Pancreatic Cancer: Stages

The most commonly used system to stage pancreatic cancer is the American Joint Committee on Cancer TNM system.

The first step in staging is to find the value for each part of the TNM system. Here's what the letters stand for in the TNM system:

• T is the size of the tumor in the pancreas and if it has grown into nearby blood vessels outside the pancreas. The tumor size is measured by centimeters (cm).
• N refers to whether any lymph nodes near the original tumor have cancer in them.
• M is whether the cancer has spread ( metastasized) to other, distant organs in the body, like the liver, bones, or lungs.

Numbers or letters after T, N, and M provide more details about each of these factors. There are also two other values that can be assigned:

• X means the provider does not have enough information to tell the extent of the main tumor (TX), or if the lymph nodes have cancer cells in them (NX).
• 0 means no sign of cancer, such as no sign of spread to the lymph nodes (N0).

To find the stage of your cancer, your healthcare provider first assigns numbers for the T, N, and M groups. These numbers are then combined in a process called stage grouping to give an overall description of the cancer. A stage grouping can have a value of 0 or Roman numeral I (1), II (2), III (3), or IV (4). The higher the number, the more advanced the cancer is. Letters and numbers can be used after the Roman numeral to give more details.

These are the stage groupings of pancreatic cancer and what they mean:

Stage 0. The cancer is only in the innermost layers of cells lining the pancreatic duct. It has not invaded the deeper layers or spread anywhere else outside the duct. This may be called pancreatic cancer in situ.

Stage I. The cancer has not spread to lymph nodes or other parts of the body. This stage is divided into two groups:

• Stage IA. The cancer is only inside the pancreas. It’s no more than 2 cm (centimeters) across.
• Stage IB. The cancer is only inside the pancreas. It’s more than 2 cm but less than 4 cm across.

Stage II. The cancer has not spread to organs in other parts of the body. This stage is divided into two groups:

• Stage IIA. The cancer is only found inside the pancreas. The tumor is more than 4 cm across. It has not spread to nearby lymph nodes.
• Stage IIB. This stage can be any one of these:
  • The cancer is only inside the pancreas. It’s not bigger than 2 cm across. It has spread to no more than 3 nearby lymph nodes.
  • The cancer is only found inside the pancreas. It’s more than 2 cm but less than 4 cm across. It has spread to no more than 3 nearby lymph nodes.
  • The cancer is only found inside the pancreas. It’s larger than 4 cm across. It has spread to no more than 3 nearby lymph nodes.

Stage III. The cancer has not spread to organs in other parts of the body. This stage can be any one of the following:

• The cancer is only found inside the pancreas. It’s no larger than 2 cm across. It has spread to 4 or more nearby lymph nodes.
• The cancer is only found inside the pancreas. It’s more than 2 cm but less than 4 cm across. It has spread to 4 or more nearby lymph nodes.
• The cancer is only found inside the pancreas. It’s larger than 4 cm across. It has spread to 4 or more nearby lymph nodes.
• The cancer has grown outside the pancreas and into large blood vessels that are nearby. It may or may not have spread to nearby lymph nodes.

Stage IV. The cancer is any size and has spread to organs farther away from the pancreas. These might include the liver, lining of the abdomen (called the peritoneum), bones, or lungs.

Healthcare providers use the TNM system to formally stage pancreatic cancer. But for practical reasons, they often use a simpler system when trying to decide the best treatment. They may divide cancer into these three main groups using the results of imaging tests done before surgery. The following groups are based on whether the cancer can be removed (resected) with surgery: