Pancreatic cancer staging is a multi-faceted process used by physicians to describe the size of the primary tumor and determine how far it has spread within the body. This information is used to guide treatment and classify patients for clinical trials.
How is pancreatic cancer staged?
Usually, the clinical stage of pancreatic cancer can be determined with pretreatment computed tomography (CT) imaging. The most frequently used staging method involves the evaluation of two key characteristics of the primary tumor:
- Whether the tumor can be surgically removed
- Where in the body the cancer has spread
Based on this information, the pancreatic cancer is then assigned to one of four categories:
Category 1: Resectable primary tumors
A resectable pancreatic tumor can be surgically removed. The cancer may be confined to the pancreas or extend slightly beyond it, but there is no involvement of vital arteries, veins or other organs that would complicate surgery.
Depending on the size and location of the tumor, a physician may suggest a Whipple procedure, a modified Whipple procedure, a distal pancreatectomy or a total pancreatectomy. During surgery, a border of healthy tissue is removed along with the tumor and examined under a microscope; if cancerous cells are found (positive surgical margins), chemotherapy or radiation therapy may be suggested to help prevent a cancer recurrence.
Category 2: Borderline resectable tumors
A borderline resectable pancreatic tumor may be difficult or impossible to surgically remove at the time of diagnosis. However, after chemotherapy and/or radiation therapy is administered, the tumor may shrink sufficiently in size to allow for its complete removal with negative surgical margins (no visible cancer cells left behind).
Category 3: Locally advanced tumors
A locally advanced pancreatic tumor is confined to the pancreas and surrounding area. However, the tumor cannot be surgically removed because it has grown into or close to nearby arteries, veins or organs, and the risk of damaging these vital structures during surgery is high. Treatment may involve chemotherapy, radiation therapy or surgery, such as a stent placement or bypass procedure, to help alleviate symptoms caused by a blockage.
Category 4: Metastatic tumors
A metastatic pancreatic tumor has spread beyond the pancreas and surrounding area to other tissues and organs, such as the liver, lungs or distant parts of the abdomen. Treatment can vary depending on the location and extent of the cancer.
The TNM system
Another method of staging pancreatic cancer is based on the TNM system, which was developed by the American Joint Committee on Cancer (AJCC) to stage many types of cancer. When using the TNM system to stage pancreatic cancer, a physician evaluates the results of diagnostic tests, such as a physical examination, imaging scans and biopsies, to determine three key criteria:
- The size and location of the primary tumor (T)
- The involvement of nearby lymph nodes (N)
- Whether the tumor has spread (metastasized) to other parts of the body (M)
The TNM stages of pancreatic cancer and the corresponding surgical resection categories are:
Stage 1A pancreatic cancer
At stage 1A, the primary tumor is resectable. The cancer is confined to the pancreas and the tumor is 2 cm or smaller in diameter.
Stage 1B pancreatic cancer
At stage 1B, the primary tumor is resectable. The cancer is confined to the pancreas and the tumor is larger than 2 cm in diameter.
Stage 2A pancreatic cancer
At stage 2A, the primary tumor is resectable or borderline resectable. The cancer extends slightly beyond the pancreas but does not involve nearby lymph nodes or major arteries.
Stage 2B pancreatic cancer
At stage 2B, the primary tumor is resectable or borderline resectable. The cancer extends slightly beyond the pancreas to nearby lymph nodes but does not involve major arteries.
Stage 3 pancreatic cancer
At stage 3, the primary tumor is locally advanced. The cancer extends slightly beyond the pancreas to nearby lymph nodes and also involves major arteries.
Stage 4 pancreatic cancer
At stage 4, the primary tumor is metastatic. The cancer has entered the lymphatic system or bloodstream and reached distant areas of the body.
Getting medical help for any stage of pancreatic cancer
The multispecialty team in the Gastrointestinal Oncology Program at Moffitt Cancer Center offers the latest options in screening, diagnosis and treatment for all stages of pancreatic cancer. At Moffitt, each patient benefits from multiple expert opinions, which are incorporated into a highly individualized treatment plan to help ensure the best possible outcome and quality of life.