Stage 4 Pancreatic Cancer and TNM System

 What is pancreatic cancer?

The pancreas, a vital endocrine organ situated behind the stomach, develops pancreatic cancer in its tissues. The pancreas plays a crucial role in digestion by generating the digestive enzymes that the body requires to break down fats, carbs, and proteins.

Glucagon and insulin are two more essential hormones that the pancreas generates. Controlling the metabolism of glucose (sugar) is the responsibility of these hormones. When glucose levels are too low, glucagon helps boost them. Insulin aids in the metabolism of glucose by cells to produce energy.

Due to the pancreas' location, pancreatic cancer may be difficult to detect and is frequently found at a later stage of the disease.

What is stage 4 pancreatic cancer?

 When pancreatic cancer reaches stage 4, it means that the bloodstream has been infected by the cells that originally formed a tumor in the pancreas. In other body parts, such as the bones or lungs, the cells begin to form tumors.
The tumors might be of any size and cancer may spread to other parts of the body like the liver, lung, abdominal wall, or bones.
Stage 4 Pancreatic Cancer (image credit

What is TNM system?

To stage other cancers, doctors generally utilize a technique known as the TNM system. It has 3 sections as follows:

  • Tumor (T): What size is the main tumor? What location is it in? Tumor stages information is listed from T0 to T4. T rating for T0 (The pancreas showed no indications of cancer), Tis (Early-stage, non-spreading cancer), T1 (Only the pancreas has the tumor, which is no larger than 2 centimeters (cm) in size.) T2 (Tumor size is more than 2cm but smaller than 4cm), T3 (The tumor is beyond 4 cm in size and spreads outside the pancreas.) and T4 (Main arteries or veins nearby the pancreas are affected by a tumor that extends outside the organ.).

  • Node (N): Lymph nodes are denoted by "N" in the TNM staging system. N0 (The regional lymph nodes did not contain any cancer), N1 (1 to 3 regional lymph nodes have been affected by the spread of cancer), and N2 (More than 3 regional lymph nodes have been affected by cancer).

  • Metastasis (M): Metastasis describes the spread of cancer to lymph nodes and further organs. Only two M stages exist M0 (Cancer has not spread to other parts of the body) or M1 (Including distal lymph nodes, cancer has spread to another area of the body).

Stages of pancreatic cancer

There are stages of pancreatic cancer as follow:

  • Stage 0: The cells in the top layer of the pancreatic duct are where the cancer is found (Tis, N0, M0).

  • Stage 1A: When a cancer is in stage 1A, it must be 2 cm or smaller and entirely internal to the pancreas. The lymph nodes don't have any cancer (T1, N0, M0).

  • Stage 1B: When a cancer is in stage 1B, it must be more than 2 cm and smaller than 4cm, and entirely internal to the pancreas. The lymph nodes don't have any cancer (T2, N0, M0).

  • Stage 2A: Beyond the pancreas, the tumor is greater than 4 cm. It has not spread to lymph nodes, arteries, veins, or other major organs. (T3, N0, M0)

  • Stage 2B: A tumor of any size has only spread to 1 to 3 regional lymph nodes but not spread to arteries, veins, or other parts of the body (T1, T2 or T3; N1; M0). 

  • Stage 3: Any size tumor that has penetrated 4 or more local lymph nodes but not the surrounding arteries, veins, or other body parts (T1, T2, or T3, N2, M0).
          A tumor that has impacted the nearby veins and arteries as well as regional lymph nodes. It has              not spread to the body's other organs (T4, any N, M0).

  • Stage 4: Stage 4 signifies that the tumor has progressed to the liver or lungs, among other organ parts (any T, any N, M1).

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