Stages of pancreatic cancer
What stages 0 to 4 mean in pancreatic cancer, how the TNM system works, and how stage relates to whether surgery is possible.
Staging describes how much cancer is present and whether it has spread. It helps your care team discuss treatment options and plan care.
You may also hear terms such as “resectable,” “borderline resectable,” or “locally advanced.” These describe whether the cancer can be removed with surgery. Stage and surgical possibility are connected questions, but they are not the same question — this guide explains both, and how they relate.
This guide describes staging for the most common forms of exocrine pancreatic cancer, including pancreatic ductal adenocarcinoma. Pancreatic neuroendocrine tumours have a different staging system.
Numbered stages · Whether surgery is possible · Questions to ask
This guide is general information, not medical advice. Your care team can explain what staging means in your situation.
How staging works: T, N and M
Care teams describe the cancer using three findings, known as the TNM system:
| Term | What it describes |
|---|---|
| T — Tumour | The primary tumour’s size and involvement of certain nearby structures |
| N — Nodes | Whether cancer is found in nearby lymph nodes |
| M — Metastasis | Whether cancer has spread to distant parts of the body |
These findings are combined to assign an overall stage. Stage is not determined by tumour size alone.
The numbered stages
| Stage | What it means |
|---|---|
| Stage 0 | Abnormal cells are confined to the lining of the pancreatic ducts and have not invaded deeper tissues. Also called carcinoma in situ. |
| Stage 1 | The cancer has not spread to nearby lymph nodes or distant sites. Substages distinguish tumour size. |
| Stage 2 | The cancer may be larger, or has spread to one to three nearby lymph nodes, without distant spread or the major arterial involvement that defines stage 3. |
| Stage 3 | The cancer involves certain major arteries, or has spread to four or more nearby lymph nodes, without distant spread. |
| Stage 4 | The cancer has spread to distant parts of the body, such as the liver, lungs, or the lining of the abdomen. |
A small primary tumour can still be stage 4 if distant spread is present — the stages are not simply a picture of a growing tumour.
Whether surgery is possible
Alongside the numbered stage, care teams describe whether surgery may be able to remove the cancer. You may hear these terms:
| Term | What it means |
|---|---|
| Resectable | The team believes the cancer can be completely removed with surgery. |
| Borderline resectable | Surgery may be possible, but the cancer’s relationship to nearby blood vessels makes complete removal uncertain. Treatment is often given first, and the cancer is then reassessed. |
| Locally advanced (unresectable) | The cancer has not spread to distant sites, but its local involvement prevents complete surgical removal at that assessment. |
| Metastatic | The cancer has spread to distant sites. Surgery to remove the pancreatic tumour is generally not used as a curative treatment in this situation. |
These categories are not a second set of stages, and they do not line up one-to-one with the numbered stages: stage and resectability describe different aspects of the cancer. Whether surgery is suitable also depends on a person’s overall health and ability to undergo a major operation.
Can the treatment plan change?
Your team may reassess the cancer after treatment. For some people with borderline resectable disease, treatment may make surgery possible; for others, it will not. Scans and specialist review help determine the next step. A change in the surgical assessment is not the same thing as a change to the original stage.
Treatment and support
Treatment planning considers the extent of the cancer, whether surgery is feasible, your health, and your preferences. Options may include surgery, chemotherapy, radiation therapy, and supportive care, depending on the circumstances.
- Treatment options for pancreatic cancer
- Surgery for pancreatic cancer
- Clinical trials
- What is biomarker testing?
- Palliative care and symptom support
Does stage tell me what will happen?
Stage helps inform prognosis, but it is not an individual prediction. Other considerations include whether the cancer is resectable and a person’s overall health. Survival statistics are often reported using “localized, regional, distant” groupings, which do not map neatly onto stages 1, 2, 3 and 4. For the statistical picture, see pancreatic cancer statistics.
Questions to ask your care team
- What is my stage, and which findings establish it?
- Is the cancer resectable, borderline resectable, locally advanced, or metastatic?
- Has my case been reviewed by a multidisciplinary team?
- What is the goal of the treatment being recommended?
- Will you reassess whether surgery is possible after treatment?
- Would a specialist surgical opinion be useful?
- Who can help me understand my scan and pathology reports?
Sources
- Canadian Cancer Society — Stages of pancreatic cancer
- American Cancer Society — Pancreatic Cancer Stages
- Canadian Cancer Society — Treatments for borderline resectable pancreatic cancer
- Canadian Cancer Society — Prognosis and survival for pancreatic cancer
Last reviewed: October 24, 2026