What are the stages of pancreatic cancer?

Staging means finding out how big the cancer is and if it has spread to other parts of your body. Staging will help your doctor to plan the best treatment for you.

The staging system normally used in pancreatic cancer is called TNM. 

This stands for:

• Tumour (T): How big is the tumour?
• Node (N): Is there cancer in your lymph nodes?
• Metastasis (M): Has the cancer spread to other parts of your body?

Your doctor often uses this information to give your cancer a number stage – from 1 to 4.

A higher number, such as stage 4, means it has spread to other parts of the body.

Stage 1

This means the cancer is at a very early stage. The tumour is approximately 2cm in size or less and found within the pancreas. There is no sign that it is in the lymph nodes or that it has spread outside the pancreas.

Stage 2

The tumour is more than 2cm in size. It is now found outside the pancreas in nearby tissues like the bile duct and/or the small bowel (duodenum). There is no sign of cancer in the nearby lymph nodes.

Stage 3

The cancer has spread outside the pancreas to nearby tissues. It is also in the lymph nodes and may have spread to other body organs through the lymphatic system or bloodstream.

Stage 4a

The cancer has spread to nearby organs and vessels. This includes the stomach, spleen, large bowel or large blood vessels. The cancer is also found in lymph nodes. 

Stage 4b

The cancer has spread to the liver and/or the lungs. Your doctor may refer to stage 4 as advanced cancer or metastatic cancer.

Staging can also be described as being resectable, borderline resectable or unresectable.

Resectable – Looks like it is removeable with a clear margin (no cancer cells left). Usually treated with surgery.

Borderline resectable – Looks like it is removeable but with a high chance of some microscopic tumour left behind. Usually treated with chemotherapy and radiotherapy first, followed by surgery.

Unresectable – Looks like it is not removeable with surgery. This is divided into two groups: locally advanced unresectable (tumour involves essential blood vessels near the pancreas) and metastatic unresectable (distant secondary tumours are present).