Stages of pancreatic cancer

Stage 1

What is happening at this stage?

This 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.

What does this mean for me?

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 2

What is happening at this stage?

A 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.

What does this mean for me?

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 3

What is happening at this stage?

This 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.

What does this mean for me?

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 4

What is happening at this stage?

The 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.

What does this mean for me?

You might be able to have treatments such as chemotherapy which will aim to slow the growth of your cancer.

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 .

Node (N), this evaluation is on whether the tumour has spread to lymph nodes.

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.

Metastasis (M), has the tumour spread outside the pancreas?

M0 = the cancer is contained to the pancreas .

T2 = means the cancer is between 2cm-4cm but within the pancreas. 

Node (N), this evaluation is on whether the tumour has spread to lymph nodes.

N0 = There are no lymph nodes with cancer .

Metastasis (M), has the tumour spread outside the pancreas?

M1= the cancer has spread to other parts of the body such as the liver.

T3 = means the cancer is more than 4cm, but not into nearby major blood vessels.

Node (N), this evaluation is on whether the tumour has spread to lymph nodes.

N1= That the cancer is more than 4cm, but not into nearby major blood vessels.

T4= means the cancer has grown outside the pancreas, near or onto major veins or blood vessels.

Node (N), this evaluation is on whether the tumour has spread to lymph nodes.

N2= This is when it is more than 3 lymph nodes with cancer cells, this often means it has spread further than the pancreas.