Stage 3 Pancreatic Cancer

Kathryn E. Vinson, MS, CCRC

I’m going to be perfectly honest with you today – I really didn’t know much about pancreatic cancer until I heard on the news that Patrick Swayze was fighting it. I mean, I knew we had a pancreas, what it does, and sure – that cancer is possible there, but I didn’t really understand why this particular type of cancer was such a killer as opposed to other cancers. When I did some research, what I found out was shocking, and scary. This killer is quiet in its earliest stages, often not becoming symptomatic until the disease has progressed substantially. Let’s take some time today to talk about this silent killer, and what a diagnosis means for patients and their families.

Pancreatic Cancer Stages

Staging in pancreatic cancer is very confusing. There are the Stages 1 through 4 that most of us are accustomed to, but stages 1 and 2 are also broken down into A’s and B’s. Stage 3 pancreatic cancer stages can be described by four different classifications within the TNM system (T – tumor size, N – lymph node involvement, M – metastases). One commonality among the TNM rankings within stage 3 is M0 – meaning that the cancer has not spread or metastasized to any distant sites, although invasion of nearby blood vessels may be involved. Tumors at stage three may be less than 2 cm in diameter (T1), 2-4 cm (T2), larger than 4 cm (T3), or have grown outside the pancreas and involve nearby blood vessels (T4). These T rankings also work in conjunction with N rankings, to describe lymph node involvement. Within stage three pancreatic cancer staging, N2 is the most common, meaning that the cancer has spread to at least 4 nearby lymph nodes; however, with T4, and N ranking is possible within stage 3.

Confused yet? The following TNM classifications all describe stage 3 pancreatic cancer:

• T1, N2, M0
• T2, N2, M0
• T3, N2, M0
• T4, any N, M0

Cancer.net also tells us that many physicians describe pancreatic cancer by its surgical properties – meaning if it can be easily resected. Sadly, only 10-15% of pancreatic cancers are resectable when diagnosed. Beyond this stage, we see borderline resectable (meaning that it might be able to be surgically removed, if first shrunk with chemo and radiation), locally advanced (meaning that it has invaded nearby blood vessels or organs), and metastatic. Locally advanced pancreatic cancer accounts for 35-40% of diagnoses. Given this, we can estimate that stage 3 cancers represent somewhere in the neighborhood of 45-50% of diagnoses, as they may fall along the continuum from resectable to locally advanced.

Life Expectancy

When we talk about life expectancy in any type of cancer, I want to warn people to take these numbers with a grain of salt. Remember that these numbers describe five-year life expectancies – so the data that these numbers are based upon reflect diagnoses made five years ago (at least) as well as the standard treatments at that time. Now for the terrifying numbers. Pancreatic cancer has some of the lowest five-year survival rates that I have ever seen, regardless of stage. These numbers are provided by the American Cancer Society.

Pancreatic cancer survival rates are one thing, but what someone with this disease wants to know is – how long can I live with stage 3 pancreatic cancer. That isn’t an easy question to answer as it will depend on a lot of factors, but we do have some averages. Sadly, the life expectancy for patients with untreated pancreatic cancer is about 3 ½ months, with life extending to an average of 8 months with good treatment. Keep in mind these are median numbers – meaning that 50% of patients fall below that number, but 50% live longer than those numbers.

I want to take this time to remind those of you battling this disease – you are not a number! Every patient and every cancer is different.

As always, much love, abundant blessings, and many prayers to all of the cancer warriors and their families.