Pancreatic cancer that has been diagnosed as Stage 3 (T4, N1-4, M0) is usually considered “unresectable” or “locally advanced” since it has grown large enough within the pancreas that it cannot be completely removed by surgery, but it has not yet spread to other parts of the body.
Typical treatment options for Stage 3 pancreatic cancer may include one or more of the following:
- Surgery
- Since research has shown that removing only a small part of the cancer found in the pancreas does not help extend the life of a patient, surgery has a limited role in treating Stage 3 pancreatic cancer. While a total pancreatectomy, where the entire pancreas is removed as well as part of the stomach and small intestine, the spleen, the gallbladder and surrounding lymph nodes may be performed, surgery also may be reserved to just relieving any blockage the cancer is causing to the bile duct or intestine.
- Radiation Therapy
- For locally advanced pancreatic cancer, radiation therapy may be given in combination with chemotherapy as first-line therapy. If this combination therapy helps to shrink the tumor to a certain size, surgery may be considered to remove the tumor.
- Chemotherapy
- The use of chemotherapy agents gemcitabine or 5-FU may be given alone or in combination with radiation therapy for first-line treatment of locally advanced or Stage 3 pancreatic cancer. Again, if the tumor shrinks enough with chemotherapy treatment, surgery may be considered to remove the tumor.
The TNM System for cancer staging
The stage of pancreatic cancer at diagnosis is typically determined by a staging system developed by the American Joint Committee on Cancer (AJCC) called the TNM System, which evaluates the tumor based on the following criteria:
- T Category
- Describes the size of the primary pancreatic tumor, which is measured in centimeters, and whether or not the cancer has spread throughout the pancrease
- N Category
- Whether or not the pancreatic cancer has spread to nearby lymph nodes
- M Category
- The absence or presence of distant metastasis
Since pancreatic cancer is hard to diagnosis, especially in the early stages, other terms are more often used to simplify the staging of this disease. These include:
- Resectable
- This means that the cancer is only in the pancreas and the entire tumor can be surgically removed.
- Unresectable or Locally Advanced
- These terms refer to the fact that the pancreatic cancer has not yet spread to other parts of the body, but the entire tumor cannot be surgically removed from the pancreas.
- Metastatic
- This term refers to the fact that the pancreatic cancer has spread to other organs. While surgery may be performed remove the tumor, it will likely only relieve symptoms rather that cure the cancer.
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