The stages of pancreatic cancer

The stage of a cancer tells the doctor how far it has spread. The tests and scans you have when diagnosing your cancer give some information about the stage. It is important because treatment is often decided according to the stage of a cancer. Your doctor may not be able to tell you the exact stage of your cancer until after your surgery. There are different ways of staging cancers. The two main ways are the TNM system and number systems. There is more about staging cancers in the about cancer section.

'TNM' stands for Tumour, Node, Metastasis. This system can describe the size of a primary tumour, whether there are lymph nodes with cancer cells in them and whether the cancer has spread to a different part of the body. There are 5 stages of tumour size in the current TNM classification

• Tis (carcinoma in situ) is very early stage pancreatic cancer, which has not had a chance to spread. This is not at all common with this type of cancer.
• T1 means the the tumour is inside the pancreas and is 2cm or less in any direction
• T2 means the tumour is still within the pancreas but is more than 2cm across in any direction
• T3 means the cancer has started to grow into tissues around the pancreas. It has not grown into the nearby large blood vessels
• T4 means the cancer has grown further outside the pancreas, into the nearby large blood vessels

N0 means there are no lymph nodes containing cancer. N1 means there are lymph nodes which contain cancer cells and so the cancer is more likely to have spread further than the pancreas itself. 

M0 means the cancer has not spread into distant organs such as the liver or lungs. M1 means the cancer has spread to other organs.

There are four stages in this system - stage 1 to 4.

Stage 1

Stage 1 is divided into stage 1A and stage 1B

Stage 1A

This is the earliest stage of invasive cancer. The cancer is completely inside the pancreas itself. It is smaller than 2 cm and there is no cancer in the lymph nodes or cancer spread. In TNM staging, this is the same as T1, N0, M0.

Stage 1B

The cancer is completely inside the pancreas itself but is bigger than 2cm. There is no cancer in the lymph nodes or cancer spread. In TNM staging, this is the same as T2, N0, M0.

Stage 2

Stage 2 is divided into stage 2A and stage 2B 

Stage 2A

The cancer has started to grow into nearby tissues around the pancreas. It may be in the duodenum or the bile duct. But there is no cancer in the nearby large blood vessels or lymph nodes. This means that, although the cancer has been growing locally, there is a chance that it may not have spread through the blood or lymph systems. In TNM staging, this is the same as T3, N0, M0.

Stage 2B

The cancer itself can be any size and may have grown into the tissues surrounding the pancreas. Cancer is also found in the nearby lymph nodes, but not the large blood vessels. In TNM staging, this is the same as T1, 2 or 3, N1, M0.

Stage 3

The cancer is growing outside the pancreas, into the nearby large blood vessels. It may or may not have spread into the lymph nodes. It has not spread to other body organs. Your doctor may call this locally advanced cancer. In TNM staging, this is the same as T4, Any N, M0.

Stage 4

The cancer has spread to distant sites such as the liver or lungs. Your doctor may call this advanced cancer. In TNM staging, this is the same as Any T, Any N, M1.