Stage 3 Pancreatic Cancer: Treatment, Survival Rates and Outlook

Understanding Stage 3 Pancreatic Cancer

Pancreatic cancer is one of the most challenging cancers to treat, with a 5-year survival rate of only around 10%. This is partly because pancreatic cancer is difficult to detect in its early stages when it is more treatable. By the time most pancreatic cancers are diagnosed, they are already at an advanced stage.

One of the systems doctors use to describe how far pancreatic cancer has advanced is called staging. Staging provides key information that helps determine treatment options and outlook.

The TNM Staging System

The most common staging system for pancreatic cancer is the TNM system, which stands for:

• T: Size and local extent of the tumor
• N: Spread to nearby lymph nodes
• M: Presence of metastasis (spread to distant organs)

Based on the combination of T, N, and M scores, pancreatic cancer is divided into overall stages. Stage 3 indicates locally advanced disease, where the cancer has grown outside the pancreas but has not yet metastasized to distant sites.

Stage 3A Pancreatic Cancer

Stage 3A pancreatic cancer means:

• The tumor is growing into nearby blood vessels and/or organs like the stomach, spleen, or colon (T4 tumor).
• It has not spread to nearby lymph nodes (N0) or has spread to only the closest lymph nodes (N1).
• There is no distant metastasis (M0).

In stage 3A, the tumor is locally advanced and involving adjacent structures. But there is no spread to distant lymph nodes or organs. This stage may be potentially resectable with surgery.

Stage 3B Pancreatic Cancer

Stage 3B pancreatic cancer signifies:

• The tumor has invaded nearby organs and/or major blood vessels (T4 tumor).
• It has spread to more distant regional lymph nodes farther from the pancreas (N2).
• There is still no distant metastasis (M0).

In stage 3B, the cancer has grown outside the pancreas into major blood vessels or surrounding organs. It has also spread to regional lymph nodes in the abdomen. At this stage, the tumor is typically considered borderline resectable or unresectable.

Stage 3C Pancreatic Cancer

Stage 3C pancreatic cancer indicates:

• The primary tumor is any size and may or may not have grown outside the pancreas (any T stage).
• It has spread to lymph nodes near the pancreas and/or distant nodes (N1 or N2).
• There is no distant metastasis (M0).

Stage 3C means the cancer has spread to regional lymph nodes but not to distant sites. The tumor may or may not have grown into nearby structures. This stage is generally considered unresectable.

Treatment of Stage 3 Pancreatic Cancer

Treatment options for stage 3 pancreatic cancer include:

Surgery

Surgery to remove the tumor and nearby involved structures may be an option for some stage 3A and select stage 3B cancers. This is known as resection. Types of surgery may include:

• Whipple procedure (pancreaticoduodenectomy)
• Total pancreatectomy
• Distal pancreatectomy

The goal is to remove all visible tumor. But even when resection is possible, microscopes may still show cancer cells at the edges, meaning cancer could come back.

Neoadjuvant Therapy

To try to shrink borderline resectable stage 3 tumors and make resection possible, doctors often prescribe chemotherapy and/or radiation before surgery. This neoadjuvant therapy may include:

• FOLFIRINOX chemotherapy
• Gemcitabine-based chemotherapy
• Stereotactic body radiation therapy (SBRT)

After neoadjuvant therapy, surgery is attempted if imaging shows the tumor became resectable. Additional adjuvant chemotherapy may follow surgery.

Chemoradiation

For locally advanced stage 3 pancreatic cancer that is still unresectable after neoadjuvant therapy, the standard treatment is chemoradiation. This combines:

• Systemic chemotherapy (FOLFIRINOX or gemcitabine-based)
• External beam radiation to the tumor

The goal is to try to shrink the tumor and control the cancer's growth. But chemoradiation is unlikely to eliminate all cancer cells.

Palliative Treatments

If all visible tumor cannot be removed with surgery, the cancer will eventually continue to grow. But additional treatments can still help control symptoms and prolong life, including:

• Chemotherapy
• Radiation therapy
• Pain management
• Stent placement or bypass surgery for jaundice or digestive obstruction
• Nutritional support

The aim is to maintain quality of life for as long as possible.

Clinical Trials

Joining a clinical trial may provide access to promising new treatments not yet widely available. Experimental therapies for stage 3 pancreatic cancer may include:

• Newer chemotherapy drugs and regimens
• Immunotherapy drugs to boost the immune system
• Targeted therapy drugs
• Higher dose radiation techniques

Patients interested in clinical trials should talk to their cancer care team about open trials they may qualify for.

Outlook for Stage 3 Pancreatic Cancer

Stage 3 pancreatic cancer has often already spread outside the pancreas into neighboring structures. But it has not yet metastasized distantly. This means curative treatment may still be possible in some cases. However, long-term prognosis remains poor.

For patients able to have surgery, 5-year survival rates by stage are:

• Stage 3A: 10-15%
• Stage 3B: 5-10%

5-year survival is less than 5% for unresectable locally advanced stage 3 disease treated with chemoradiation. Still, cancer-directed therapies and palliative care can sometimes prolong survival somewhat beyond these estimates.

Participating in clinical trials also provides the chance to possibly benefit from new investigational treatments. Increased awareness of pancreatic cancer symptoms combined with improved early detection methods also offer hope for detecting more cases at treatable stages.

While stage 3 pancreatic cancer has a poor prognosis overall, treatment can improve quality of life and survival. Patients should discuss individualized options with their cancer care team.

With continued advances in research, better treatments are on the horizon that may eventually lead to improved outcomes for stage 3 pancreatic cancer patients.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.