Tests and procedures
to stage pancreatic cancer are usually done at the same time as diagnosis. For
the proper staging of Pancreatic Cancer we should first highlight on how the
cancer may spread in the human body.
- Through tissue. Cancer invades the surrounding normal tissue.
- Through the lymph system. Cancer invades the lymph system and travels through the lymph vessels to other places in the body.
- Through the blood. Cancer invades the veins and capillaries and travels through the blood to other places in the body.
When cancer cells break away from the
primary (original) tumor and travel through the lymph or blood to other places
in the body, another (secondary) tumor may form. This process is called
metastasis. The secondary (metastatic) tumor is the same type of cancer as the
primary tumor. For example, if breast cancer spreads to the bones, the cancer
cells in the bones are actually breast cancer cells. The disease is metastatic
breast cancer, not bone cancer.
Pancreatic
Cancer Stages
Stage 0 (Carcinoma in Situ)
In stage 0, abnormal cells are found in
the lining of the pancreas. These abnormal cells may become cancer and spread
into nearby normal tissue. Stage 0 is also called carcinoma in situ.
Stage I
In stage I, cancer has formed and is found
in the pancreas only. Stage I is divided into stage IA and stage IB, based on
the size of the tumor.
Stage II
In stage II,
cancer may have spread to nearby tissue and organs, and may have spread to
lymph nodes near the pancreas. Stage II is divided into stage IIA and stage
IIB, based on where the cancer has spread.
- Stage IIA: Cancer has spread to nearby tissue and organs but has not spread to nearby lymph nodes.
- Stage IIB: Cancer has spread to nearby lymph nodes and may have spread to nearby tissue and organs.
Stage III
In stage III, cancer has spread to the major blood vessels
near the pancreas and may have spread to nearby lymph nodes.
In stage IV, cancer may be of any
size and has spread to distant organs, such as the liver, lung, and peritoneal
cavity. It may have also spread to organs and tissues near the pancreas or to
lymph nodes.
- Stage IVA: Cancer has spread to organs, such as the stomach, spleen, and colon, that are near the pancreas, but it has not spread to distant organs, such as the liver or lungs.
- Stage IVB: Cancer has spread to organs, such as the stomach, spleen, or colon, that are near the pancreas or to places far away from the pancreas, such as the liver or lungs.
Recurrent
The cancer has come back (recurred) after it has been
treated. It may come back in the pancreas or in another part of the body.
TNM System
One way to describe the stages of pancreatic cancer is to
use the TNM system. This system uses three different codes to describe the size
and location of the tumor, whether it has spread to the lymph nodes around the
tumor, and whether it can be found in other parts of the body. Because doctors
usually classify tumors during surgery and many patients with pancreatic cancer
do not have surgery, the TNM system is not used as much with pancreatic cancer
as it is for other diseases.
In the TNM system, “T” plus a letter or number (0 to 4) is
used to describe the size and location of the tumor. The tumor stages are:
TX - The primary, or original, tumor cannot be evaluated
because of incomplete information.
TO - There is no evidence of the primary site.
Tis (carcinoma in situ) - The cancer is present only in the lining of the pancreatic ducts.
Tis (carcinoma in situ) - The cancer is present only in the lining of the pancreatic ducts.
T1 - The cancer has not spread beyond the pancreas
and is smaller than 2 centimeters (about ¾ inch).
T2 - The cancer has not spread beyond the pancreas, but is larger than 2 centimeters (about ¾ inch).
T3 - The cancer has spread from the pancreas to surrounding tissues near the pancreas but not blood vessels.
T4 - The cancer has spread from the pancreas into nearby large blood vessels.
T2 - The cancer has not spread beyond the pancreas, but is larger than 2 centimeters (about ¾ inch).
T3 - The cancer has spread from the pancreas to surrounding tissues near the pancreas but not blood vessels.
T4 - The cancer has spread from the pancreas into nearby large blood vessels.
The "N" in the TNM system stands for node. Lymph
nodes are tiny organs shaped like beans that can be found throughout the body.
Lymph nodes help the body fight infections. Regional lymph nodes are near the
cervix, while distant lymph nodes are in other parts of the body. Lymph node
stages are:
NX - The regional lymph nodes cannot be evaluated
because of incomplete information.
N0 - The cancer has not spread into the regional lymph nodes.
N1 - The cancer has spread into the regional lymph nodes.
N0 - The cancer has not spread into the regional lymph nodes.
N1 - The cancer has spread into the regional lymph nodes.
The "M" in the TNM system is used for cancer that
has spread, or metastasized, to other parts of the body. The stages for
metastatic pancreatic cancer are:
MX - Distant metastasis cannot be evaluated because
of incomplete information.
M0 - The cancer has not metastasized, or spread, to
distant lymph nodes (those not near the pancreas) or distant organs.
M1 - The cancer has spread to other parts of the body
beyond the pancreas, such as the liver, lungs, or brain.
Stages for Surgery
Availability
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.
Since surgery has
risks, doctors first determine whether pancreatic cancer appears to be
removable by surgery (resectable). Pancreatic cancer is then described as
follows:
- Resectable: On imaging tests,
pancreatic cancer hasn't spread (or at least not far), and a surgeon feels
it might all be removable. About 10% of pancreatic cancers are considered
resectable when diagnosed.
- Locally advanced (unresectable):
Pancreatic cancer has grown into major blood vessels on imaging tests, so
the tumor can't safely be removed by surgery.
- Metastatic: Pancreatic cancer has clearly spread to other organs, so surgery can't remove it.
If pancreatic
cancer is resectable, surgery could extend life and offer a small chance of
cure.
Pancreatic cancer survival by stage
Survival rates are often used by doctors as a standard way
of discussing a person's prognosis (outlook). Some patients with cancer may
want to know the survival statistics for people in similar situations, while
others may not find the numbers helpful, or may even not want to know them.
Whether or not you want to read about the survival statistics below for cancer
of the pancreas is up to you.
The 5-year survival rate refers to the percentage of
patients who live at least 5 years after their cancer is diagnosed. Of
course, many people live much longer than 5 years (and many are cured).
Five-year relative survival rates assume that some
people will die of other causes and compare the observed survival with that
expected for people without the cancer. This is a better way to see the impact
of the cancer on survival.
In order to get 5-year survival rates, doctors have to look
at people who were treated at least 5 years ago. Improvements in treatment
since then may result in a more favorable outlook for people now being diagnosed
with cancer of the pancreas.
Survival rates are often based on previous outcomes of large
numbers of people who had the disease, but they cannot predict what will happen
in any particular person's case. Many other factors may affect a person's
outlook, such as the patient's overall health and how well the cancer responds
to treatment. Your doctor can tell you how the numbers below may apply to you,
as he or she is familiar with the aspects of your particular situation.
The numbers below come from the National Cancer Institute's
SEER database and are based on people diagnosed with exocrine cancer of the
pancreas between 1988 and 2001.
Exocrine pancreatic cancer (5-year relative survival by
stage)
Stage IA: 37%
Stage IB: 21%
Stage IIA: 12%
Stage IIB: 6%
Stage III: 2%
Stage IV: 1%
Overall, about 20% of people with pancreatic cancer live at
least 1 year after diagnosis, while less than 4% will be alive after 5 years.
The statistics for pancreatic neuroendocrine cancers are not
broken down by AJCC stages like cancers of the exocrine pancreas. Instead the
statistics are broken down into different stages: localized (only in the
pancreas), regional (spread to nearby lymph nodes or tissues), and distant
(spread to distant sites, such as the liver). These numbers also come from the
National Cancer Institute's SEER database:
Pancreatic neuroendocrine tumors (5-year relative
survival by stage)
Localized: 87%
Regional: 70%
Distant: 24%
Overall: 42%
Sources and Additional
Information:
