Stage 3 Pancreatic Cancer

What is Stage 3 Pancreatic Cancer?

Pancreatic cancer is a deadly disease that affects the pancreas, an important organ located in the abdomen. The pancreas is crucial in producing enzymes that aid digestion and hormones that help regulate blood sugar levels. Unfortunately, pancreatic cancer often goes undetected until it has progressed to an advanced stage.

Stage 3 pancreatic cancer is characterized by the spread of cancerous cells to nearby lymph nodes and other organs in the abdominal cavity, such as the liver or spleen [¹].

What are the subtypes of stage 3 pancreatic cancer?

Stage 3 pancreatic cancer involves two metastatic cancer stages: 3A and 3B. The sub-staging is based on the extent of tumor involvement and the spread of cancer to nearby organs and lymph nodes.

In stage 3A pancreatic cancer, the tumor has grown beyond the pancreas and into nearby tissues, such as the stomach, spleen, or colon. Additionally, cancerous cells may have spread to up to three nearby lymph nodes.

In cancer stage 3B, the tumor has spread further beyond the pancreas and into nearby major blood vessels. Cancerous cells may have also spread to four or more nearby lymph nodes.

Stage 3 pancreatic cancer staging and diagnosis

Pancreatic cancer staging

Pancreatic cancer is divided into four main stages based on the progression level of the cancer. In general, the TNM system is used to describe and classify the stage of cancer development and is managed by The American Joint Committee on Cancer (AJCC) and the Union for International Cancer Control (UICC) [²].

T (tumor) describes the size and location of the tumor and can either be TX (no information), T0 (no evidence), Tis (the pre-cancer stage where cancer is growing in the tissue it was found), and any number between one to four after the T (The higher the number, the bigger the tumor or, the more it has spread).
N (nodes) indicates whether it has spread to nearby lymph nodes and can either be NX (no information about nearby lymph nodes), N0 (no cancer in nearby lymph nodes), or any number between one to four after N (the higher the number, the bigger the tumor or, the more it has spread to nearby lymph nodes).
M (metastasis) describes if and how far the cancer has spread from its origin and can either be M0 (the cancer did not spread) or M1) the cancer has spread to distant organs.

How common is stage 3 pancreatic cancer

According to the American Cancer Society, the average lifetime risk of developing pancreatic cancer is one in 64 people. Moreover, the Society estimates that more than 64,000 people will be diagnosed with pancreatic cancer and more than 50,000 deaths because of the disease in 2023 [³].

According to the Surveillance, Epidemiology, and End Result (SEER) program by the National Cancer Institute, pancreatic cancer makes up more than 3.2% of all cancers. Additionally, the rate of new pancreatic cancer cases was 13 persons per every 100,000 men and women annually. Moreover, stage three pancreatic cancer comprised more than 52% of all pancreatic cancer cases [⁴].

How is stage 3 pancreatic cancer diagnosed?

Diagnosing pancreatic cancer can be challenging, as symptoms may not appear until the cancer has advanced. However, diagnosing cancer is an essential process in tumor staging and grading. Several diagnostic tests are available to detect grade 3 cancer [⁵]. Here are some of the most common tests used to diagnose stage three cancer:

Imaging tests: Imaging tests typically involve CT scans, MRI scans, and PET scans and can help detect the presence of a pancreatic tumor and determine its size and location. These tests can also help identify if the cancer has spread to nearby organs or lymph nodes, which is essential for staging the cancer accurately.
Biopsy: A biopsy is a procedure in which a small tissue sample is removed from the pancreas and examined under a microscope to confirm the presence of cancer. Biopsies can be done using a fine needle biopsy, which involves inserting a thin needle into the pancreas to collect a sample of cells, or through endoscopy, which involves inserting a flexible tube with a camera down the throat and into the stomach to access the pancreas.
Blood tests: Certain blood tests can help diagnose and monitor pancreatic cancer. For example, the CA 19-9 blood test can detect elevated protein levels commonly found in people with pancreatic cancer [⁶].
Laparoscopy: Laparoscopy is a minimally invasive surgical procedure in which a thin, lighted tube with a camera is inserted through a small incision in the abdomen to visualize the pancreas and surrounding tissues [⁷].
Endoscopic ultrasound: This technique combines endoscopy with ultrasound, allowing doctors to examine the pancreas and surrounding tissues in detail [⁸]. This procedure can help determine the size and location of the tumor.

Stage 3 pancreatic cancer symptoms

Pancreatic cancer often does not cause symptoms in its early stages, and symptoms may not become apparent until the cancer has advanced. However, here are some common stage 3 cancer symptoms [⁹]:

Jaundice
Abdominal pain
Nausea and vomiting
Weight loss
Fatigue
Changes in bowel movements
Loss of appetite

Stage 3 pancreatic cancer treatment

Stage 3 pancreatic cancer primary/first-line treatment

The primary or first-line treatment for stage III cancer typically involves a combination of chemotherapy and radiation therapy. This approach is known as chemoradiation and aims to shrink the tumor and reduce the risk of cancer recurrence [¹⁰]. Surgery may also be considered in some cases, but this depends on various factors, such as the size and location of the tumor and the patient's overall health [¹¹].

Chemotherapy involves using drugs that kill cancer cells or prevent them from growing. Chemotherapy drugs may be given intravenously or orally, and treatment is typically administered in cycles over several months. Common chemotherapy drugs used for pancreatic cancer include gemcitabine, 5-fluorouracil, and oxaliplatin [¹²].

Radiation therapy involves using high-energy radiation beams to kill or prevent cancer cells from growing. Radiation therapy may be administered externally, using a machine that directs the radiation beams at the tumor, or internally, using a small radioactive device inserted into the body near the tumor [¹³]. Radiation therapy is typically administered daily over several weeks.

The combination of chemotherapy and radiation therapy can help improve the treatment's effectiveness and may also reduce the risk of side effects associated with each treatment alone. Additionally, chemoradiation may help to improve the chances of surgical success in cases where surgery is possible.

Other types of treatment for stage 3 pancreatic cancer

Several treatment options may help slow the progression of the disease, alleviate symptoms, and improve quality of life [¹⁴]. These treatments are mostly reserved for patients that do not respond to or do not prefer chemoradiation.

Surgery: Surgery may be an option for some patients with stage 3 pancreatic cancer, particularly if the tumor can be removed without affecting nearby organs. Surgery may involve removing part or all of the pancreas, nearby lymph nodes, and other tissues [¹⁵].
Targeted therapy: Targeted therapy is a type of treatment that targets specific molecules or pathways that are involved in the growth and spread of cancer cells [¹⁶]. Examples of targeted therapy drugs used for pancreatic cancer include erlotinib and cetuximab.
Immunotherapy: Immunotherapy is a treatment that helps the body's immune system fight the cancer. Immunotherapy drugs target specific molecules in cancer cells or stimulate the immune system to attack cancer cells [¹⁷].

Can pancreatic stage 3 cancer be cured?

Unfortunately, stage 3 pancreatic cancer is typically not considered curable, but treatment can help manage the disease and improve quality of life. At stage 3, the cancer has spread beyond the pancreas to nearby organs or lymph nodes, making it more difficult to treat. However, several treatment options can help extend stage 3 cancer life expectancy.

Prognosis of cancer: Stage 3 pancreatic cancer survival rate

Stage 3 pancreatic cancer survival rate

According to the National Cancer Institute, the five-year pancreatic cancer survival rate is 11.5%. However, the survival rate varies depending on the stage of cancer. Stage 3 cancer survival rate is relatively low: around 3.1%. This means that out of a hundred patients, only three would survive the first five years after diagnosis [⁴].

However, it is important to note that the survival rate can increase depending on early diagnosis and relevant treatment. Moreover, several factors can affect cancer stage 3 survival rate, including the location and tumor size, how much the cancer has spread, and the patient's overall health [¹⁸].

Stage 3 pancreatic cancer recurrence rate

Pancreatic stage-three cancer has a relatively high recurrence rate. Studies have shown that after surgical removal of the tumor, up to 70% of people with stage 3 pancreatic cancer will experience a recurrence of their cancer within two years [¹⁹] [²⁰] [²¹]. The risk of recurrence is highest within the first year after treatment, but it can occur at any time [²²].

Stage 3 pancreatic cancer growth rate

In general, pancreatic cancer grows and spreads quickly, making it difficult to detect and treat in its early stages.

Studies have estimated that the average doubling time of pancreatic cancer is approximately 1 to 2 months, which means that the tumor size can double every 1 to 2 months and show growth rates of around 21% [²³]. However, the growth rate can vary widely from person to person and even within the same individual over time.

Lifestyle changes for preventing and managing stage 3 pancreatic cancer

While there is no guaranteed way to prevent or cure pancreatic cancer, there are several lifestyle changes that can help reduce your risk of developing the disease or manage it if you have been diagnosed with stage 3 pancreatic cancer [²⁴].

Quit smoking

Cigarette smoking is one of the leading risk factors for pancreatic cancer. Studies have shown that smokers are two to three times more likely to develop pancreatic cancer than non-smokers [²⁵]. Even if you have already been diagnosed with pancreatic cancer, quitting smoking can help improve treatment outcomes and overall quality of life.

Maintain a healthy weight

Obesity has been linked to an increased risk of pancreatic cancer and can increase the risk of pancreatic cancer by 20% [²⁶]. Maintaining a healthy weight through a balanced diet and regular exercise can help reduce your risk of developing pancreatic cancer.

Reduce alcohol consumption

Excessive alcohol consumption has been linked to an increased risk of pancreatic cancer [²⁷]. The American Cancer Society recommends that men limit their alcohol consumption to two drinks per day, while women should limit their intake to no more than one drink per day [²⁸].

Manage diabetes

People with diabetes are at an increased risk of developing pancreatic cancer [²⁹]. Therefore, managing diabetes through medication, diet, and exercise can help reduce your risk of developing pancreatic cancer. If you have been diagnosed with diabetes, working with your healthcare provider to manage your condition and reduce your risk of developing pancreatic cancer is important.

Get regular check-ups

Regular check-ups with your healthcare provider can help detect pancreatic cancer early when it is more treatable. If you are at high risk of developing pancreatic cancer, your healthcare provider may recommend regular screening tests, such as CT or MRI scans. Regular check-ups can also help manage your condition if you have been diagnosed with stage 3 pancreatic cancer.

Conclusion

Takeaway

stage 3 pancreatic cancer is a serious and often difficult-to-treat disease. It is important to be aware of the risk factors and to seek medical attention if you experience any symptoms. While the survival rates for pancreatic cancer are low, there are steps you can take to reduce your risk of developing the disease, and early detection and treatment can help improve your chances of survival.