Pancreatic Cancer staging

Function of pancreas is to produce juices that help the body break down food and make hormones to regulate blood sugar. Uncontrolled growth of any part of pancreas results in cancer.

Diagnosis: -If you develop symptoms of pancreatic cancer, your doctor will advise blood tests and imaging tests to see if there is any growth in the pancreas.

Though biopsy is not must but in some cases, your doctor will advise it to confirm the diagnosis of cancer. A biopsy involves removing a small piece of tissue from the growth, which is examined by the pathologist under a microscope to see if there are signs of cancer.

Staging: – Once pancreatic cancer is diagnosed, then the staging of pancreatic cancer is done. Staging is a way of finding out where the cancer is located, how much the cancer has spread and whether it can be completely removed or not. In short it helps out doctor to give you accurate treatment choices, to predict a patient’s prognosis and the chance of his recovery.

For staging clinical exam, computed tomography (CT) scan or magnetic resonance imaging (MRI) or PET Scan is done.

There are different stage descriptions for different types of cancer. It is important for the staging to be done at a medical center with experience in staging pancreatic cancer.

Pancreatic cancer stages range from stage I, the earliest stage, to stage IV. In stage I to Stage III cancer is limited to pancreas, while stage IV means that the cancer has spread to distant organs. In general, lower stage cancers are more likely to be successfully treated than higher stage cancers.

Another more common way to classify pancreatic cancer is based on whether it can be completely removed with surgery or it has spread and surgery cannot be done as below:-

(1)Resectable:- In this the tumor is located only in the pancreas and can be  easily removed by surgery in 10% to 15%  of pancreatic cancer . Doctor is able to remove tumor with negative margins. A negative margin means that no visible cancer cells are left behind.

(2)Borderline resectable:- This occurs because some locally advanced cancers can be resected completely, but many cannot. At times it is large, may be difficult to remove surgically when it is first diagnosed, as imaging doesn’t always accurately distinguish between the two. So chemotherapy or chemotherapy along with radiotherapy is advised before surgery to reduce the size and then surgically removed.

(3) Unresectable:- In 30% to 40% of patients, cancer is located in the pancreas only, but because it has grown into arteries, veins or nearby organs so it cannot be surgically removed. Though at this stage it still has not spread to any distant parts of the body, its removal with surgery will increase the risk of damaging these nearby structures.

(4) Metastatic: – when it has spread to other parts of body away from pancreas like liver, lung and other parts of body and is treated with chemotherapy only and surgery cannot be done at this stage. Majority of our patients fall in this category.

Most physicians treating pancreatic cancer refer to patients as having surgically resectable cancer (stage I and II), locally advanced cancer (stage III), or metastatic cancer (stage IV).

Laparoscopy —even the latest imaging tests may not give your doctor perfect information and if there is doubt than surgery which in good centers is in form of laparoscopy is performed so that complete information about the correct stage, location and size of the cancer is obtained before an attempt to remove the cancer with surgically at a later stage. During a laparoscopy, a surgeon will insert a small endoscope with a camera by small incisions in abdomen to visualise the organs inside the abdomen.

Recurrent:  cancer that has come back after treatment is called as recurrent pancreatic cancer. At this stage, there will be repeat tests often similar to those during the original diagnosis to learn about the extent of the recurrence.

It is very important to understand that complete staging tests are very important after which only doctor can give you accurate advise on what treatment to be done.