Stages of pancreatic cancer

Staging describes or classifies a cancer based on how much cancer there is in the body and where the cancer is when it is first diagnosed. This is often called the extent of cancer. The healthcare team uses information from tests to find out the size of the tumour, which parts of the organ have cancer, whether the cancer has spread from where it first started and where the cancer has spread. Doctors use the stage to plan treatment and estimate the outcome (prognosis).

Multiple staging systems are used for pancreatic cancer. The most common staging system is the AJCC TNM system. For pancreatic adenocarcinoma there are 5 stages – stage 0 followed by stages 1 to 4. Often the stages 1 to 4 are written as the Roman numerals I, II, III and IV. Generally, the higher the stage number, the larger the tumour is or the more the cancer has spread.

When the healthcare team is determining prognosis and planning treatment for pancreatic cancer, the most important factor is whether a tumour can be removed through surgery (called resectability). Because of this, you may hear your doctor use the words resectable, borderline resectable or unresectable when they talk about the stage.

Resectable means the cancer can be removed entirely through surgery. Typically, a resectable pancreatic tumour is only in the pancreas and the other tissues and organs close to it. The tumour is not touching or surrounding any blood vessels near the pancreas and the cancer hasn’t spread to other parts of the body.

Borderline resectable means it is unclear whether the cancer can be removed entirely through surgery because it has grown into or around major blood vessels. Doctors will determine if the tumour is resectable or unresectable based on which blood vessels are affected and whether they can be reconstructed after surgery to remove the tumour. Sometimes, neoadjuvant therapies( for example, chemotherapy and radiation therapy) can be used to shrink a tumour and make it resectable. Neoadjuvant therapy also tries to kill any cells that may have broken off the tumour in the pancreas and spread.

Unresectable means the cancer is advanced or cannot be removed entirely through surgery. Pancreatic cancer that has spread outside of the pancreas is considered unresectable. Cancer that has spread to structures close to the pancreas, such as the major blood vessels near the pancreas, is called locally advanced cancer. Cancer that has spread to distant parts of the body, such as the lungs, is called metastatic cancer. Pancreatic cancer that comes back after treatment (called recurrent pancreatic cancer) is also usually considered unresectable.

Talk to your doctor if you have questions. Find out more about staging cancer.

Cancer is only in the inner lining of the ducts of the pancreas (epithelium). It has not spread into deeper layers of the ducts or outside of the pancreas. Sometimes, precancerous conditions of the pancreas may be described as carcinoma in situ.

The tumour is no more than 2 cm wide (stage 1A).

OR

The tumour is more than 2 cm but less than 4 cm wide (stage 1B).

The tumour is more than 4 cm wide (stage 2A).

OR

The tumour is of any size and has spread to 1 to 3 nearby lymph nodes (stage 2B).

The cancer has not spread to other parts of the body.

The tumour is of any size and has spread to 4 or more nearby lymph nodes.

OR

The tumour has grown into one or more of the large blood vessels outside of the pancreas (including the celiac axis, superior mesenteric artery and common hepatic artery). Cancer may be found in nearby lymph nodes.

The cancer has not spread to other parts of the body.

The cancer has spread to other parts of the body (called distant metastasis) , such as to the liver or lungs. This is also called metastatic pancreatic cancer.

Recurrent pancreatic cancer means that the cancer has come back after it has been treated. If it comes back in the same place that the cancer first started, it's called local recurrence. If it comes back in tissues or lymph nodes close to where it first started, it's called regional recurrence. It can also come back in another part of the body. This is called distant metastasis or distant recurrence.