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The grading, staging and prognosis of pancreatic cancer

Grading

Grading describes how the cancer cells look under a microscope compared to normal cells and how aggressive they may be. The higher the number, the more likely the cancer is to grow quickly. Grade is particularly important for pancreatic NETs, which may be described as grade 1 (low grade), 2 (intermediate grade) or 3 (high grade).

Staging

The test results will show what type of pancreatic cancer it is, where in the pancreas it is, and whether it has spread. This is called staging and it helps your doctors work out the best treatment options for your situation.

Pancreatic cancer is commonly staged using the TNM (tumour– nodes–metastasis) system. The TNM scores are combined to work out the overall stage of the cancer, from stage 1 to stage 4.

stage 1Cancer is found only in the pancreas. This is sometimes called early-stage disease.
stage 2 Cancer is large but has not spread outside the pancreas; or it has spread to a few nearby lymph nodes (exocrine tumours) or nearby structures such as the duodenum or common bile duct (endocrine tumours).
stage 3Cancer has grown into nearby major blood vessels (exocrine tumours) or nearby organs such as the stomach or colon (endocrine tumours). There may or may not be cancer in the lymph nodes. This is called locally advanced cancer.
stage 4The cancer has spread to more distant parts of the body, such as the liver, lungs or lining of the abdomen. There may or may not be cancer in the lymph nodes. This is known as metastatic cancer.

Prognosis

Prognosis means the expected outcome of a disease. You may wish to discuss your prognosis with your doctor, but it is not possible for any doctor to predict the exact course of the disease. Instead, your doctor can give you an idea about the general prognosis for people with the same type and stage of cancer.

To come up with a prognosis, your doctor will consider:

  • test results
  • the type, stage and location of the cancer
  • how the cancer responds to initial treatment
  • other factors such as age, fitness and medical history.

As in most types of cancer, the results of cancer treatment tend to be better when the cancer is found and treated early. As symptoms can be vague or go unnoticed, most pancreatic cancers are not found until they are advanced.