Staging of Pancreatic Cancer

The most commonly used staging system for pancreatic cancer was developed by the American Joint Committee on Cancer (AJCC) and is outlined in the table below.

Stage 0: Carcinoma in situ.  This is not yet a cancer, but it is the final step in the transformation process from normal pancreas to cancer.  The individual cells in carcinoma in situ look identical to cancer, but they have not yet become invasive and at this stage they do not yet have the ability to invade and spread to other organs.
Stage I: Invasive cancer stage that is confined to the pancreas only.
IA: The tumor is 2 centimeters or smaller and limited to the pancreas only
IB: The tumor is larger than 2 centimeters, but limited to the pancreas only
Stage II: Invasive cancer that has locally grown beyond the pancreas to involve adjacent organs but does not involve local blood vessels or distant parts of the body.
IIA: Cancer has not spread to local lymph nodes but has spread to nearby organs and tissue
IIB: Cancer has spread to local lymph nodes and may have spread to nearby organs and tissue
Stage III: Any invasive cancer that the surgeon cannot remove because of involvement of the local major blood vessels, but which has not yet spread to distant organs.  Also called ‘locally advanced’, ‘borderline’, or ‘inoperable.’
Stage IV: The cancer has spread outside of the pancreas to other parts of the body (most often the liver).

While the staging system may appear confusing at first, it is heavily dependent upon whether or not a tumor can be removed by the surgeon, because the patients who do the best and live the longest are the ones in which the tumor can be removed surgically.  Stage I is a tumor that is limited to the pancreas.  Patients seldom present with stage I disease.  Stage II is any tumor that the surgeon can remove.  If there is no disease in the lymph nodes, then the stage is IIA.  If there is disease in the lymph nodes, the stage is IIB.  Stage III is a tumor that involves the local blood vessels preventing the surgeon from safely removing the tumor, but has not spread to a distant site.  Stage IV is when the pancreatic cancer has spread to other organs (such as the liver or the lungs).

A patient’s treatment plan will depend on the stage of the disease.  Patients with Stage I or II disease will be offered surgical removal of the tumor.  Patients with stage III will undergo chemotherapy and or radiation therapy in an effort to make the tumor operable.  If the surgeon is ultimately able to remove the tumor, then the patient will have successfully been converted from stage III to stage II.  The primary mode of therapy for patients with Stage IV disease is systemic chemotherapy.