Pancreatic Cancer Stages

When diagnosed with pancreatic cancer, most patients are naturally anxious to learn the severity of their disease – the stage of pancreatic cancer they have. The cancer stage gives them an idea of the disease outcome and the types of treatment that may be needed. Being well-informed about the pancreatic cancer stages can help patients prepare for what’s to come physically, mentally and emotionally.

Related: Pancreatic Cancer Survival Rates

Patients with pancreatic cancer are grouped into stages to describe how advanced the disease is. While doctors can use the detailed system from the American Joint Committee on Cancer (AJCC), most often they use a simpler system based on whether the tumor can be removed by surgery.

This system has four categories: resectable (can be removed), borderline resectable (maybe removable), locally advanced (cannot be removed because it involves nearby blood vessels), and metastatic (has spread to other parts of the body).

The most common staging system for pancreatic cancer in the United States follows the American Joint Committee of Cancer (AJCC) staging manual. For more detailed staging, doctors follow the American Joint Committee of Cancer (AJCC) staging manual. In the latest 8th edition, there are two staging systems for pancreatic cancer – the clinical stage and the pathological stage.

The clinical stage is the stage given regardless of the type of treatment. It is based on physical examinations, imaging tests, diagnostic tests and biopsies.

The pathological stage is the stage given after surgery or resection of the tumor, if these treatments are carried out. It is based on information obtained from the surgery together with any tests done before surgery. The pathological stage tends to be more reflective of the patient’s outlook than the clinical prognosis stage as it is based on more accurate information on the size and spread of cancer.

Both the clinical stage and pathological stage are based on:

• Size of primary tumor
• Nodal involvement
• Presence of distant metastases

The size of the primary tumor, nodal involvement and presence of distant metastases are described using the AJCC TNM system.

Primary tumor (T)

This category is based on the size of the tumor, the number of tumors and whether or not the cancer has spread to nearby structures such as the veins in the liver. It is described with the letter ‘T’ followed by ‘X’, 0, 1a, 1b, 2, 3 or 4.

TX: Size of the tumor cannot be measured.

T0: No tumor is present.

Tis: In situ carcinoma

T1: A single tumor 2 cm (about 0.8 inches) or smaller, or larger than 2 cm without vascular invasion.

T1a: A single tumor 2 cm or smaller.

T1b: A single tumor larger than 2 cm without vascular invasion.

T2: A single tumor larger than 2 cm but no larger than 4 cm (about 1.6 inches), or multiple tumors with none being larger than 5 cm (about 2 inches).

T3: Multiple tumors with at least one being larger than 5 cm.

T3a: Multiple tumors that are larger than 5 cm.

T3b: Any tumor involving a major branch of the portal vein or hepatic vein (a large vein of the liver).

T4: Any size of tumor or multiple tumors growing into a major branch of the portal or hepatic vein, or any size of tumor or multiple tumors directly invading adjacent organs (other than the gallbladder).

Nodal involvement (N)

This category looks at how many lymph nodes the cancer has spread to, if any. It is described with the letter ‘N’ followed by ‘X’, 0 or 1. This is a brief and simplified description of nodal involvement:

NX: The lymph nodes cannot be assessed.

N0: No cancer has advanced to the neighboring lymph nodes.

N1: Cancer has spread to the neighboring lymph nodes.

Distant metastases (M)

This category determines if the cancer has spread to more distant parts of the body, such as the lungs or bones, after imaging tests, physical examination or biopsy. It is described with the letter ‘M’ followed by 0 or 1.

M0: Cancer has not advanced to other parts of the body.

M1: Cancer has advanced to distant organs.

Depending on the TNM assessment, the cancer is clinically staged according to the categories below.

Stages

Learning your pancreatic cancer stage can be a challenging and emotional experience, but it is an essential part of your cancer journey. Understanding the pancreatic cancer stages can give you a greater sense of control and help you feel more prepared for what lies ahead. It's natural to feel a range of emotions after receiving a diagnosis, and having a strong support system to lean on throughout the process can provide some comfort. Rest assured that your healthcare team will be with you every step of the way, answering your questions and providing guidance as you navigate your treatment.

Related: Pancreatic Cancer Treatments