What are the various stages of pancreatic cancer and what is the likelihood for successful treatment for each stage? Does the treatment vary depending on the stage of cancer a patient has?
Academic Title: Assistant Professor
Pancreatic cancer is staged by the size of the primary tumor and whether it has spread beyond the pancreas. Stages are:
Stage 0: The tumor is confined to the top layers of pancreatic duct cells and has not invaded deeper tissues. It has not spread outside of the pancreas. These tumors are sometimes referred to as pancreatic carcinoma in situ or pancreatic intraepithelial neoplasia III (PanIn III).
Stage I : The tumor is confined to the pancreas. It has not spread to nearby lymph nodes or distant sites.
Stage II: The tumor is growing outside the pancreas but not into large blood vessels. It may have spread to nearby lymph nodes but not distant sites.
Stage III: The tumor is growing outside the pancreas into nearby large blood vessels or major nerves. It may or may not have spread to nearby lymph nodes. It has not spread to distant sites.
Stage IV: The cancer has spread to distant sites.
Treatment of pancreatic cancer is based on stage. Surgery, either the Whipple procedure (pancreaticoduodenectomy) or distal pancreatectomy, depending on the location of the tumor, is offered to patients with stage I and II cancers. Several trials have shown a benefit to “adjuvant” chemotherapy after surgery. The role of post-operative radiation therapy after complete resection is somewhat controversial although most large Cancer Centers will offer this treatment to patients.
Chemotherapy with or without radiation are options for stage III tumors to shrink the cancer and potentially downsize or improve the ability to remove these tumors by surgery. This is called “neoadjuvant” chemotherapy. It is currently not known which chemotherapeutic agents are best or exactly how to combine chemotherapy with radiation so often patients with stage III pancreatic cancer are treated on a clinical trial.
Stage IV pancreatic cancer is treated with chemotherapy. The regimens typically involve either gemcitabine or 5-FU.