Staging is part of the cancer diagnosis process. It tells us if the cancer has spread, and how far. The stage also tells us about the tumor’s location.

Diagnostic tests tell us whether a cyst is benign (not cancer), a precancerous lesion, or a malignant (cancer) tumor.

If the tumor is cancer, the information from your diagnostic tests will tell us the cancer’s stage. This includes how much the tumor has grown in the pancreas and whether it has spread. Staging helps your doctor choose a treatment and follow-up care.

Your doctor will give you a physical exam and review the results of your diagnostic and imaging tests. Your care team will find the cancer’s stage. They may adjust the stage if you have surgery or more tests. 

MSK uses the TNM (tumor, node, metastasis) system to stage cancer.

• T: The position and size of the primary tumor.
• N: Whether the cancer cells have metastasized (spread) to nearby lymph nodes.
• M: Whether the cancer cells have spread to other parts of the body.

The 4 stages of pancreatic cancer

Stage I (1) pancreatic cancer

The tumor is less than 2 centimeters across (about the size of a quarter). It’s only in the pancreas. It’s hard to diagnose stage I tumors by using imaging tests alone. We often wait until you have surgery to remove the tumor and then we find out the stage.

Stage II (2) pancreatic cancer

The tumor starts to grow outside the pancreas. It’s not yet in a major blood vessel. Stage 2 pancreatic cancer may have spread to nearby lymph nodes but not farther.

Stage III (3) pancreatic cancer

The tumor is growing outside of the pancreas. It has moved into nearby large blood vessels or major nerves. We often cannot operate on stage 3 pancreatic cancers. But we can shrink some of these tumors and then operate on them.

Stage IV (4) pancreatic cancer

The cancer has spread into parts of the body far from the pancreas. This can include the liver, lungs, or peritoneum (inner lining of the abdomen). You may feel some symptoms at this stage.

Laparotomy and Laparoscopy to Stage Pancreatic Cancer

Often our doctors will do a surgery called a laparotomy (LA-puh-RAH-toh-mee) as a part of the staging process. Your surgeon makes a small cut in the abdomen (belly) to look at the pancreatic tumor. They decide if they can remove it without harming your health.

About MSK’s laparoscopy procedure, an alternative to laparotomy

MSK surgeons pioneered an alternative to laparotomy for pancreatic cancer, called a laparoscopy (LA-puh-ROS-koh-pee). It’s a minimally invasive procedure, which means it does not use large incisions (cuts) that can harm the body.

Laparoscopy process

Your surgeon will use a laparoscope and surgical tools. A laparoscope is a long, thin surgical tool with a video camera on the end of it. Your surgeon will make a small (1 to 2 inch) incision near your belly button. They will put the laparoscope through this cut to look at your pancreas and nearby organs.

Recovery from laparoscopy

Recovery from laparoscopy is much faster than from open surgery. You can start treatments such as chemotherapy right away.