Pancreatic cancer has taken the lives of numerous celebrities and well-known people, such as Steve Jobs, Jerry Springer, Patrick Swayze, the astronaut Sally Ride, opera singer Luciano Pavarotti, and Aretha Franklin. Pancreatic cancer leads to the deaths of approximately 50,550 Americans every year. The signs and symptoms of pancreatic cancer may go unnoticed until the disease is in its later stages, which is why the five year survival rate of pancreatic cancer is 12%. When Pancreatic cancer is diagnosed, it is typically staged using the TNM (tumor, node, metastasis) staging system in combination with a numerical staging system (stages 0 to IV).
The TNM staging system considers:
- The size of the tumor and if the tumor has spread from the pancreas to nearby blood vessels.
- Whether the cancer has spread to nearby lymph nodes. If yes, how many of the nearby lymph nodes have cancer?
- Whether the cancer has metastasized (spread) to other parts of the body. If yes, has it spread to nearby or distant organs?
The numerical stages of pancreatic cancer:
Stage 0: Also called carcinoma in situ, this stage refers to abnormal cells that are found in the lining of the pancreas. These cells have not spread to nearby tissues or organs.
Stage I: The tumor is confined to the pancreas and has not spread to nearby lymph nodes or other organs.
Stage II: The tumor has grown beyond the pancreas and may have invaded nearby organs or tissues, but it has not spread to distant sites.
Stage III: The tumor has spread to nearby lymph nodes and may have invaded nearby blood vessels or nerves.
Stage IV: The cancer has spread to distant organs or tissues.
Application of the TNM and Numerical Staging Systems to Pancreatic Cancer:
T: Tumor
- TX: Primary tumor cannot be assessed
- T0: No evidence of primary tumor
- Tis: Carcinoma in situ, also known as pancreatic intraepithelial neoplasia (PanIN)
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- T1: Tumor confined to the pancreas, 2 cm or smaller
- T2: Tumor confined to the pancreas, larger than 2 cm but not larger than 4 cm
- T3: Tumor extends beyond the pancreas but does not involve the celiac axis or
superior mesenteric artery (SMA)
- T4: Tumor involves the celiac axis or SM
N: Node
- NX: Regional lymph nodes cannot be assessed
- N0: No regional lymph node metastasis
- N1: Regional lymph node metastasis
M: Metastasis
- MX: Distant metastasis cannot be assessed
- M0: No distant metastasis
- M1: Distant metastasis present
Overall stages:
- Stage 0: Tis, N0, M0
- Stage IA: T1, N0, M0
- Stage IB: T2, N0, M0
- Stage IIA: T3, N0, M0
- Stage IIB: T1-T3, N1, M0 or T4, N0-N1, M0
- Stage III: T1-T4, N2, M0
- Stage IV: Any T, Any N, M1
- Resectable (Localized) Pancreatic Cancer: The tumor is confined to the pancreas and has not spread to other organs or structures nearby. Surgery is typically the first line of treatment. Chemotherapy or radiation therapy may be used before or
after surgery to help prevent the cancer from recurring. - Borderline Resectable Pancreatic Cancer: The tumor has grown into nearby structures or blood vessels but has not yet spread to other organs. Surgery may be an option, but it may require a more complex surgical approach. Chemotherapy or radiation therapy may be used before or after surgery to help shrink the tumor.
- Locally Advanced Pancreatic Cancer: The tumor has grown into nearby structures or blood vessels and is considered inoperable. Chemotherapy and radiation therapy are the main treatment options for this stage of pancreatic cancer.
- Metastatic Pancreatic Cancer: In this stage, which is the most advanced, the cancer has spread to distant organs. Treatment options for metastatic pancreatic cancer focus on controlling symptoms and improving quality of life, rather than curing the cancer. Chemotherapy is the main treatment option for this stage.
Overall, the exact classification of pancreatic cancer into stages depends on numerous factors, including the location and size of the tumor, whether it has spread to nearby lymph nodes or distant organs, and a patient’s overall health. Pancreatic cancer is often diagnosed at an advanced stage because it tends to be asymptomatic in its early stages. This makes treatment more difficult, which is why early detection and screening are crucial for improving outcomes.
