Staging and grading of pancreatic cancer

The stage of a cancer describes its size and whether it has spread. Knowing this helps doctors plan the best treatment.

Staging of pancreatic cancer

The stage of a cancer describes its size and whether it has spread. Knowing the stage of pancreatic cancer helps doctors decide the best treatment for you.

The staging systems most commonly used are:

  • the number staging system
  • TNM staging.

Number staging

A common staging system uses numbers to describe the stage of the cancer.

Stage 1

This is the earliest stage. The cancer is contained inside the pancreas. But it may be quite large. There is no cancer in the lymph nodes close to the pancreas. There is also no sign that it has spread anywhere else in the body.

Stage 1 is divided into two:

  • Stage 1A – The cancer is smaller than 2cm.
  • Stage 1B – The cancer is bigger than 2cm.

Stage 2

The cancer has started to grow outside the pancreas into nearby tissues. There may be cancer in lymph nodes near the pancreas.

Stage 2 is divided into two:

  • Stage 2A – The cancer is in nearby tissue, but has not spread into the blood vessels or lymph nodes.
  • Stage 2B – The cancer may have grown into nearby tissue. It is in the lymph nodes but not blood vessels.

Doctors often call stages 1 and 2 resectable or early-stage cancer. Resectable means a surgeon may be able to operate to remove (resect) the tumour. About 2 in 10 cancers of the pancreas (21%) are diagnosed at stages 1 and 2.

We have more information about surgery for pancreatic cancer.

Stage 3

The cancer has spread to large blood vessels near the pancreas and may have spread to lymph nodes. But it has not spread to other parts of the body, such as the liver or lungs.

Stage 3 cancer is often called locally advanced cancer. Usually, surgery is not possible for this stage. It is sometimes called unresectable cancer.

Occasionally, a person with stage 3 cancer may be able to have surgery to try to remove the cancer. It will depend on what blood vessels are involved. This is called borderline resectable cancer.

Stage 4

The cancer has spread to other parts of the body, such as the liver or lungs. Surgery is not possible.

Stage 4 cancer is often called metastatic or advanced cancer.

Nearly 8 in 10 cancers of pancreatic cancers (79%) are diagnosed at stages 3 and 4.

We have more information about coping with advanced cancer.

TNM staging

In the TNM staging system, TNM stands for tumour, nodes and metastases.

  • T describes the size of the tumour and whether it has grown into nearby tissues or organs.
  • N describes whether the cancer has spread to the lymph nodes and which nodes are involved.
  • M describes whether the cancer has spread to another part of the body. These include the liver or lungs (secondary or metastatic cancer).

Grading of pancreatic cancer

Grading describes how the cancer cells look when they are examined under a microscope. The grade gives doctors an idea of how quickly a cancer may develop.

Grade 1 (low-grade)

The cancer cells tend to grow slowly and look similar to normal cells (they are well differentiated). These cancers are less likely to spread than higher grade cancers.

Grade 2 (moderate-grade)

The cancer cells look more abnormal.

Grade 3 (high-grade)

The cancer cells tend to grow more quickly and look very abnormal (they are poorly differentiated). These cancers are more likely to spread than low-grade cancers.

We understand that waiting to know the stage and grade of your cancer can be a worrying time. We're here if you need someone to talk to. You can:

About our information

  • References

    Below is a sample of the sources used in our pancreatic cancer information. If you would like more information about the sources we use, please contact us at

    British Society of Gastroenterology. Guidelines for the management of patients with pancreatic cancer peri-ampullary and ampullary carcinomas. 2005.

    European Society for Medial Oncology. Cancer of the pancreas: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology, 2015. 26 (Supplement 5): v56 to v68.

    Fernandez-del Castillo. Clinical manifestations, diagnosis, and staging of exocrine pancreatic cancer. UpToDate online. Jan 2018.

    Fernandez-del Castillo C, et al. Supportive care of the patient with locally advanced or metastatic exocrine pancreatic cancer. UpToDate online. Feb 2017. 

    Winter JM, et al. Cancer of the pancreas, DeVita Hellman and Rosenberg’s Cancer: Principles and Practice of Oncology (10th edition). Lippincott Williams and Wilkins. 2016.

  • Reviewers

    This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Chief Medical Editor, Professor Tim Iveson, Consultant Medical Oncologist.

    Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.