Guide To Understanding Pancreatic Cancer Stages

The pancreas, an organ in the upper abdomen, is responsible for producing and secreting certain hormones and digestive enzymes. Pancreatic cancer hat develops in the cells responsible for the digestive enzymes is called exocrine pancreatic cancer. It includes adenocarcinomas, acinar cell carcinoma, ampullary cancer, adenosquamous carcinoma, squamous cell carcinoma, and giant cell carcinomas. Pancreatic cancer that develops in the cells responsible for hormones is called endocrine pancreatic cancer. It includes insulinomas, glucagonomas, gastrinomas, somatostatinomas, and VIPomas. Blood, urine, and stool tests may be used to help make a pancreatic cancer diagnosis along with endoscopic ultrasound, CT scans, MRI scans, PET scans, x-rays, an angiogram, and a tissue biopsy.

Thankfully, patients have several options for pancreatic cancer treatment. A major option is surgery for pancreatic cancer. Surgery may remove part of the pancreas or the entire organ. Patients who get pancreas removal surgery need insulin and enzyme replacement to compensate. Of course, patients can also benefit from radiation and chemotherapy for pancreatic cancer. Ultimately, however, the best treatment for pancreatic cancer varies based on the stage. Learn about the stages of this cancer now.

Stage 0

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Stage 0 pancreatic cancer and carcinoma in situ are terms used to describe abnormal cells contained within the pancreatic lining. Some doctors will refer to these abnormal cells as precancerous cells. The precancerous cells are strictly isolated to the surface layer cells of the pancreatic ducts. Most diagnostic imaging tests like x-ray, computerized tomography (CT) scans, magnetic resonance imaging (MRI), and positron emission tomography (PET) scans cannot detect stage 0 pancreatic cancer. 

During surgery, stage 0 pancreatic cancer is often unable to be seen and identified by the naked eye. The stage grouping used to refer to stage 0 pancreatic cancer is Tis, N0, and M0. These stages mean the cancer has not spread to any nearby lymph nodes or distant regions of the body. Stage 0 is often excluded from the pancreatic malignancy category and can only be detected during a microscopic biopsy of the pancreatic duct cells.

Stage 1

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Stage 1 pancreatic cancer describes pancreatic cancer that has not exceeded four centimeters in size. Stage 1 is further grouped into stage 1A and stage 1B. When a pancreatic tumor is limited to the inside of the pancreas and measures less than two centimeters or four-fifths of an inch, it is referred to as stage 1A pancreatic cancer. Stage 1A can also be abbreviated by a stage grouping of T1, N0, and M0. 

When pancreatic cancer is confined to the inside of the pancreas and measures between two and four centimeters or one and three-fifths inches, it is referred to as stage 1B pancreatic cancer. Stage 1B has a stage grouping of T2, N0, and M0. Both the N and M stage grouping remain at 0 in individuals with pancreatic cancer stages 1A and 1B. This is because the malignancy has not moved into neighboring lymph nodes or any other tissue outside the pancreas.

Stage 2

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Stage 2 pancreatic cancer is a stage separated into stage 2A and stage 2B. When an affected individual's pancreatic tumor has grown larger than four centimeters or one and three-fifths inches across, but has not spread to the lymph nodes or other distant regions, it is referred to as stage 2A pancreatic cancer. Stage 2A has a stage grouping of T3, N0, and M0. Stage 2B pancreatic cancer is defined by a tumor no larger than two centimeters in diameter that has not spread into more than three neighboring lymph nodes. It has a stage grouping of T1, N1, and M0. 

A pancreatic tumor with a diameter measurement between two and four centimeters that has not spread to more than three neighboring lymph nodes with a stage grouping of T2, N1, and M0 has also been classified as stage 2B pancreatic cancer. In addition, stage 2B pancreatic cancer can include a tumor with a diameter measurement of larger than four centimeters that has not spread to any more than three neighboring lymph nodes and has a stage grouping of T3, N1, and M0.

Stage 3

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Four different stage groupings are included in stage 3 pancreatic cancer. A pancreatic tumor measuring two centimeters or less in diameter that has spread to four or higher neighboring lymph nodes with a stage grouping of T1, N2, and M0 is considered stage 3. A pancreatic tumor measuring between two and four centimeters in diameter that has spread to four or higher lymph nodes with a stage grouping of T2, N2, and M0 is another example of stage 3 pancreatic cancer. 

In addition, a pancreatic tumor measuring larger than four centimeters in diameter that has spread to four or more neighboring lymph nodes with a stage grouping of T3, N2, and M0 is considered stage 3 pancreatic cancer. Furthermore, pancreatic cancer that has started growing beyond the tissues of the pancreas into neighboring major blood vessels and may or may not be present in neighboring lymph nodes with a stage grouping of T4, N0-N2, and M0 is considered stage 3 pancreatic cancer.

Stage 4

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Stage 4 pancreatic cancer is the most advanced and final stage in the cancer staging system. Pancreatic cancer is considered stage 4 when it has metastasized to distant organs and regions of the body. Stage 4 pancreatic cancer may or may not have spread to neighboring lymph nodes and can measure any size. The stage grouping that defines stage 4 pancreatic cancer is T1-T4, N0-N2, and M1. The most common sites of pancreatic cancer metastasis are the lungs, bowel, spleen, stomach, bones, liver, and abdominal cavity lining. 

Over half of all individuals who develop pancreatic cancer receive a stage 4 diagnosis. It is estimated that between one and three patients out of every one hundred will still be alive five years following a stage 4 pancreatic cancer diagnosis. Considering that numerous factors influence survival, the median survival rate of stage 4 pancreatic cancer is between three and six months following diagnosis. There is no way to cure stage 4 pancreatic cancer. However, some treatments may improve life expectancy and quality.

Resectable Tumors

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Many pancreatic cancer patients will hear their oncologist talk in detail about their tumor and how it can be treated. One of the common terms used to describe pancreatic tumors is ‘resectable.’ Resectable tumors are those that surgeons can remove in their entirety through surgery. Patients have a resectable pancreatic tumor if their tumor is only in their pancreas and has not spread. In addition, the tumor must not tough the portal vein, superior mesenteric vein, celiac axis, superior mesenteric artery, or hepatic artery. Resectable tumors are often found in the early stages of pancreatic cancer, since this is when the cancer has not spread.

Borderline Resectable Tumors

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Some pancreatic cancer patients will have borderline resectable tumors. Doctors consider pancreatic tumors to be borderline resectable when the tumor has grown into a major blood vessel, but they believe it can still be removed and the blood vessel rebuilt. Borderline resectable pancreatic tumors cannot have spread to other parts of the patient’s body. They can be touching the portal vein or superior mesenteric vein, but doctors must be able to rebuild the vein after removing the tumor safely. In addition, these tumors can be near or touching the patient’s hepatic artery, but they must not extend to the celiac axis. Finally, borderline resectable tumors can be near or touch the superior mesenteric artery, but they cannot grow into it.

Locally Advanced Tumors

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Locally advanced tumors in pancreatic cancer are often found in Stage 3. They are tumors that have not spread to distant organs in the patient’s body, but surgeons cannot completely remove them with surgery. The reason that they cannot be completely removed is often that the tumor has grown into nearby blood vessels or surrounded them. Surgery to remove locally advanced tumors can be unhelpful and have major side effects. However, some less extensive surgeries may be performed. They are often to prevent or relieve symptoms. Surgeries for these tumors can also deal with issues such as a blocked intestinal tract or bile duct. In most cases, surgery on a locally advanced tumor is not intended to cure the patient’s pancreatic cancer. Other cancer treatments may be examined instead.

Metastatic Tumors

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Metastatic tumors in pancreatic cancer are those that have spread to distant organs in the patient’s body. Thus, metastatic tumors are part of Stage 4 pancreatic cancer. Unfortunately, metastatic tumors in pancreatic cancer cannot be completely removed with surgery. Similar to locally advanced tumors, patients may still receive surgery for metastatic tumors to relieve or prevent some symptoms. Thus, surgery on these tumors at this stage of pancreatic cancer is often for quality of life purposes, rather than a cure. However, other treatments for pancreatic cancer, including chemotherapy and radiation therapy, may be examined to help treat patients with metastatic pancreatic tumors.

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    Whitney Alexandra