Pancreatic cancer that has been diagnosed as Stage 4 (T1-4, N1-2, M1) is considered "metastatic" because it has spread via the lymph nodes to other parts of the body. Since this stage of cancer cannot be removed by surgery and has spread too far for radiation to be effective, treatment options are limited.
When diagnosed at this stage, chemotherapy is the standard first-line treatment option. Gemcitbine is usually given alone or in combination a targeted therapy called erlotinib. Additionally, a chemotherapy regimen called FOLFIRINOX, which combines 5-FU, irinotecan, leucovorin and oxaliplatin chemotherapies also may be given to certain patients.
Since treatment options are limited for Stage 4 pancreatic cancer, enrollment into a clinical trial that is studying either a new, investigational treatment option and/or experimental regimen of existing treatment options also should be considered.
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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