Pancreatic cancer stages

Understanding the stages of pancreatic cancer is helpful in planning the appropriate treatment. Cancer stages are determined by testing, rather than specific symptoms.

Most of the time, pancreatic cancer lacks symptoms in the early stages, so it’s often caught in more advanced stages, when the cancer has already spread beyond the pancreas.

Symptoms associated with pancreatic cancer include:

• Jaundice (a yellowing of the skin; often the first symptom of pancreatic cancer)
• Blood clots
• Gallbladder or liver enlargement
• Lack of appetite
• Nausea
• Pain in the abdomen or back
• Vomiting

If you experience any of these symptoms, check with your doctor to determine a cause. Also, keep in mind that these symptoms may be due to other conditions.

The TNM staging system, from the American Joint Committee on Cancer, uses numbers and letters, such as stage 0 or stage IA, to describe the size and location of pancreatic cancer.

This staging system is based on:

• Tumor (T) size, and whether it has grown into blood vessels near the pancreas
• Spread to nearby lymph nodes (N)
• Spread to distant lymph nodes or organs, or metastasis (M)

Below is more information on those stages, and the corresponding TNM indications.

Stage 0 (carcinoma in situ)

In this stage, the pancreas has abnormal cells that might become cancer and spread to nearby tissue.

Stage I (T1, N0, M0/T2, N0, M0)

Cancer is limited to the pancreas in stage I.

• Stage IA describes a tumor that is 2 cm (0.8 inches) or smaller.
• Stage IB indicates a tumor measuring from 2 to 4 cm.

Stage II (T3, N0, M0/T1, T2, or T3 and N1, M0)

• Stage IIA signals a tumor bigger than 4 cm.
• Stage IIB describes a tumor of any size and cancer that has spread to one to three nearby lymph nodes.

Stage III (T1, T2 or T3, N2, M0/T4, any N, M0)

Stage III describes cancer that has spread to four or more lymph nodes near the tumor and/or major blood vessels near the pancreas. The tumor can be any size.

Stage IV (any T, any N, M1)

In stage IV, the tumor has spread to other parts of the body, such as the liver, lungs or bones. The tumor can be any size.

After determining the cancer stage, a care team will plan treatment using the following groupings:

Resectable pancreatic cancer

Resectable pancreatic cancer may be surgically removed because it has not expanded into major blood vessels. About 10 to 15 percent of pancreatic cancer patients are diagnosed at this stage, according to the American Society of Clinical Oncology (ASCO). 

Surgery is a potential treatment option for about 20 percent of those with pancreatic cancer, ASCO says. This percentage is low because pancreatic cancer is typically diagnosed after it has spread. Sometimes other treatments, such as radiation therapy, are used before surgery.

For this type of cancer, doctors use the following surgical procedures:

• Distal pancreatectomy, which removes parts of the pancreas known as the body and tail. Sometimes, the spleen is removed as well, if cancer has spread there.
• Total pancreatectomy, which involves removal of the whole pancreas, common bile duct, gallbladder, spleen, nearby lymph nodes, and parts of the stomach and small intestine.
• Whipple procedure, which removes what’s called the head of the pancreas, as well as the gallbladder and parts of the bile duct, stomach and small intestine.

In addition to surgery, doctors may also use one or more of the following treatments for pancreatic cancer:

• Chemotherapy, which involves using drugs to kill cancer cells
• Radiation therapy, or the use of high-energy X-rays, to kill cancer cells
• Chemoradiation therapy, or a mix of both chemotherapy and radiation therapy
• Targeted therapy, which uses drugs or other substances to attack specific cancer cells

Borderline resectable pancreatic cancer

This type of pancreatic cancer has grown into nearby tissues, organs or a major blood vessel. Although it may be possible to remove the tumor, surgeons may not be able to extract all of the cancer via surgery. Chemotherapy or radiation therapy may be used to shrink the tumor, so it may be surgically  removed.

The five-year survival rate for this stage of pancreatic cancer is 39 percent, according to the American Cancer Society (ACS). Remember that survival rates are estimates. They may not reflect treatments developed during that five-year period that could improve the chances of survival. 

Locally advanced pancreatic cancer

This type of pancreatic cancer is close to nearby arteries, lymph nodes, organs or veins. The cancer can’t be completely removed by surgery, and surgery would possibly damage those nearby areas. About 35 to 40 percent of pancreatic cancer patients are diagnosed at this stage, according to ASCO. The five-year relative survival rate for regional pancreatic cancer (which has spread to lymph nodes or other nearby structures) is 13 percent, the ACS reports.

Even if the cancer can’t be removed, doctors have use of several procedures to improve a patient’s symptoms or quality of life, including:

• Biliary bypass is used if the cancer is blocking the bile duct and bile continually builds up in the gallbladder. Doctors create a new way for bile to move in the body.
• Endoscopic stent placement drains bile that has built up.
• Gastric bypass is used if the tumor blocks food from leaving the stomach. With this procedure, the stomach is connected to the small intestine, enabling the patient to continue to eat normally.

Metastatic pancreatic cancer

Surgery won’t completely remove this type of pancreatic cancer because it has spread to other organs (for example, the lungs or liver). About 45 to 55 percent of pancreatic cancer patients are diagnosed at this stage, according to ASCO. The five-year relative survival rate for this stage is 3 percent, the ACS reports.

Recurrent pancreatic cancer

This refers to cancer that has returned after treatment. It may appear in the pancreas or elsewhere in the body. Cancer that occurs again may be restaged, meaning that doctors will add a new staging classification to the original stage. The new classification doesn’t replace the original stage. A care team may recommend chemotherapy or new anticancer agents in addition to or instead of chemotherapy to treat recurrent pancreatic cancer.   

Clinical trials

Clinical trials provide state-of-the-art care and new treatments, and help cancer care teams improve the available treatments. Clinical trials for cancer always compare new treatments to standard care. Trials are supported by several organizations, including the National Cancer Institute (NCI), and online listing search services are available, such as NCI’s “Steps to Find A Clinical Trial.” The NCI also has a website for pancreatic cancer treatment-focused trials. It’s important to check with a doctor to make sure clinical trials are right for the patient.