Stages of pancreatic cancer

Pancreatic Cancer Action
Patient Information Booklets

What is Pancreatic cancer and how is it diagnosed?

This booklet for patients and carers describes pancreatic cancer, its causes and symptoms. It gives detailed information on the diagnostic tests used and the stages of pancreatic cancer. It includes a section on what to ask your doctor, where to go for further information and a glossary to explain many of the terms used.

The tests for pancreatic cancer not only diagnose the cancer, but help doctors determine the stage of the cancer and the best treatment for you. Staging describes the size of the cancer, and how advanced the cancer is (whether it has spread).

Treatment decisions are made by an MDT (Multi-Disciplinary Team) team (click for more info). The MDT team discusses what treatment is best for you based on:

  • The stage of your cancer
  • Where it is in the pancreas
  • Your general health and fitness.

The doctors will explain what stage of cancer you have, and then the consequent treatment option/s that are available to you.

Information is likely to be given as to whether you can be considered for surgery or not rather than what stage of cancer you have for example:

  • Resectable: they can remove the tumour through surgery 
  • Borderline resectable: it is less clear whether it can be removed 
  • Unresectable: Surgery is not being considered, this may be locally advanced which means the cancer has spread to nearby organs or it may have spread to more distant organs.

However, knowing what the different stages are may be helpful to understand what your doctor has said to you, how your cancer is presenting itself and how this relates to your treatment option.

There are two main types of staging to describe the size of the cancer. One which uses numbers, stages 1-4, and one that is called the TNM (Tumour-Node-Metastases) staging.

One common way to stage pancreatic cancer:

StageWhat is happening at this stage?What does this mean for me?
Stage 1This is known as early-stage disease. Cancer is found only in the pancreas and has not spread to any organs or lymph nodes next to the pancreas and is not more than 4cm in size. There is a 1A and 1B categorization.   1A= The tumour is completely inside the pancreas and is less than 2cm in size in any direction. This is around the size of or smaller than the size of a peanut.   1B= The tumour is completely inside the pancreas and is between 2cm-4cm in size in any direction. This is around the size of or smaller than the size of a walnut.  As the tumour is localised, this means it is likely to be resectable (able to have surgery to remove the cancer). Therefore, early diagnosis is especially important for the patient, getting pancreatic cancer caught at the stage is currently quite rare.
Stage 2A tumour that has spread outside the pancreas into nearby tissues, or local lymph nodes. Lymph nodes are very small glands that are located throughout the body. They are a few millimetres to 1-2 cm and form part of the immune system. There are two stages: 2A: This means that the cancer has grown to nearby tissue for example the duodenum or the bile duct, but it has NOT spread to any lymph nodes.   2B: This means the cancer has spread to nearby lymph nodes.   This may be a resectable pancreatic cancer (able to have surgery), but this does depend on where and how far the cancer has grown. It is likely that you will have chemotherapy after you have recovered from surgery.  
Stage 3This is called locally advanced cancer, when the tumour has spread outside the pancreas into nearby major blood vessels, and may have spread into lymph nodes, but crucially it has not spread to other parts of the body.   This usually means it is unresectable (unable to have surgery). However, it could be, borderline resectable, although this is uncommon. This means it may be possible to remove the cancer but is very dependent on where the tumour is, and what major blood vessels are affected.   Chemotherapy is usually the main considered treatment option for locally advanced cancer, if it is borderline, it is likely you will have chemotherapy before surgery.  
Stage 4The cancer has spread to other organs, such as the liver, lungs or lining of the abdomen. This can be referred to as metastatic disease or advanced pancreatic cancer.  You might be able to have treatments such as chemotherapy which will aim to slow the growth of your cancer.

The second common way to stage pancreatic cancer: The TNM system of staging

TNM system, Tumour, Node and Metastasis. (T) this is referring to the size of the tumour, (N) whether there are lymph nodes with cancer in, (M) this is whether the cancer has spread to various parts of the body.

The Tumour Size (T)Node (N), this evaluation is on whether the tumour has spread to lymph nodes.Metastasis (M), has the tumour spread outside the pancreas?
T1=means that the tumour is inside the pancreas and is smaller than 2cm in any direction. This has three levels: T1A is when the cancer in no more than 0.5cm in size .  T1B is when the cancer is more than 0.5cm but no more than 1cm in size in any direction . T1C is when the cancer is more than 1cm but no more than 2cm in size in any direction . Lymph nodes are very small glands located throughout the body. They are a few millimetres to1-2 cm and they are part of the immune system. Sometimes cancer can spread to one or several lymph nodes.   M0= the cancer is contained to the pancreas .
T2= means the cancer is between 2cm-4cm but within the pancreas.  N0= There are no lymph nodes with cancer .  M1= the cancer has spread to other parts of the body such as the liver.  
T3= the cancer is more than 4cm, but not into nearby major blood vessels.   N1= That the cancer has spread to the nearby lymph nodes usually to around 1-3. 
T4= means the cancer has grown outside the pancreas, near or onto major veins or blood vessels.   N2= This is when it is more than 3 lymph nodes with cancer cells, this often means it has spread further than the pancreas.  

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Information Product № Published 12/07/2022
Last Updated 26/09/2022 Next Review Due 28/01/2022