Staging

Once pancreatic cancer is diagnosed, it is "staged". Pancreatic cancer is broken into five stages with stage 0 being the earliest stage and stage IV being the most advanced (metastatic disease).

There are two ways to describe the stages of pancreatic cancer, by stage number or by surgical resection category.  The stage number indicates the size and location of the cancer and the extent of spread. The surgical resection category indicates whether or not the tumor can be surgically removed.  Both are determined by the size and location of the primary tumor, the involvement of local lymph nodes and blood vessels and the presence of distant metastases.

Determining pancreatic cancer's stage is often tricky. Imaging tests like CT scans and MRIs provide some information, but knowing exactly how far pancreatic cancer has spread usually requires surgery. Your stage of pancreatic cancer and your overall health will determine the method your physician recommends for treating your illness. The main ways of attacking pancreatic cancer are surgery, radiation, and chemotherapy (drugs).

Stage

The following stages of pancreatic cancer exist partly to guide treatment, but also to classify patients for clinical trials:

Stage 0: No spread. Pancreatic cancer is limited to a single layer of cells in the pancreas. The pancreatic cancer is not visible on imaging tests or even to the naked eye.
Stage I: Local growth. Pancreatic cancer is limited to the pancreas, but has grown to be less than 2 centimeters across (stage IA) or greater than 2 centimeters (stage IB).
Stage II: Local spread. Pancreatic cancer has grown outside the pancreas, and/or has spread to nearby lymph nodes.
Stage III: Wider spread. The tumor has expanded into nearby major blood vessels or nerves. As yet, pancreatic cancer can't be seen in other organs.
Stage IV: Confirmed spread. Pancreatic cancer is found in distant organs.

Surgical Resection Category

Unlike many cancers, patients with pancreatic cancer are typically grouped into three categories: those with local disease, those with locally advanced unresectable disease, and those with metastatic disease. Initial therapy often differs for patients in these three groups.

Patients with stage I and stage II cancers are thought to have local or "resectable" cancer. Patients with stage III cancers have "locally advanced unresectable" disease. In patients with stage IV "metastatic" pancreatic cancer, chemotherapy is most commonly recommended as a means of controlling the symptoms related to the cancer and extending life. By classifying pancreatic cancer into one of these three categories, the oncology team can then plan a treatment strategy that is best suited to manage the disease.

Resectable: This type of pancreatic cancer can be surgically removed. A tumour may lie within the pancreas or extend beyond it, but there is no involvement of the critical arteries or veins in the area. There is no evidence of any spread to areas outside of the pancreas. Approximately 10% to 20% of patients are diagnosed at this stage.

Locally advanced unresectable: This type is still confined to the area around the pancreas, but cannot be surgically removed because there is involvement of the critical arteries or veins, or the tumour directly extends to  surrounding organs. There is no evidence of spread to any distant areas of the body. Approximately 35% to 40% of patients are diagnosed at this stage. In this situation, the opportunity for cure has been lost but local treatments such as radiation remain as options.

Metastatic: The tumour has spread beyond the area of the pancreas and involves other organs, such as the liver or distant areas of the abdomen. Approximately 45% to 55% of patients are diagnosed at this stage.