Staging and grading

The stage of a cancer describes its size and whether it has spread. Knowing the stage of the cancer helps doctors decide the best treatment for you.

The staging systems most commonly used are:

  • the number staging system
  • TNM staging.

Number staging

A common 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. But it may be quite large. There is no cancer in the lymph nodes close to the pancreas. There is also no sign that it has spread anywhere else in the body.

Stage 1 is divided into two:

  • Stage 1A – The cancer is smaller than 2cm.
  • Stage 1B – The cancer is bigger than 2cm.

Stage 2

The cancer has started to grow outside the pancreas into nearby tissues. There may be cancer in lymph nodes near the pancreas.

Stage 2 is divided into two:

  • Stage 2A – The cancer is in nearby tissue, but has not spread into the blood vessels or lymph nodes.
  • Stage 2B – The cancer may have grown into nearby tissue. It is in the lymph nodes but not 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. About 2 in 10 cancers of the pancreas (21%) are diagnosed at stages 1 and 2.

Stage 3

The cancer has spread to large blood vessels near the pancreas and may have spread to lymph nodes. But it has not spread to other parts of the body, such as the liver or lungs.

Stage 3 cancer is often called locally advanced cancer. Usually, surgery is not possible for this stage. 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.

Stage 4

The cancer has spread to other parts of the body, such as the liver or lungs. Surgery is not possible.

Stage 4 cancer is often called metastatic or advanced cancer.

Nearly 8 in 10 cancers of pancreatic cancers (79%) are diagnosed at stages 3 and 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.

What is pancreatic cancer?

Abdominal surgeon Charles Imber talks about symptoms and treatments for pancreatic cancer in our video.

About our cancer information videos

What is pancreatic cancer?

Abdominal surgeon Charles Imber talks about symptoms and treatments for pancreatic cancer in our video.

About our cancer information videos

Grading

Grading describes how the cancer cells look when they are examined under a microscope. The grade gives doctors an idea of how quickly a cancer may develop.

Grade 1 (low-grade)

The cancer cells tend to grow slowly and look similar to normal cells (they are well differentiated). These cancers are less likely to spread than higher grade cancers.

Grade 2 (moderate-grade)

The cancer cells look more abnormal.

Grade 3 (high-grade)

The cancer cells tend to grow more quickly and look very abnormal (they are poorly differentiated). These cancers are more likely to spread than low-grade cancers.

Back to Understanding your diagnosis

Just been diagnosed

Just been diagnosed with cancer? We're here for you every step of the way. There are many ways we can help.

Cancer registry

Each country in the UK has its own cancer registry: information that helps the NHS and other organisations to plan and improve cancer services.

Treatment overview

Surgery, chemotherapy and radiotherapy may all be used to treat pancreatic cancer. Treatments can also control symptoms (supportive care).