What is Pancreatic Cancer Staging?

You probably have heard of cancer being described as Stage IV before.

But do you understand what the different stages of cancer are and what they mean?

ealry-detection-pancreatic-cancer-1Doctors stage cancer based on how far the cancer has spread throughout the body.

By categorizing cancer growth into stages, it enables doctors to have a short-hand way to describe the cancer, give a prognosis to the patient, and allows them to focus on treatments specifically targeted towards the patient’s current condition.

You might think that all cancers are staged in the same way, but actually certain cancers are staged specifically based on where the bulk of cancerous cells resides.

Pancreatic cancer, for instance, has factors different from other cancers that are taken into consideration when determining its stage in a patient.

 

How Is Pancreatic Cancer Diagnosed?

Pancreatic cancer can be difficult for pancreatic surgeons to diagnose early on. Tumors in the pancreas cannot be detected through a routine checkup and patients do not often experience or display any symptoms during the early stages.

However, if a patient has been previously diagnosed with pancreatic cancer and is thought to be in remission, or if a patient is at high risk and has a family history of pancreatic cancer, there are tests that can be administered to detect the presence of factors related to the disease.

Blood Tests

When screening for pancreatic cancer, a blood test may be done to check for any tumor markers (proteins that are produced in high volume with pancreatic cancer). The two most common tumor markers for pancreatic cancer are CA 19-9 and carcinoembryonic antigen.

Although, a new technique may make it easier to detect these tumor markers and circulating tumor cells in the future.

Imaging Tests

  • CT Scan – A CT Scan uses a series of X-Rays to form an image of a cross-section of the body. Compared to other imaging tests, CT Scans are able to show the pancreas clearly.
  • MRI – Through heavy magnets and radio waves, MRIs are able to produce images of the body more clearly than some other techniques.
  • Ultrasound – Ultrasound works in much the same way as radar. While ultrasound is most commonly used for imaging embryos, it can also be used to capture the image of abdominal organs like the pancreas.
  • OctreoScan – An OctreoScan uses a hormone-like substance that is injected into the patient. It then attaches itself to any cancerous cells exhibiting type two receptors. The patient is then scanned with a special camera that detects the gamma energy radiating from the infected tissues.

Biopsies

  • CT Scan Guided Biopsy uses a needle to collect cell samples from the tumor.
  • Endoscopic Ultrasound uses a brush-like device to collect samples of pancreatic cells.

 

The TNM System

The TNM System was developed to define the different stages of pancreatic cancer.  The acronym stands for Tumor, Nodes, Metastasize. Think of these as a checklist that doctors go through when determining the stage of a patient’s pancreatic cancer.

  • Tumor : Size and Location
  • Nodes: Has the Cancer Spread to Nearby Lymph Nodes?
  • Metastasize: Has the Cancer Spread to Other Organs in the Body?

Each letter also has its own set of levels based on the severity of the cancer.

T ranges from Tx – T4, N from Nx –N1, and M from M0 – M1. The following explanations have been pulled from The American Cancer Society’s website:

T categories

  • TX:The main tumor cannot be assessed.
  • T0:No evidence of a primary tumor.
  • Tis:Carcinoma in situ (the tumor is confined to the top layers of pancreatic duct cells). (Very few pancreatic tumors are found at this stage.)
  • T1:The cancer is still within the pancreas and is 2 centimeters (cm) (about ¾ inch) or less across.
  • T2:The cancer is still within the pancreas but is larger than 2 cm across.
  • T3:The cancer has grown outside the pancreas into nearby surrounding tissues but not into major blood vessels or nerves.
  • T4:The cancer has grown beyond the pancreas into nearby large blood vessels or nerves.

N categories

  • NX:Nearby (regional) lymph nodes cannot be assessed.
  • N0:The cancer has not spread to nearby lymph nodes.
  • N1:The cancer has spread to nearby lymph nodes.

M categories

  • M0:The cancer has not spread to distant lymph nodes (other than those near the pancreas) or to distant organs such as the liver, lungs, brain, etc.
  • M1:The cancer has spread to distant lymph nodes or to distant organs.

 

The Stages of Pancreatic Cancer

Stage 0 – At this stage, pancreatic surgeons consider the cancer to be confined to the pancreas and it has not yet spread to nearby blood vessels or tissues.

Stage I The cancer is still limited to the pancreas, but has grown. Stage 1A refers to growth less than 2cm. Stage 1B refers to growth of more than 2cm.

Stage II – The cancer has spread from the pancreas to surrounding lymph nodes, but not into major blood vessels nor lymph nodes.

Stage III – Pancreatic cancer has spread into major nerves or blood vessels.

Stage IV – Pancreatic cancer has spread to other organs, often into the liver or abdomen.

 

Treatment for Pancreatic Cancer

Pancreatic Surgery

If considering surgery for your pancreatic cancer, be sure to speak to an experienced pancreatic surgeon to determine the best option for you. There are three ways to classify pancreatic cancer in terms of whether or not it can be removed surgically.

  • Resectable means that the all of the tumor can be removed by a pancreatic surgeon.
  • Borderline Resectable means that the bulk of the main tumor can be removed surgically, but some cancerous cells might remain in the body.
  • Unresectable means that the tumor cannot be removed entirely through surgical means.

Radiation Therapy

Radiation therapy works by using high-energy waves to kill cancerous cells within the body. To reduce the side effects of radiation therapy, doctors try to target only the area of the body infected with cancerous cells.

Chemotherapy and Other Drugs

Chemotherapy is classified as a systemic treatment. This means rather than targeting a specific area of the body, chemotherapy drugs travel throughout the body by way of the blood stream.

 

Finding Answers

If you or someone you know has just been staged with pancreatic cancer, now is the time to discuss possible treatment options, including surgery, with your doctor. If the cancer has been determined to be resectable or borderline resectable, speak with an experienced pancreatic surgeon to discuss your options further.

 

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