Physicians conduct diagnostic tests to determine the extent of cancer growth. This is a process known as staging. Pancreatic cancer spreads through the bloodstream and the lymph nodes to the other parts of the body. It is therefore considered a systemic disease, because even if the tumors are visible locally, the cancer can be more widespread. The stages are:

• Stage I. Cancer is located in the pancreas only and has not spread to any other area.
  
  
• Stage II. Cancer is located in the pancreas and outside into the large blood vessels. It may or may not be in nearby lymph nodes. It has not spread to distant organs.
  
  
• Stage III. Cancer is located in the pancreas and has spread locally to the lymph nodes and to major blood vessels near the pancreas but not distant sites.
  
  
• Stage IV. Cancer is located in the pancreas and can be any size, and it has spread to distant sites.
  
  
• Recurrent. Cancer that recurs after treatment and may return to the pancreas or other parts of the body.

The American Joint Committee on Cancer (AJCC) has developed a more detailed “TNM” staging system used by physicians:

• “T” describes the extent of cancer growth.
• “N” describes the extent of regional lymph node involvement.
• “M” describes the extent of distant metastasis.

A simpler staging system is used when the exact extent of cancer growth cannot be precisely determined until surgery is performed. This staging system estimates where the cancer can be removed and to what extent based on physical examination and some imaging tests such as CAT scan. The categories:

• Resectable. The entire tumor is located in the pancreas and can be removed. Stage I is in this category.
  
  
• Locally advanced. Complete removal is not possible because the cancer has spread locally and blood vessels may be involved. For unresectable cancer, surgery would be performed only to relieve symptoms from obstructions such as in the bile duct or intestinal tract and not for complete removal. Stage II is in this category.
  
  
• Metastatic. For metastatic cancer, the spread is too extensive and distant and surgery is not possible for removing the cancer. Surgery would be performed only to relieve symptoms from obstructions such as in the bile duct or intestinal tract. Stage III and IV are in this category.

About 5 percent of people with pancreatic cancer live for at least five years after diagnosis. This rate improves to 20 percent for the few cases where cancer is confined to the pancreas, according to the American Cancer Society.