On the surface this would seem to be a fairly straight forward question, but as there exists the controversy of competing stage nomenclatures for pancreatic cancer stages, it is not as simple as one might think. In fact, in the U. S., universal agreement on a standardized staging system does not exist. The fundamental problem is that the stages system for exocrine cancer of the pancreas as put forth by, for example, the American Joint Committee on Cancer (“AJCC”) is felt to be somewhat impractical by certain experts. This classification rests on knowing the status of the TNM (that is Tumor, lymph Nodes and distal Metastasis).
Under this classification (roughly) Stage I pancreatic cancer includes tumors which have not spread into certain proscribed sensitive areas and which have no involved regional nodes or distal metastasis. Stage II pancreatic cancer includes tumors which have spread into the duodenum, bile duct, or “peripancreatic” tissues AND which have no involved regional nodes or distal metastasis. Stage III pancreatic cancer includes tumors which may have OR may not have spread into these aforementioned areas and which have involved regional nodes, but which show no evidence of distal metastasis. Stage IVA pancreatic cancer includes tumors which have spread into the stomach, spleen, large bowel OR the adjacent large vessels AND which have involved regional nodes, but show no evidence of distal metastasis. And Stage IVB pancreatic cancer includes pancreatic tumors of any kind with node status of any kind AND with evidence of distal metastasis.
Leaving aside that fact that this stage classification may not completely comport with similar nomenclature for pancreatic cancer by the International Union Against Cancer (Union Internationale Contre le Cancer), in practice, though referred to, this classification is rarely used in its pure form as the stages do not fully match treatment options for pancreatic cancer or even patient prognosis, and very often the true lymph-node status cannot be fully determined without surgery (which most people with pancreatic cancer do NOT receive).
For doctors and patients then, staging is USUALLY based on sophisticated radiologic studies. And for these cases, a clinical/radiographic stage classification for pancreatic cancer has been proposed which attempts to more closely follow prognosis and clinical decision making in regard to the actual treatment options for pancreatic cancer. This three stage classification (potentially resectable, locally advanced and advanced) of pancreatic cancer involvement, is based on radiological findings, and is not directly referent to the TNM status.
In this proposed classification, potentially “resectable pancreatic cancer” stage (or Local) is defined roughly as that including no evidence of extra-pancreatic involvement of the tumor, demonstration of fully patent superior mesenteric / portal veins and showing no evidence of encroachment (“encasement”) by the tumor on the arterial celiac axis or the superior mesenteric artery. The “locally advanced pancreatic cancer” stage is that which demonstrates evidence of arterial encroachment (celiac axis or superior mesenteric artery) or venous occlusion (superior mesenteric / portal veins). And the advanced “pancreatic cancer stage” includes evidence of metastatic spread (typically to the liver, peritoneum or lungs).
There are other terms in use and still other stage classifications. Of course, this makes for a messy kind of communication, although in practice oncologists seem to be able to speak with one another without apparent misunderstanding. It is possible and even likely perhaps, over time, assuming the great strides in the sophistication and power of radiographic techniques continue to move forward, the future will further free these staging classifications of pancreatic cancer from their strictly surgical origins and enable a more uniformly agreed upon stage nomenclature.
The following are descriptions of titles of abstracts of medical journal articles that may be interesting or useful to those who are interested in further information about this topic.These abstracts can be searched Here.
Our science board is composed of:
James Abbruzzese, MD Chief, Medical Oncology Duke University
Markus Büchler, MD Chairman, Surgery Heidelberg University, Germany
Ralph Hruban, MD Director, GI / Liver Pathology Johns Hopkins University
Eileen O’Reilly, MD Associate Director for Clinical Research – Memorial Sloan-Kettering Cancer Center
Margaret Tempero, MD Chief, Medical Oncology University of California at San Francisco
Our Philosophy About Pancreatic Cancer
Pancreatic cancer is a serious disease. Taking an aggressive rational stance at the earliest possible time, supported by the best medical team, and treated in the most appropriate manner gives the best chance for survival.
We believe in strong patient-physician bonds, scientifically-based treatment, and that comfort can come from knowing that everything that reasonably can be done – is being done.
That the best approach is meeting cancer of the pancreas head-on and armed with the best available information.
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PROPOSED: Every newly diagnosed person with pancreatic cancer (ductal adenocarcinoma of the pancreas) should receive genetic screening prior to beginning treatment – to test for germline genetic mutations in the homologous recombination DNA repair pathway, including genes such as BRCA1, BRCA2, PALB2, and others. These results, in from 12% to 17% of pancreatic cancer patients, suggest that treatment that includes DNA cross-linking agents such as platinum compounds or PARP inhibitors may be superior to standard best practices therapy.
OFFER: Color Genomics offers a 30-gene cancer panel for $224 (normally $249) when the Promotion Code “PANCREATIC” is entered at checkout (price will reduce upon entering this code). This is a physician-ordered saliva kit. Click Here for more information
RATIONALE: The age of precision medicine in pancreatic cancer is approaching … [MORE]
This year an estimated 57,600 Americans will be diagnosed with pancreatic cancer. Approximately 47,050 Americans are expected to die from the disease. There are many reasons why the outcome for pancreatic cancer patients is bleaker than for most other cancer types. There are no reliable methods to detect the disease early, and there are very few effective treatment options. Which is why we are so focused on supporting research for early diagnosis.
Together with You our Mission is to promote awareness, increase education, and further pancreatic cancer research aimed at early diagnosis.
Most of our fundraisers, supporters, and volunteers, have been in one way or another, personally effected by this disease. We want to acknowledge what hardships you may have gone through (or are currently facing) and sincerely thank you for visiting our site!
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Cancer Patients Alliance is a 501(c)(3) non-profit. Initiatives include, ToFightCancer.com and Pancreatica.org. All Donations are tax-deductible.
Pancreatic cancer is expected to become the 2nd leading cause of cancer-related death by the year 2020. There are many reasons why the outcome for pancreatic cancer patients is much bleaker than for most other cancer types. There are no reliable methods to detect the disease early, and there are very few effective treatment options.
|There remains a dire need for more research and an increase in focused funding for pancreatic cancer. Your Donation will go directly to promoting awareness, increasing education, and furthering pancreatic cancer research aimed at early diagnosis.|
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