Pancreatic cancer

Abdominal Cancer
What are the Stages of Pancreatic Cancer?

Pancreatic cancer has taken the lives of numerous celebrities and well-known people,
such as Steve Jobs, Jerry Springer, Patrick Swayze, the astronaut Sally Ride, opera
singer Luciano Pavarotti, and Aretha Franklin. Pancreatic cancer leads to the deaths of
approximately 50,550 Americans every year. The signs and symptoms of pancreatic
cancer may go unnoticed until the disease is in its later stages, which is why the five-
year survival rate of pancreatic cancer is 12%. When pancreatic cancer is diagnosed, it
is typically staged using the TNM (tumor, node, metastasis) staging system in
combination with a numerical staging system (stages 0 to IV).


The TNM staging system considers:

  • The size of the tumor and if the tumor has spread from the pancreas to nearby blood vessels.
  • Whether the cancer has spread to nearby lymph nodes. If yes, how many of the nearby lymph nodes have cancer?
  • Whether the cancer has metastasized (spread) to other parts of the body. If yes, has it spread to nearby or distant organs?


The numerical stages of pancreatic cancer:


Stage 0: Also called carcinoma in situ, this stage refers to abnormal cells that are found
in the lining of the pancreas. These cells have not spread to nearby tissues or organs.
Stage I: The tumor is confined to the pancreas and has not spread to nearby lymph
nodes or other organs.
Stage II: The tumor has grown beyond the pancreas and may have invaded nearby
organs or tissues, but it has not spread to distant sites.
Stage III: The tumor has spread to nearby lymph nodes and may have invaded nearby
blood vessels or nerves.
Stage IV: The cancer has spread to distant organs or tissues.

Application of the TNM and Numerical Staging Systems to Pancreatic Cancer:


T: Tumor
 TX: Primary tumor cannot be assessed
 T0: No evidence of primary tumor
 Tis: Carcinoma in situ, also known as pancreatic intraepithelial neoplasia (PanIN)
3
 T1: Tumor confined to the pancreas, 2 cm or smaller
 T2: Tumor confined to the pancreas, larger than 2 cm but not larger than 4 cm

 T3: Tumor extends beyond the pancreas but does not involve the celiac axis or
superior mesenteric artery (SMA)
 T4: Tumor involves the celiac axis or SMA
N: Node
 NX: Regional lymph nodes cannot be assessed
 N0: No regional lymph node metastasis
 N1: Regional lymph node metastasis
M: Metastasis
 MX: Distant metastasis cannot be assessed
 M0: No distant metastasis
 M1: Distant metastasis present
Overall stages:
 Stage 0: Tis, N0, M0
 Stage IA: T1, N0, M0
 Stage IB: T2, N0, M0
 Stage IIA: T3, N0, M0
 Stage IIB: T1-T3, N1, M0 or T4, N0-N1, M0
 Stage III: T1-T4, N2, M0
 Stage IV: Any T, Any N, M1
The TNM staging system combined with the numerical staging system is just one tool
used to guide surgical and treatment decisions for patients with pancreatic cancer. For
treatment purposes, doctors often classify patients’ pancreatic cancer into four stages
based on how advanced the disease is: resectable (localized), borderline resectable,
locally advanced, and metastatic.

  1. Resectable (Localized) Pancreatic Cancer: The tumor is confined to the pancreas
    and has not spread to other organs or structures nearby. Surgery is typically the
    first line of treatment. Chemotherapy or radiation therapy may be used before or
    after surgery to help prevent the cancer from recurring.
  2. Borderline Resectable Pancreatic Cancer: The tumor has grown into nearby
    structures or blood vessels but has not yet spread to other organs. Surgery may
    be an option, but it may require a more complex surgical approach.
    Chemotherapy or radiation therapy may be used before or after surgery to help
    shrink the tumor.
  3. Locally Advanced Pancreatic Cancer: The tumor has grown into nearby
    structures or blood vessels and is considered inoperable. Chemotherapy and radiation therapy are the main treatment options for this stage of pancreatic cancer.
  1. Metastatic Pancreatic Cancer: In this stage, which is the most advanced, the
    cancer has spread to distant organs. Treatment options for metastatic
    pancreatic cancer focus on controlling symptoms and improving quality of life,
    rather than curing the cancer. Chemotherapy is the main treatment option for this
    stage.

Overall, the exact classification of pancreatic cancer into stages depends on numerous
factors, including the location and size of the tumor, whether it has spread to nearby
lymph nodes or distant organs, and a patient’s overall health. Pancreatic cancer is often
diagnosed at an advanced stage because it tends to be asymptomatic in its early
stages. This makes treatment more difficult, which is why early detection and screening
are crucial for improving outcomes.

May 2, 2023

Abdominal Cancer
Signs and Symptoms of Pancreatic Cancer

Pancreatic cancer is actually a fairly common form of cancer, ranking 11th amongst cancers in total number of cases this year. However, pancreatic cancer is known for hiding under the radar. Known as the “silent” cancer, many early forms of pancreatic cancer go undetected.

To help our community better understand when to get tested, the Surgery Group of Los Angeles have made this little brochure to help you know when to speak to a doctor about a possible case of pancreatic cancer.

Stage 1: Set up a physical, talk to your doctor but you might be fine

The problem with pancreatic cancer is that the symptoms of early-stage of pancreatic cancer are so easy to confuse with every other stomach disease.

  • Pain in the abdomen or stomach
  • Bloating
  • Loss and appetite
  • Difficulty pooping

Can mean pancreatic cancer, but it could mean dehydration, hemorrhoids, or simply not enough fiber. The key is to speak to your doctor once it becomes chronic – more than two weeks. Even if it’s not pancreatic cancer you may need 

Stage 2: It’s probably fine, but talk to the doctor ASAP

If you’re developing any of these symptoms run, don’t walk to your nearest hospital. You don’t need to call 911 necessarily, but it could be an option if you are in great pain.

  • You develop signs of diabetes suddenly or your diabetes gets worse
  • Your poop starts to smell like rotting oil
  • Your poop is bone dry, and takes hours of struggling to pass

These are more serious signs of your pancreas malfunctioning, and you should see a doctor immediately.

Stage 3: Go to a doctor right now

Almost all forms of pancreatic cancer don’t need emergency room treatment. However, some symptoms are so dramatic they are signs that you require a specialist diagnosis and treatment right away.

If you start suffering from:

  • skin and eyes looking yellow (jaundice)
  • Your urine is consistently light brown or orange
  • Unexplained nausea for multiple days

Go to urgent care and let your medical provider know that you may feel that you have developed a form of pancreatic cancer.

The key is to stay calm and not jump to conclusions. Explain your symptoms with your doctor clearly and try to write down how long you’ve experienced these symptoms to help you remember them prior to your appointment.

If you or a loved one believe that you are suffering from these symptoms, speak to your doctor today.

February 21, 2023

Surgery Group LA
New Drug Combination may treat Pancreatic Cancer

A team of MIT researchers has discovered that a combination of three immunotherapy drugs can eliminate pancreatic tumors in mice, and should enter clinical trials later this year.

Immunotherapy

Immunotherapy drugs work by facilitating the immune response of T cells, a white blood cell crucial for a person’s ability to fight off a variety of diseases, including cancer. The problem is that most cancerous tumors, including pancreatic tumors, create immunosuppressive proteins that shut down the response of the T cells, causing cancer cells to grow unabated.

Most common immunotherapies, such as Immune Checkpoint Therapy, block the interaction between these immunosuppressive proteins and T Cells, allowing T Cells to return to their natural job of destroying cancerous cells. While these more common therapies have shown success in treating Melanoma and Lung Cancer, they have not proven to be successful at treating Pancreatic Cancer.

Researchers found that this was because the most common form of immunosuppressive protein, PD -1, was not often found in pancreatic cells, but instead had a protein called CD 155/TIGIT which is not only harder to detect but can effectively shut a T cell down.

New Immunotherapy Combinations

Using this knowledge, researchers crafted combinations of drugs that not only suppress the formation and interaction of the more common cancerous PD -1 Protein but the CD 155/TIGIT protein as well. Combining more traditional immunotherapy drugs with a new experimental drug called CD 40, researchers were able to shrink the tumors of about 50 percent of the animals they tested on, and in 25% of the animals they tested, the tumors disappeared completely. Perhaps even more importantly, once the treatment was stopped, the tumors did not regrow.

While neither of these drugs is FDA approved currently, they are in stage 2 of their clinical trials. If these results prove capable of lasting through human trials, it could be amazing news to the lives of the more than 60,000 Americans every year that are suffering from pancreatic cancer. While rare, pancreatic cancer is especially deadly due to a lack of effective treatment options, and only 10% of patients survive 5 years after diagnosis.

If you or anyone you know has a family history of pancreatic cancer, please speak to a medical professional today.

February 7, 2022



Surgery Group of LA is a multi-specialty surgical practice based in Los Angeles, dedicated to providing expert, compassionate care across a wide range of specialties including colorectal, thyroid, general, and minimally invasive surgery. Our board-certified surgeons are committed to delivering personalized treatment using the latest technology and techniques.

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