Pancreatic Cancer Staging

After confirming a pancreatic cancer diagnosis, oncologists will conduct additional testing to determine the stage. 

Pancreatic cancer staging is the process of gathering information about the cancer’s location, the size of the tumor, and whether it has invaded lymph nodes or other areas of the body outside the pancreas.  

The information collected helps the pancreatic cancer specialist, known as a gastrointestinal (GI) oncologist, understand the severity of the cancer. Based on that information, they will create a treatment plan with the GI surgeon.

How to Determine Pancreatic Cancer Stages

Until recently, staging for pancreatic cancer did not include information about whether the tumor can be resected or removed surgically. The tumor’s resectability is key to directing the treatment plan. 

Pancreatic Cancer Resectability

The surgeon will review images of the pancreas and surrounding areas to decide whether it can be surgically removed. The tumor is classified into one of the following categories:

Resectable Pancreatic Cancer

The tumor can be removed with surgery and has not spread beyond the pancreas. Surgery is likely going to remove all of the cancer cells.

Borderline Resectable Pancreatic Cancer

This describes a tumor that may not be operable initially but could become so after shrinking through chemotherapy or radiation therapy.

Unresectable Pancreatic Cancer

This means the tumor cannot be surgically removed because it’s too close to important arteries, veins, or organs and has spread to other parts of the body. Unresectable pancreatic cancer includes both locally advanced and metastatic cancers.

Resectability is Combined with Standard TNM Staging

The TNM system is a careful attempt to find out the following:

  • T = The size of the tumor in the pancreas
  • N = Whether the tumor has invaded nearby tissues, including lymph nodes
  • M = Whether the cancer has spread (metastasized), and if so, to what parts of the body

T Categories for Pancreatic Cancer

T, followed by a number from 0 to 4, describes the principal (primary) tumor's size and if it has spread. Higher T numbers mean a larger tumor and/or wider spread.

TX: The primary tumor cannot be evaluated. 

T0 (T zero): No evidence of cancer was found in the pancreas.

Tis: Refers to carcinoma in situ, a very early cancer that has not spread.

T1: The tumor is contained in the pancreas only, and its size is 2 cm or smaller.

T2: The tumor is contained in the pancreas only, and its size ranges from larger than 2 cm to no larger than 4 cm. 

T3: The tumor is larger than 4 cm and extends beyond the pancreas but does not involve the major arteries or veins near the pancreas. 

T4: The tumor extends beyond the pancreas into major arteries or veins near the pancreas and cannot be completely removed with surgery.

N Categories for Pancreatic Cancer

N, followed by a number from 0 to 3, indicates whether the cancer has spread to lymph nodes.

NX: The regional lymph nodes cannot be evaluated.

N0: Cancer was not found in the regional lymph nodes.

N1: Cancer has spread to 1 to 3 regional lymph nodes.

N2: Cancer has spread to 4 or more regional lymph nodes.

M Categories for Pancreatic Cancer

M describes whether the cancer has spread to other parts of the body (called distant metastasis).

M0: The disease has not spread to other parts of the body.

M1: Cancer has spread to other parts of the body, including distant lymph nodes. Pancreatic cancer most commonly spreads to the liver, the lining of the abdominal cavity called the peritoneum, and the lungs.

Pancreatic Cancer Stage Grouping

Stage 0 Pancreatic Cancer

This is also known as cancer in situ. The cancer has not yet grown outside the duct where it started (Tis, N0, M0).

pancreas cancer stage 0 medical illustration

Stage I Pancreatic Cancer

Most stage I pancreatic cancers are resectable, meaning the pancreas can be surgically removed, entirely removing the cancer.

Stage IA

The tumor is 2 cm or smaller within the pancreas and has not spread to lymph nodes or other parts of the body (T1, N0, M0). 

Stage IB

The tumor in the pancreas is larger than 2 cm but has not spread to lymph nodes or other parts of the body (T2, N0, M0).

pancreatic-ca-stage-1A1B

Stage II Pancreatic Cancer

Tumors in stage II are either resectable (can be removed entirely) or borderline resectable. Borderline resectable tumors can sometimes be removed by surgery, especially if treatments are used to shrink the cancer before surgery.

Stage IIA

The tumor is larger than 4 cm and has developed outside of the pancreas. It has not spread to the nearby arteries, veins, lymph nodes, or other parts of the body (T3, N0, M0).

pancreatic-ca-stage-2A

Stage IIB

This is considered a tumor of any size that has not spread to arteries or veins nearby. It has spread to 1 to 3 regional lymph nodes but not other parts of the body (T1, T2, or T3; N1; M0).

pancreatic-ca-stage-2B

Stage III Pancreatic Cancer

Either of these conditions:

  • A tumor of any size has spread to 4 or more regional lymph nodes but not to nearby arteries, veins, or other parts of the body (T1, T2, or T3, N2, M0).
  • A tumor that has spread to nearby arteries and veins and may have spread to regional lymph nodes. It has not spread to other parts of the body (T4, any N, M0).

Most stage III pancreatic cancers are unresectable, which means they cannot be removed surgically. Cancer has grown too far into the areas around the pancreas and/or into too many lymph nodes to remove all of the cancer cells surgically.

pancreatic-ca-stage-3

Stage IV Pancreatic Cancer

Any tumor that has spread to other parts of the body (any T, any N, M1). This is referred to as metastatic pancreatic cancer. Pancreatic cancer at this stage is unresectable. 

pancreatic-ca-stage-4

Recurrent Pancreatic Cancer

Recurrent disease means that cancer has returned (recurred) after its initial treatment. It may have come back to the original site in the pancreas or another part of the body.

Pancreatic Cancer Treatment After Staging

After determining if surgery is possible, your pancreatic cancer specialist will identify other treatments that will be beneficial in making sure cancer cells are destroyed. Learn more about pancreatic cancer surgery and pancreatic cancer treatments. 

If you would like to request an initial consultation or a second opinion, request an appointment at one of our Portland or Vancouver locations.

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