Staging

The stage of a cancer is a term used to describe its size and whether it has spread from the place in the body where it started. Knowing the stage of the cancer helps the doctors when they are looking at the best treatment for you.

Number staging

A commonly used staging system uses numbers to describe the stage of the cancer:

Stage 1

This is the earliest stage. The cancer is contained inside the pancreas, although it may be quite large. Stage 1A means the cancer is smaller than 2cm. Stage 1B means it is bigger than 2cm. There is no cancer in the lymph nodes close to the pancreas and no sign that it has spread anywhere else in the body.

Stage 2

The cancer has started to grow outside the pancreas into nearby tissues and/or there is cancer in lymph nodes near the pancreas. In stage 2A, the cancer is in nearby tissue but does not involve blood vessels or lymph nodes. In stage 2B, the cancer may have grown into nearby tissue and is in the lymph nodes but not in the blood vessels.

Doctors often call stages 1 and 2 resectable or early-stage cancer. Resectable means a surgeon may be able to operate to remove (resect) the tumour. Fewer than 1 in 5 cancers of the pancreas (20%) are diagnosed at stages 1 and 2.

Stage 3

The cancer has spread to large blood vessels near the pancreas but hasn’t spread to other parts of the body such as the liver or lungs.

Stage 3 cancer is often called locally advanced cancer. Surgery may not always be possible for this cancer. It is sometimes called unresectable cancer.

Occasionally, a person with stage 3 cancer may be able to have surgery to try to remove the cancer. It will depend on what blood vessels are involved. This is called borderline resectable cancer. About 2 in 5 cancers of the pancreas (35–40%) are diagnosed at stage 3.

Stage 4

The cancer has spread to other parts of the body such as the liver or lungs.

Stage 4 cancer is often called metastatic or advanced cancer. This means the cancer has spread to other parts of your body. About half of pancreatic cancers (45–55%) are diagnosed at stage 4.

TNM staging

In the TNM staging system, TNM stands for Tumour, Nodes and Metastases:

T describes the size of the tumour.

N describes whether the cancer has spread to the lymph nodes and which nodes are involved. For example, N0 means no lymph nodes are affected, while N1 means there are cancer cells in the lymph nodes.

M describes whether the cancer has spread to another part of the body (metastasised). For example, M0 means the cancer has not spread to other parts of the body.

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