Pancreatic Cancer Overview

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Early Detection, Diagnosis, and Staging TOPICS

Staging for pancreatic cancer

The stage of a cancer is a standard way for doctors to sum up how far the cancer has spread. This is very important because your treatment and outlook depend on the stage of your cancer. The tests described in the section “How is pancreatic cancer found?” are used to decide the stage of the cancer.

The most common staging system for pancreatic cancer is the AJCC staging system, also known as the TNM system. It uses 3 key pieces of information:

  • T describes the size of the main tumor and if it has grown into nearby structures.
  • N describes spread to nearby lymph nodes.
  • M tells whether the cancer has spread (metastasized) to other parts of the body.

The T, N, and M categories are combined to get an overall stage, using 0 and the Roman numerals I through IV (1-4). The lower the number, the less the cancer has spread. A higher number, such as stage IV (4), means a more advanced cancer.

If you have pancreatic cancer, ask your doctor to explain its stage in a way that you understand. This can help you take a more active role in making informed decisions about your treatment.

Other factors

Although not part of the AJCC staging system, some other factors are also important. The grade of the cancer (whether the cells look more or less normal under the microscope) is sometimes listed on a scale from G1 to G3 (or G4), with G1 cancers looking the most like normal cells and having the best outlook.

If you have surgery, the extent of the resection — whether or not all of the tumor is removed — is also important with regard to outlook. This is sometimes listed on a scale from R0 (where all of tumor that can be seen has been removed) to R2 (where some tumor could not be removed).

Resectable versus unresectable pancreatic cancer

The AJCC staging system provides a detailed summary of how far the cancer has spread. But for treatment purposes, doctors often use a simpler staging system which divides cancers into groups based on whether or not it is likely they can be removed (resected) by surgery. These groups are listed below.

Resectable: The cancer is only (or mostly) in the pancreas and the doctors think all of it can be removed.

Borderline resectable: The cancer has just reached nearby blood vessels, but the doctors feel it might still be removed completely with surgery.

Locally advanced (unresectable): The cancer has not spread to distant organs, but the doctor still can’t remove all of the cancer. Surgery would be done only to relieve symptoms or other problems.

Metastatic: The cancer has spread to distant organs. Surgery would be done only to relieve symptoms or other problems.

Last Medical Review: 08/01/2014
Last Revised: 02/01/2016