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The staging, grading and prognosis of pancreatic cancer

Staging and grading

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.

Your doctor may also tell you the grade of the cancer. 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).

If you need help to understand staging and grading, ask someone in your treatment team to explain it in a way that makes sense to you. You can also call Cancer Council 13 11 20.

TNM staging system for pancreatic cancer

The most common staging system for pancreatic cancer is the TNM system. In this system, each letter is given a number that shows how advanced the cancer is.

T (Tumour)Refers to the size of the tumour (T0–4). The higher the number, the larger the cancer.
N (Nodes)Refers to whether the cancer has spread to lymph nodes. Exocrine tumours (N0–N2) and pancreatic NETs (N0–N1) are assessed differently. N0 means the cancer has not spread to nearby lymph nodes; N1 or N2 means there is cancer in nearby lymph nodes.
M (Metastasis)M0 means the cancer has not spread to other parts of the body; M1 means it has.

Stages of pancreatic cancer

stage 1Cancer is found only in the pancreas. This is sometimes called early-stage disease.
stage 2Cancer 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 anyone to predict the exact course of the disease.

To work out your prognosis, your doctor will consider:

  • test results
  • the type, stage and location of the cancer
  • how the cancer responds to initial treatment
  • your medical history
  • your age and general health.

As symptoms can be vague or go unnoticed, most pancreatic cancers are not found until they are advanced. Cancer that has spread to nearby organs or blood vessels (locally advanced) or other parts of the body (metastatic) is hard to treat successfully. If the cancer is diagnosed at an early stage and can be surgically removed, the prognosis may be better, especially in the case of pancreatic NETs.

Discussing your prognosis and thinking about the future can be challenging and stressful. It is important to know that although the statistics for pancreatic cancer can be frightening, they are an average and may not apply to your situation. Talk to your doctor about how to interpret any statistics that you come across.

When pancreatic cancer is advanced, treatment will usually aim to control the cancer for as long as possible, relieve symptoms and improve quality of life. This is known as palliative treatment.

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Understanding Pancreatic Cancer

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This information is reviewed by

This information was last reviewed February 2020 by the following expert content reviewers: Dr Lorraine Chantrill, Head of Department, Medical Oncology, Illawarra Shoalhaven Local Health District, NSW; Marion Bamblett, Nurse Unit Manager, Cancer Centre, Fiona Stanley Hospital, WA; Prof Katherine Clark, Clinical Director of Palliative Care, Northern Sydney Local Health District Cancer and Palliative Care Network, and Conjoint Professor, Northern Clinical School, The University of Sydney, NSW; Lynda Dunstone, Consumer; Kate Graham, Accredited Practising Dietitian – Upper GI Dietitian, Peter MacCallum Cancer Centre, VIC; Dr Gina Hesselberg, Radiation Oncologist, St George Hospital Cancer Centre, NSW; Dr Marni Nenke, Endocrinologist and Mary Overton Early Career Research Fellow, Royal Adelaide Hospital, SA; Caitriona Nienaber, 13 11 20 Consultant, Cancer Council WA; A/Prof Nicholas O’Rourke, Head of Hepatobiliary Surgery, Royal Brisbane Hospital and The University of Queensland, QLD; Rose Rocca, Senior Clinical Dietitian – Upper GI, Peter MacCallum Cancer Centre, VIC; Gail Smith, Consumer.