How Do Doctors Stage Pancreatic Cancer?

Staging pancreatic cancer means doctors describe the size and location of a tumor on the pancreas and whether it has spread. This is a critical phase in planning treatment. Correctly identifying pancreatic cancer stages helps healthcare professionals determine the odds of recovery. Staging is a complex process that may involve additional tests or surgery after diagnosis.

Commonly Used Staging Methods

• TNM (tumor, node, metastasis) This is the most commonly used system and categorizes cancer into one of five stages, ranging from 0 to 4. The determination of which stage best describes a tumor depends on how large the tumor is, whether it has grown into nearby blood vessels, whether it has spread to nearby lymph nodes, and whether it has metastasized (spread) to distant sites. A stage 0 tumor is the least advanced, while stage 4 pancreatic cancer is the most advanced.
• Surgical resection staging This method focuses on whether a surgeon can remove (or resect) the cancer and where it has spread. Complete surgical resection of pancreatic cancer leads to the best long-term prognosis.

The TNM System for Staging Cancer: From 0 to 4

With the TNM system:

• “T” stands for tumor
• “N” stands for node (as in lymph node)
• “M” stands for metastasis.

Doctors stage each cancer according to factors such as:

• The tumor’s size
• The tumor’s location
• Whether it has spread to the lymph nodes
• How far from the site of the tumor it has spread
• Whether it has metastasized and how much

Here’s how each stage breaks down and what this means for the cancer diagnosis:

• Stage 0, or carcinoma in situ This occurs when abnormal cells are present in the lining of the pancreas, but none are present in deeper tissue.
• Stage 1 The cancer has stayed in the pancreas. A cancer specialist would consider the cancer stage 1A if the tumor is 2 centimeters (cm) or smaller in diameter and stage 1B if the tumor is between 2 and 4 cm.
• Stage 2 In stage 2A, the tumor is larger than 4 cm. In stage 2B, the tumor is any size and has spread to 1 to 3 nearby lymph nodes.
• Stage 3 The tumor has spread to 4 or more nearby lymph nodes or major blood vessels near the pancreas.
• Stage 4 The cancer has spread to distant tissues and organs, such as the lungs, liver, or the peritoneal cavity (containing most of the organs in the abdomen).

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Doctors may also describe pancreatic cancer as recurrent if it comes back after treatment, either in the pancreas or in another part of the body, such as the liver.

Pancreatic tumors that recur prompt further rounds of tests and scans to learn about the extent of the cancer.

A Surgery-Focused Staging System

• Resectable A cancer is resectable if it hasn’t spread beyond the pancreas or has only spread beyond it in a very limited way. While a doctor may classify some cancers as resectable based on imaging tests, surgery may reveal that the disease has spread more widely. The surgeon will stop the operation to avoid potential side effects if that happens.
• Borderline resectable The tumor has grown into neighboring structures or blood vessels, but the surgeon believes it can still be completely removed. Shrinking the tumor before surgery with chemotherapy or radiation may mean a surgeon can remove it without leaving any visible tumor behind.
• Unresectable A surgeon can’t remove all of the cancer, either because it has grown into or grown around major blood vessels or nearby organs, or because it has metastasized to distant organs.

Staging Pancreatic Neuroendocrine Tumors (PNETS)

• Stage 1 The tumor is less than 2 cm across and is limited to the pancreas.
• Stage 2 The tumor is between 2 and 4 cm or more than 4 cm and is still just in the pancreas; or it has grown into the first part of the small intestine or the common bile duct.
• Stage 3 The tumor has grown into nearby organs or large blood vessels or it has spread to nearby lymph nodes.
• Stage 4 The cancer has spread to distant parts of the body.

Is Pancreatic Cancer Curable?

This means that people with pancreatic cancer are 13 percent as likely as those without a pancreatic cancer diagnosis to still be alive five years after diagnosis. However, this doesn’t account for the stage at which a doctor diagnoses pancreatic cancer or how well a person responds to treatment.

These numbers are only averages, and some people live a lot longer than these statistics suggest. Age, overall health, and an individual’s response to treatment can all affect pancreatic cancer life expectancy.

The Takeaway

• Correctly staging pancreatic cancer is vital for doctors to develop an appropriate treatment plan and assess recovery chances, as early detection plays a crucial role in survival rates.
• While surgery can offer the best possibility of survival for resectable cancers, it requires confirmation by a highly experienced surgeon to accurately determine your options.
• The TNM system, which stands for tumor, node, and metastasis, remains the primary method for staging pancreatic cancer, though accurate staging requires a series of tests and imaging to assess cancer spread.
• If experiencing symptoms or concerns related to pancreatic cancer, it is important to consult a healthcare professional for a comprehensive evaluation and possible early intervention.