Pancreatic cancer

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Stages of pancreatic cancer

Staging describes or classifies a cancer based on how much cancer there is in the body and where it is when first diagnosed. This is often called the extent of cancer. Information from tests is used to find out the size of the tumour, which parts of the organ have cancer, whether the cancer has spread from where it first started and where the cancer has spread. Your healthcare team uses the stage to plan treatment and estimate the outcome (your prognosis).

A common staging system for pancreatic cancer is the TNM system. Doctors often also use a simple clinical staging system based on whether the pancreatic cancer can be removed with surgery.

Can the tumour be removed with surgery?

Even with advanced tests used to diagnose pancreatic cancer, doctors can’t always tell exactly how big the tumour is or where it has grown until they do surgery. So doctors often divide pancreatic cancers into groups based on resectability.

Resectable

Resectable means that the entire tumour can be removed with surgery. The cancer is resectable when the tumour:

  • is only in the pancreas and has not spread to other parts of the body (called distant metastasis)
  • isn’t touching the superior mesenteric vein (SMV) or portal vein
  • 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 still may be possible to remove the tumour and rebuild the blood vessel. The cancer is borderline resectable when the tumour:

  • has not spread to other parts of the body (there is no distant metastasis)
  • is touching or pressing against the SMV or portal vein but doctors may be able to safely remove the tumour and rebuild the vein
  • may be next to or touching the hepatic artery but it doesn’t extend to the celiac axis
  • may be next to or touching the SMA but doesn’t grow into it

Unresectable

A tumour is 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 completely removed but has not spread to distant organs or tissues.

Metastatic means the cancer has spread to distant organs.

TNM staging

For pancreatic cancer there are 5 stages in the TNM system – stage 0 followed by stages 1 to 4. Often the stages 1 to 4 are written as the Roman numerals I, II, III and IV. Generally, the higher the stage number, the more the cancer has spread. Talk to your doctor if you have questions about staging.

Stage 0 (or carcinoma in situ)

The cancer cells are found only in the lining of the pancreas.

Stage 1

The tumour is 4 cm or smaller. For stage 1A, the tumour is 2 cm or smaller. For stage 1B, the tumour is larger than 2 cm but not larger than 4 cm.

Stage 2

The tumour is larger than 4 cm (stage 2A). Or the tumour is any size and the cancer has spread to 1 to 3 nearby lymph nodes (stage 2B).

Stage 3

The cancer has spread to 4 or more nearby lymph nodes. Or the tumour has grown into large blood vessels outside of the pancreas and the cancer may have spread to nearby lymph nodes.

Stage 4

The cancer has spread to other parts of the body, such as the liver, lungs or abdominal cavity. This is also called metastatic pancreatic cancer.

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. If it comes back in tissues or lymph nodes close to where it first started, it’s called regional recurrence. It can also recur in another part of the body. This is called distant metastasis or distant recurrence.

Find out more about staging cancer.

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