The short answer
NCI sorts pancreatic cancer into resectable, borderline resectable, locally advanced and metastatic before treatment. A T4 tumor is one involving the celiac axis, the superior mesenteric artery or the common hepatic artery, whatever its size.
Four categories drive the plan: resectable, borderline resectable, locally advanced and metastatic. Ask which one you are in, and who decided.
Three arteries settle that call. NCI marks a tumor as T4 when it involves the celiac axis, the superior mesenteric artery or the common hepatic artery. Size does not change it.
NCI says resectability may vary with surgical judgment and experience, and that referral to a high-volume center should be considered.
NCI recommends neoadjuvant therapy in consensus guidelines for borderline resectable disease and says it is being tested in resectable and borderline resectable disease. Chemotherapy after surgery improves overall survival, while the role of chemoradiation remains controversial.
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The whole article, with every detail and caution.
This page is for people with pancreatic cancer and those helping them. It explains how treatment is planned and lists questions to ask your care team before treatment starts.
Four groups, decided by blood vessels
Pancreatic cancer is sorted before treatment. NCI sets out the categories used by surgeons. Roughly:
- Resectable: the tumor has not grown into major blood vessels, so surgery can remove it completely.
- Borderline resectable: the tumor has grown into a major blood vessel or nearby tissue.
- Locally advanced: the tumor is usually considered unresectable, meaning surgery cannot remove it completely.
- Metastatic: the cancer has spread beyond the pancreas to other organs.
NCI says treatment is often guided by resectability, but this may vary with surgical judgment and experience. Ask your team how they made the call for your tumor.
Ask which of the four you are in, and who decided.
The vessels the scan is looking at
Three named vessels drive that decision. In NCI's staging tables, a T4 tumor is one that involves the celiac axis. Or the superior mesenteric artery. Or the common hepatic artery. Size does not change it.
So the scan report is not just a picture. Ask whether your tumor touches any of those three.
NCI also lists endoscopic ultrasonography among the imaging tests.
Where you have the operation matters
NCI says this in a single sentence, and it is easy to skim past.
Whether a tumor can be removed may vary with surgical judgment and experience. Referral to a high-volume center should be considered.
So ask how many of these operations your surgeon does each year. Ask the same about the hospital. If the answer is small, ask about a second surgical opinion.
Treatment before surgery is being studied
Neoadjuvant therapy is chemotherapy, with or without chemoradiation, given before surgery. NCI says consensus guidelines recommend it for borderline resectable disease. It is being tested in resectable and borderline resectable disease in ongoing trials.
NCI says chemotherapy after surgery improves overall survival. It says the role of chemoradiation (chemotherapy and radiation given together) remains controversial.
Ask why your team has chosen the order they have chosen.
Questions to ask before treatment starts
- Am I resectable, borderline resectable, locally advanced or metastatic?
- Does my tumor touch any of those three arteries?
- Do I need endoscopic ultrasound, and what will it add?
- How many of these operations does this surgeon and this hospital do each year?
- Should I have chemotherapy before surgery rather than after?
- Is chemoradiation part of the plan, and what is the evidence for it here?
- Which tests on my tumor will guide treatment?
Two complications to plan for, not react to
NCI names both directly.
The first is malabsorption, when the body cannot take in nutrients from food. NCI says poor enzyme output (exocrine insufficiency) often contributes to malnutrition, and that pancreatic enzyme replacement can help.
The second is pain. NCI says celiac axis nerve blocks can give effective, long-lasting pain control. Ask about both before they become urgent.
Related pages
Read next: Cancer Staging, Cancer Treatment Overview, Palliative Care, and Questions to Ask Your Doctor.
Where this comes from
Common questions
What does borderline resectable mean?
NCI describes it as a tumor that has grown into a major blood vessel or nearby tissue. Ask your team how they judged your tumor and what it means for surgery.
Why ask how many of these operations my surgeon does?
NCI says resectability may vary with surgical judgment and experience, and that referral to a high-volume center should be considered. Ask about the surgeon's and hospital's yearly counts, and ask whether a second surgical opinion makes sense.
What is endoscopic ultrasound for?
NCI lists it among the imaging tests for pancreatic cancer. Ask your team what it would be used for in your case.
Questions to ask your doctor
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Sources last checked: 2026-07-30 what this meansLast updated: 2026-08-19Next planned review: 2027-07-30
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Cancer Explained does not originate medical claims. Every page restates guidance already published by the National Cancer Institute, the CDC, the USPSTF and the FDA, in plain language, with the source cited so you can check the original yourself. AI does the translating and organizing; automated checks test claims, citations, clarity and safety before anything publishes, and this is translation and navigation, not clinical judgment. Nothing here is personal medical advice, and no page can account for your particular situation.
Editorial status: Source checked — This page was written with AI assistance and then compared with the sources listed on it, looking for statements those sources do not back up. That check is not a sentence-by-sentence record and can miss errors. It is not a medical review, and it does not confirm the page is complete or right for your situation.
Human medical review: not completed. Pages here are not signed off by a clinician before they publish. That is not an oversight we are quietly working around: we restate published guidance and cite it, so the authority belongs to the source rather than to us, and every page names where its claims come from — you can verify us instead of trusting us. Where a volunteer clinician has reviewed a page, their name and credentials appear on it; where no name appears, no clinician has checked it. We are glad to have reviewers and are recruiting them, and we do not hold pages back waiting for one. Use this site to understand your situation and to ask better questions of the people treating you.
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