Staging and grading of pancreatic cancer

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.

Staging can be confusing, so ask your doctor or nurse to explain if you are unsure. They can explain more about what each stage of pancreatic cancer means and what to expect.

The staging systems used are:

• TNM staging
• the number staging system.

The TNM and number stage are combined to give the complete stage of the cancer.

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:

• N0 means no lymph nodes are affected.
• N1 means there are cancer cells in between 1 and 3 of the lymph nodes tested.
• N2 means there are cancer cells in 4 or more, of the lymph nodes tested.

M describes whether the cancer has spread to another part of the body (metastasised):

• M0 means the cancer has not spread to other parts of the body.
• M1 means the cancer has spread to other parts of the body.

Stage 0 or carcinoma in situ

This is a very early-stage pancreatic cancer, where the cancer is in the top layer of cells and has not grown deeper into the pancreas. It is also called Tis (tumour in situ). It is uncommon for pancreatic cancer to be diagnosed at this stage.

Stage 1

This is the earliest stage. The cancer is contained inside 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 2cm or smaller
• Stage 1B – the cancer is bigger than 2cm but less than 4cm.

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 less than or equal to 4cm and 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, and it is in up to 3 lymph nodes but not blood vessels. 

Early-stage cancer

Stage 1 and 2 cancers are often called resectable or borderline resectable early-stage cancers. About 2 in 10 cancers of the pancreas (21%) are diagnosed at stages 1 and 2.

Resectable means a surgeon may be able to operate to remove (resect) the tumour. Borderline resectable means that a surgeon may be able to operate, but they might not be able to remove all the cancer. In some borderline resectable cancers, you may have chemotherapy before surgery (neo-adjuvant treatment) to shrink the cancer, making it resectable.

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.

We have more information about coping with advanced cancer.