and organs (such as the duodenum, bile ducts, or fat surrounding the pancreas) and possibly to regional lymph nodes. * Stage IIA – Cancer has spread to nearby tissue and organs but not to nearby lymph nodes (T3, N0, M0).
* Stage IIB – Cancer has spread to nearby lymph nodes and possibly to nearby tissue and organs but has not spread to the blood vessels (T1-3, N0, M0). * Stage III – Cancer has spread to the major blood vessels near the pancreas. It may or may not have spread to nearby lymph nodes (T4, any N, M0). * Stage IV – Cancer has spread to the stomach or bowel or to distant organs, such as the liver, lungs, and bones (any T, any N, M1).
* Recurrent or relapsed – Pancreatic cancer has returned (or regrown) following initial treatment with surgery, radiation therapy, and/or chemotherapy. The cancer may have returned to the pancreas or another place.