Staging and Categorizing Pancreatic Cancer

The Extent of Pancreatic Cancer Determines Both Prognosis and Treatment

Several types of cancer originate in the pancreas. The most common form, and the one this article specifically addresses, is known as adenocarcinoma. This term refers to the cells from which it originates as well as its cellular features.

Carcinoma refers to the type of cell from which the cancer originates that lines many organs and cavities known as endothelium. The prefix "adeno" refers to the fact that the cancer has glandular features.

Other types, to which this article is not applicable, include neuroendocrine tumors and lymphoma.

Understanding the Different Stages

So what is staging? Staging is an objective attempt to gauge the degree of involvement of the cancer. In its simplest terms, pancreatic cancer is staged from stages one to four. Roman numerals are used to designate (e.g., I, II, III and IV).

In stage I, the tumor is confined to the pancreas. In stage II, the tumor extends beyond the pancreas and may involve regional lymph nodes. In stage III, the tumor is locally advanced involving the celiac plexus (a collection of nerves and blood vessels near the pancreas) and/or the superior mesenteric artery (an important blood vessel also near the pancreas). In stage IV, the cancer has spread to distant sites, most commonly distant lymph nodes or the liver.

Steps to Staging

First, the primary tumor needs to be staged. This is denoted as T1, T2, T3, and T4, where T stands for tumor and the number indicates the extent of the tumor as follows:

Primary Tumor
 T1 Tumor confined to the pancreas and less than 2 cm
 T2 Tumor confined to the pancreas and more than 2 cm
 T3  Tumor extends beyond the pancreas but does not involve the celiac axis or  superior mesenteric artery
 T4 Tumor involves the celiac artery or the superior mesenteric artery

 

The next step is to evaluate if nodes are involved.

N stands for nodes in this case.

Lymph Node Involvement
 N0 No involvement of regional lymph nodes
 N1 Regional lymph nodes are positive for cancer

 

Has the cancer spread out of the pancreatic region? M stands for metastasis.

Distant Metastasis (spread) of the Cancer
 M0 No distant metastasis
 M1 Distant metastasis

 

You should now have a value for each category above. For example, it may look like T2, N1, M0. Using this information you can know the exact stage. Stages have degrees of subdivision, which are shown in the table below.

Final Staging
TNMStage
100IA
200IB
300IIA
110IIB
210IIB
310IIB
40 or 10III
1,2,30 or 10IV

 

So using our example, T2, N1, M0 shows stage IIB.

Why Is Staging Important?

Staging is important in determining the prognosis. In other words, it aids in determining the outlook of the individual with the cancer. Survival is actually linked to stage. When it is early stage (I-II), 29.3 percent of people are still alive in 5 years. When it is regionally advanced (II-III) that number drops to 11.1 percent and further down to 2.6 percent for those with stage IV disease.

Staging is also important because it determines which treatments may or may not be indicated. For example, those with earlier stage disease, mostly stage I and II, may be candidates for surgery, which is the only known treatment which can possibly result in cure.

Those in this population may also be candidates for chemotherapy following surgery. Those with higher stage disease, III and IV, are not typically surgical candidates.

The unfortunate truth is that the majority of persons diagnosed with pancreatic cancer already have stage IV disease, which may significantly limit options. In stage IV disease there are treatment options, mostly chemotherapy or clinical trials, but they are not considered to be curative.

A Word From Verywell

Health care professionals, especially oncologists, will complete staging as part of their workup for cancer. Questions regarding the exact stage and resulting treatment options should be answered by qualified professionals.

Ask them. Regardless of stage, a good doctor will work with you to help you understand the disease, address your feelings and concerns, and develop a treatment plan that fits you.

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