Pancreatic Cancer: Stages

Approved by the Lineagotica Editorial Board, 05/2018

ON THIS PAGE: You will learn about how doctors describe a cancer’s growth or spread. This is called the stage. Use the menu to see other pages.

Staging is a way of describing where the cancer is located, if or where it has spread, and whether it is affecting other parts of the body. Doctors use diagnostic tests to find out the cancer's stage, so staging may not be complete until all the tests are finished. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient's prognosis, which is the chance of recovery. There are different stage descriptions for different types of cancer. It is important for the staging to be done at a medical center with experience in staging pancreatic cancer.

Doctors use several systems to stage pancreatic cancer. The method used to stage other cancers, called the TNM classification, is not often used for pancreatic cancer; however, for completeness, it is discussed further below.

The more common way to classify pancreatic cancer is to divide it into 4 categories based on whether it can be removed with surgery and where it has spread:

Resectable

This type of pancreatic cancer can be surgically removed. Surgery is often done right after diagnosis. Sometimes, additional treatment may be recommended before surgery. The tumor may be located only in the pancreas or extend beyond it, but it has not grown into important arteries or veins in the area. There is no evidence that the tumor has spread to areas outside of the pancreas. Approximately 10% to 15% of patients are diagnosed with this stage.

Borderline resectable

This category describes a tumor that may be difficult or not possible to remove surgically when it is first diagnosed, but if chemotherapy and/or radiation therapy is able to shrink the tumor first, it may be able to be removed later with negative margins. A negative margin means that no visible cancer cells are left behind.

Locally advanced

This type is still located only in the area around the pancreas, but it cannot be surgically removed because it has grown into or close to nearby arteries, veins, or nearby organs. This means that it cannot be removed with surgery because the risk of damaging these nearby structures is too high. There are no signs that it has spread to any distant parts of the body. Approximately 35% to 40% of patients are diagnosed with this stage.

Metastatic

The tumor has spread beyond the area of the pancreas and to other organs, such as the liver, lungs, or distant parts of the abdomen. Approximately 45% to 55% of patients are diagnosed with this stage.

By classifying each cancer into 1 of these categories, the health care team can plan the best treatment strategy.

TNM Staging System

Doctors frequently use a tool called the TNM system to stage other types of cancer. Doctors generally classify a tumor during surgery, and many patients with pancreatic cancer do not receive surgery. Therefore, the TNM system is not used as much for pancreatic cancer as it is for other cancers.

For the TNM system, doctors use the results from diagnostic tests, scans, and surgery to answer these questions:

  • Tumor (T): How large is the primary tumor? Where is it located?

  • Node (N): Has the tumor spread to the lymph nodes? If so, where and how many? 

  • Metastasis (M): Has the cancer spread to other parts of the body? If so, where and how much?

The results are combined to determine the stage of cancer for each person. There are 5 stages: stage 0 (zero) and stages I through IV (1 through 4). The stage provides a common way of describing the cancer, so doctors can work together to plan the best treatments. Here are more details on each part of the TNM system for pancreatic cancer:

Tumor (T)

Using the TNM system, the "T" plus a letter or number (0 to 4) is used to describe the size and location of the tumor. Tumor size is measured in centimeters (cm). A centimeter is roughly equal to the width of a standard pen or pencil.

The tumor stage helps the doctor develop the best treatment plan for each patient. Specific tumor stage information is listed below.

TX: The primary tumor cannot be evaluated.

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

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

T1: The tumor is in the pancreas only, and it is 2 centimeters (cm) or smaller in size. This stage may be further divided into T1a, T1b, and T1c based on the size of the tumor.

T2: The tumor is in the pancreas only, and it is larger than 2 cm but not larger than 4 cm.

T3: The tumor is larger than 4 cm and extends beyond the pancreas. It 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. A T4 tumor cannot be completely removed with surgery.

Node (N)

The "N" in the TNM staging system is for lymph nodes. These tiny, bean-shaped organs located throughout the body help fight infection and disease as part of the body's immune system. In pancreatic cancer, regional lymph nodes are those lymph nodes near the pancreas and distant lymph nodes are those lymph nodes in other parts of the body.

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.

Metastasis (M) 

The "M" in the TNM system indicates 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 another part 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 lungs.

Cancer stage grouping

Doctors assign the stage of the cancer by combining the T, N, and M classifications.

Stage 0: Refers to cancer in situ, in which the cancer has not yet grown outside the duct in which it started (Tis, N0, M0).

Stage IA: The tumor is 2 cm or smaller in the pancreas. It has not spread to lymph nodes or other parts of the body (T1, N0, M0).

Stage IB: A tumor larger than 2 cm is in the pancreas. It has not spread to lymph nodes or other parts of the body (T2, N0, M0).

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

Stage IIB: A tumor of any size has not spread to nearby arteries or veins. It has spread to 1 to 3 regional lymph nodes but not to other parts of the body (T1, T2, or T3; N1; M0).

Stage III: Either of these conditions:

  • A tumor of any size that 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).

Stage IV: Any tumor that has spread to other parts of the body (any T, any N, M1).

Recurrent: Recurrent cancer is cancer that has come back after treatment. If the cancer does return, there will be another round of tests to learn about the extent of the recurrence. These tests and scans are often similar to those during the original diagnosis.

Used with permission of the American College of Surgeons, Chicago, Illinois. The original and primary source for this information is the AJCC Cancer Staging Manual, Eighth Edition (2017) published by Springer International Publishing.

Information about the cancer’s stage will help the doctor recommend a specific treatment plan. The next section in this guide is Types of Treatment. Use the menu to choose a different section to read in this guide.