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Pancreatic Cancer: How Staging Works

The Importance of Staging

After you’re diagnosed with pancreatic cancer, your doctor will work to identify your cancer’s exact stage. Knowing a cancer’s stage is vital to understanding and making decisions about your treatment options, as well as to predict your outlook.

Learn how staging works and understand how to make sense of the terms, letters, and numbers that doctors use to talk about pancreatic cancer.

What Is Cancer Staging?

Staging is the most important factor in your cancer treatment and outlook. Once a cancer has been detected and diagnosed, your doctor and cancer care team will work to “stage” the cancer. A cancer’s stage is determined by how far, if at all, the cancer has spread beyond the primary location.

In order to determine your cancer’s stage, your doctor will perform a series of tests and exams to better understand what organs and tissues the cancerous cells have affected.

Discover what your pancreatic cancer's stage says about your survival rates »

Pancreatic Cancer Categories

Pancreatic cancer’s staging system is unique compared to other cancers. Most cancer stages are determined on a scale from 0 to 4, with stage 4 being the most advanced. Pancreatic cancer also makes use of the “TNM” system. This system, developed by the American Joint Committee on Cancer, helps explain the cancer’s stage more clearly.

T Categories

The “T” category explains the primary tumor’s size and whether or not the tumor has grown outside the pancreas and into other nearby organs. T categories range from TX to T4.

T Definition
TXThe tumor can’t be assessed.
T0Doctors can find no evidence of a primary tumor.
T1These tumors are rather small (about 2 centimeters or less in diameter), and are only present in the pancreas.
T2Tumors are present only in the pancreas, but the tumor diameter is larger than 2 centimeters.
T3Pancreatic cancer has spread beyond the pancreas and into nearby tissues, but not into blood vessels or nerves.
T4Pancreatic cancer has spread beyond the pancreas and nearby tissue into nearby blood vessels and nerves.

N Categories

N explains if the cancer has spread into lymph nodes. N categories range from NX to N1.

NDefinition
NXNearby lymph nodes can’t be assessed.
NOThe cancer hasn’t spread to nearby lymph nodes.
N1The cancer has spread to lymph nodes or distant organs.

M Categories

M describes whether or not the cancer has metastasized or spread to other organs in the body. Only two M categories exist: M0 and M1.

MDefinition
MOThe cancer hasn’t spread to distant lymph nodes or distant organs.
M1The cancer has spread beyond nearby tissue and organs into distant lymph nodes and distant organs.

Stages of Pancreatic Cancer

Once your doctor and cancer care team determine your cancer’s categories, they’ll work to develop a staging number on a scale of 0 to 4. A letter that provides additional information about the cancer also often follows these numbers.

Stage 0

The cancerous tumor is only present in the very top layers of the pancreatic duct cells. The cancer hasn’t penetrated deeper layers of the pancreatic tissue, and it hasn’t spread beyond the pancreas.

Stage 1A

The tumor is present in the pancreas and is no more than 2 centimeters across. Tumors in this stage have not spread to nearby lymph nodes or tissues.

Stage 1B

The tumor is present in the pancreas and is larger than 2 centimeters across. The tumor hasn’t spread to nearby lymph nodes or distant sites.

Stage 2A

The tumor has begun to grow outside the pancreas but hasn’t yet spread to major blood vessels or nerves. Lymph nodes are still unaffected, as are distant sites.

Stage 2B

The tumor may be only present in the pancreas, or it may be growing outside the pancreas. However, it’s not yet affecting blood vessels or nerves. The cancer has also spread to nearby lymph nodes but not distant sites.

Stage 3

This advanced stage of pancreatic cancer means the tumor is growing in locations outside the pancreas. It has grown into nearby major blood vessels and nerves. Nearby lymph nodes may or may not be affected. However, the cancer hasn’t spread to distant locations within the body.

Stage 4

The cancer has spread beyond the pancreas and nearby locations to distant sites.

Moving Forward with Treatment

Pancreatic cancer is very difficult to detect. The pancreas hides deep within your abdomen and is surrounded by many other organs. Detecting a tumor through a routine physical exam is highly unlikely.

Most cases of pancreatic cancer are only detected and diagnosed after the cancer has spread to other organs. For that reason, most cases of pancreatic cancer are already at advanced stages by the time they’re diagnosed.

Once your cancer care team has determined your cancer’s categories and stage, you will discuss treatment options based on established treatment protocols. Advanced-stage pancreatic cancer often requires invasive treatment options. Less advanced cancers may benefit from less invasive treatment options. You and your doctor can decide what’s best for you based on the stage, your overall health, and other important factors.

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