Your doctor may assign one of the three pancreatic cancer stages to the disease:

• Resectable: The tumor nodules can be removed.
• Locally advanced: The cancer has spread to areas surrounding the pancreas, such as tissues or blood vessels.
• Metastatic: The cancer resides in multiple organs.

Sometimes, doctors use a classification system based on four numeric stages. This is known as the AJCC (American Joint Committee on Cancer) staging system and is used for a variety of different cancer types, including pancreatic cancer. Using this pancreatic cancer staging system, doctors differentiate when the disease has spread to the tissue surrounding the pancreas (stage II) and when cancer has reached the blood vessels near the pancreas (stage III). This system still acknowledges the advanced stage of pancreatic cancer as metastatic.

Other times, a grade level is given to pancreatic cancer. Much like the stages of pancreatic cancer, grades help classify how aggressive the tumor is, and how likely it is to grow and spread to surrounding tissue and other locations in the body. Grade levels range between 1 and 4 with G1 (grade 1) denoting cancers that look similar to normal cells, and G4 (grade 4) denoting cancer cells that are highly abnormal in appearance.

The pancreatic cancer staging process often uses the American Joint Committee on Cancer TNM system, which uses three criteria to judge the stage of the cancer: the size and location of the primary tumor (T), the adjacent lymph nodes (N) and whether the tumor has spread to the rest of the body (M).

Primary tumor (T)

• TX: Primary tumor cannot be assessed.
• T0: No evidence of primary tumor has been found.
• Tis: This is carcinoma in situ.
• T1: The tumor is limited to the pancreas and is 2 cm or less in greatest dimension.
• T2: The tumor is limited to the pancreas, and is more than 2 cm in greatest dimension.
• T3: The tumor extends beyond the pancreas but without involvement of the celiac axis or the superior mesenteric artery.
• T4: The tumor involves the celiac axis or the superior mesenteric artery (unresectable primary tumor).

Regional lymph nodes (N)

• Nx: Regional lymph nodes cannot be assessed.
• N0: No regional lymph node metastasis has been found.
• N1: Regional lymph node metastasis has been found.

Distant metastasis (M)

• M0: No distant metastasis has been found.
• M1: Distant metastasis has been found.

Next topic: How is pancreatic cancer diagnosed?