Staging is a method of describing pancreatic cancer based on its size and how far it has metastasized (spread). Pancreatic tumors may be staged based on the results of various tests and exams. The TNM Staging System from the American Joint Committee on Cancer (AJCC) and the numerical system are used to characterize cancer stages.

TNM Staging System

This staging system is used to describe the disease using three values.

T categories describe the size of the primary tumor and whether it has grown outside the pancreas:

• TX: The main tumor cannot be assessed.
• T0: There is no evidence of a primary tumor.
• Tis: Carcinoma in situ, which means that the tumor is confined to the top layers of the pancreatic duct cells.
• T1: The cancer’s greatest dimension is 2 centimeters (or less). The cancer has not grown outside the pancreas.
  • T1a: The cancer’s greatest dimension is .5 centimeters (or less).
  • T1b: The cancer is larger than .5 centimeters but its greatest dimension is less than 1 centimeter.
  • T1c: The cancer is 1-2 centimeters in its greatest dimension.
• T2: The cancer is larger than 2 centimeters but its greatest dimension is less than or equal to 4 centimeters. The cancer has not grown outside the pancreas.
• T3: The cancer’s greatest dimension is larger than 4 centimeters. The cancer has not grown outside the pancreas.
• T4: Regardless of size, the cancer has grown beyond the pancreas and into nearby large blood vessels, including the celiac axis, the superior mesenteric artery and/or the common hepatic artery.

N categories indicate whether the cancer has spread to nearby lymph nodes:

• NX: Nearby lymph nodes cannot be assessed.
• N0: The cancer has not spread to nearby lymph nodes.
• N1: The cancer has spread to one to three nearby lymph nodes.
• N2: The cancer has spread to four or more nearby lymph nodes.

M categories indicate whether the cancer has metastasized to other parts of the body, which is known as distant metastasis:

• M0: The cancer has not spread to other organs or distant lymph nodes.
• M1: The cancer has spread to other organs or distant lymph nodes. Pancreatic cancer most frequently spreads to the liver, lungs and the peritoneum (the lining of the abdominal cavity).

Numerical Stages

By combining the categories assigned using the TNM Staging System, physicians may use the following numerical stages to describe the progression of pancreatic cancer:

Stage 0

Abnormal cells are found in the lining of the pancreas. The cells may become cancerous and metastasize into nearby normal tissue. Stage 0 is also called carcinoma in situ (Tis; N0; M0).

Stage I

Cancer is only found in the pancreas. Stage I is divided into the following stages based on the size of the tumor:

• Stage IA: The tumor is 2 centimeters or smaller (T1; N0; M0).
• Stage IB: The tumor is larger than 2 centimeters (T2; N0; M0).

Stage II

The cancer may have metastasized to nearby tissue and organs or lymph nodes near the pancreas. Stage II is divided into the following stages based on where the cancer has spread:

• Stage IIA: The cancer is confined to the pancreas and has not spread to nearby tissue and organs or lymph nodes. (T3; N0; M0).
• Stage IIB: The cancer has spread to nearby lymph nodes and may have also spread to nearby tissue and organs; however, it has not spread to distant sites or major blood vessels or nerves (T1, T2 or T3; N1; M0).

Stage III

The cancer has spread to the major blood vessels near the pancreas and may have spread to nearby lymph nodes. However, it has not spread to distant sites (T1, T2, T3 or T4; N2, or any N if T4; M0).

Stage IV

The cancer may be of any size and may have spread to distant organs, such as the liver, lungs and peritoneal cavity. It may also have spread to the lymph nodes or organs and tissues near the pancreas (any T; any N; M1).