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Pancreatic Cancer Stages

Scan of the abdomen and pancreas, showing where in the body patients would experience pancreatic cancer symptoms

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 diameter of the cancer is 2 centimeters (or less). The cancer has not grown outside the pancreas.
    • T2: The diameter of the cancer is larger than 2 centimeters. The cancer has not grown outside the pancreas
    • T3: The cancer has spread outside the pancreas into nearby surrounding structures; however, it is not found in major blood vessels or nerves.
    • T4: The cancer has grown beyond the pancreas and into nearby large blood vessels or nerves.
  • N categories indicate whether cancer has spread to regional (nearby) lymph nodes.
    • NX: Regional lymph nodes cannot be assessed.
    • N0: The cancer has not spread to regional lymph nodes.
    • N1: The cancer has spread to regional lymph nodes.
  • M categories indicate whether the cancer has metastasized to other parts of the body, which is known as distant metastasis.
    • MX: Distant metastasis cannot be evaluated.
    • M0: The disease has not spread to distant organs or distant lymph nodes.
    • M1: The cancer has spread to distant organs or distant lymph nodes. Pancreatic cancer most frequently spreads to the liver, lungs and the peritoneum (the lining of the abdominal cavity).

Our Approach to Pancreatic Cancer

Dr. Weiss and Dr. Wolfgang in the operating room

Johns Hopkins pancreatic surgeons perform a variety of innovative techniques to treat pancreatic cancer, including operations using both traditional open methods and minimally invasive methods. During one appointment at our multidisciplinary clinic, patients will meet with experienced specialists who will care for them at every stage of the journey.

Learn more about Johns Hopkins’ Hepato-Pancreato-Biliary Program.

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: Cancer has spread to nearby tissue and organs but not to nearby lymph nodes, major blood vessels and nerves or distant sites (T3, N0, M0).
  • Stage IIB: 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 (T4, Any N, M0).

Stage IV

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

More Information About Pancreatic Cancer in the Health Library

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