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Pancreatic cancer

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Stages of pancreatic cancer

Staging is a way of describing or classifying a cancer based on the extent, or amount, of cancer in the body. Pancreatic cancer is given a stage based on whether or not the tumour can be removed with surgery and on the TNM system described below.

Can the tumour be removed with surgery?

Even with the advanced tests that doctors use to diagnose pancreatic cancer, they can’t always tell exactly how big the tumour is or where it has grown until they do surgery. Doctors often use a simple staging system to divide pancreatic cancers into groups based on whether or not they think it can be removed with surgery.

Resectable

Resectable means that the entire tumour can be removed, or resected, with surgery. Doctors call pancreatic cancer resectable when:

  • The tumour is only in the pancreas and there is no distant metastasis, or spread, to parts of the body farther away from the pancreas.
  • The tumour isn’t touching the superior mesenteric vein (SMV) or portal vein.
  • The tumour isn’t touching the celiac axis, hepatic artery or superior mesenteric artery (SMA).

Borderline resectable

A tumour is borderline resectable when it has grown into a major blood vessel, but it is possible to remove the tumour and rebuild the blood vessel. Doctors call a pancreatic tumour borderline resectable when:

  • There is no distant metastasis.
  • The tumour is touching or pressing against the SMV or portal vein, but doctors can safely remove the tumour and rebuild the vein.
  • The tumour may be next to or touch the hepatic artery, but it doesn’t extend to the celiac axis.
  • The tumour may be next to or touch the SMA, but it doesn’t completely cover, or encase, it.

Unresectable

A tumour is called unresectable if it can’t be entirely removed with surgery. This may be because it is locally advanced or metastatic.

Locally advanced means the cancer has grown too far into nearby blood vessels or other tissues to be removed completely, but has not spread to distant organs or tissues.

Metastatic means the cancer has spread to distant organs.

Stage grouping based on TNM

Overall stage, or stage grouping, is based on the TNM system.

  • T describes the size of the primary tumour and if it has grown into tissues around the pancreas.
  • N describes the number and location of any lymph nodes around the pancreas that have cancer cells in them.
  • M describes whether or not the cancer has spread, or metastasized, to other parts of the body.

Each stage is given a number from 0 to 4, usually as a Roman numeral (I, II, III or IV). Generally, the higher the number, the farther the cancer has progressed. Your healthcare team uses the stage grouping to plan treatment and estimate prognosis.

When describing the stage, doctors may use the terms localized, regional and distant. Localized means that the cancer is only in the area where it started and has not spread to other parts of the body. Regional means close to or around the pancreas. Distant means in a part of the body farther from the pancreas.

Stage 0 (or carcinoma in situ)

The following describes stage 0 pancreatic cancer.

StageTNMExplanation

stage 0

Tis

Cancer cells are found only in the lining of the pancreas.

N0

There is no regional lymph node metastasis (no cancer cells in lymph nodes near the pancreas).

M0

There is no distant metastasis (cancer hasn’t spread to other parts of the body).

Stage I

The following describes all stage I pancreatic cancers.

StageTNMExplanation

stage IA

T1

The tumour is only in the pancreas and is 2 cm or less.

N0

There is no regional lymph node metastasis (no cancer cells in lymph nodes near the pancreas).

M0

There is no distant metastasis (cancer hasn’t spread to other parts of the body).

stage IB

T2

The tumour is only in the pancreas and is larger than 2 cm.

N0

There is no regional lymph node metastasis (no cancer cells in lymph nodes near the pancreas).

M0

There is no distant metastasis (cancer hasn’t spread to other parts of the body).

Stage II

The following describes all stage II pancreatic cancers.

StageTNMExplanation

stage IIA

T3

The tumour has spread to nearby tissues but not to nearby large blood vessels.

N0

There is no regional lymph node metastasis (no cancer cells in lymph nodes near the pancreas).

M0

There is no distant metastasis (cancer hasn’t spread to other parts of the body).

stage IIB

T1, T2 or T3

The tumour is in the pancreas or has spread to nearby tissues but not to nearby large blood vessels.

N1

The cancer has spread to regional lymph nodes.

M0

There is no distant metastasis (cancer hasn’t spread to other parts of the body).

Stage III

The following describes stage III pancreatic cancer.

StageTNMExplanation

stage III

T4

The tumour has spread beyond the pancreas into nearby large blood vessels.

any N

The cancer may have spread to regional lymph nodes.

M0

There is no distant metastasis (cancer hasn’t spread to other parts of the body).

Stage IV

The following describes stage IV pancreatic cancer.

Stage

TNM

Explanation

stage IV

any T

The tumour can be any size.

any N

The cancer may have spread to regional lymph nodes.

M1

The cancer has spread to distant sites, such as the liver, lung or abdominal (peritoneal) cavity.

Recurrent pancreatic cancer

Recurrent pancreatic cancer means that the cancer has come back after it has been treated. If it comes back in the same place that the cancer first started, it’s called local recurrence. It can also recur in another part of the body, which is called metastatic pancreatic cancer.

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