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 whether a tumor can be removed may vary with surgical judgment and experience, and that referral to a high-volume center should be considered.
Neoadjuvant therapy is listed for resectable and borderline resectable disease. Chemotherapy after surgery improves overall survival, while the role of chemoradiation remains unsettled.
Choose how you want to understand this
The full explanation.
Four groups, decided by blood vessels
Pancreatic cancer is sorted before treatment. NCI sets out the categories used by surgeons.
Roughly: resectable means the surgeon expects to take the whole tumor out with clear margins and no vascular reconstruction. Borderline resectable means there is contact with vessels, but of a kind and extent that may still allow removal, sometimes with a vein rebuilt. Locally advanced means the vessel involvement is extensive enough that removal is not expected to work. Metastatic means it has reached other organs.
Those lines are finer than "clear" or "not clear". What counts is which vessel, how far the tumor wraps around it, whether the vein could be reconstructed, how far any common hepatic artery involvement extends, and how the tumor is behaving over time — alongside your own fitness for a long operation. Some tumors touching a vessel are still removable; some with no vessel contact are not, because of other findings. A multidisciplinary team makes this call, and NCI notes it can vary with surgical judgment and experience, which is why a high-volume centre is worth asking about.
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 ultrasound. A probe is passed into the gut. It takes close-range images. It can also take a tissue sample.
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, get a second surgical opinion.
Treatment before surgery is on the list
For resectable and borderline resectable disease, NCI lists neoadjuvant therapy as an option alongside surgery.
Chemotherapy after surgery is listed too. NCI says it improves overall survival. It also says the role of chemoradiation remains unsettled.
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 a tissue sample by endoscopic ultrasound before treatment?
- 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?
- Should germline testing be sent now, before the first chemotherapy?
Two complications to plan for, not react to
NCI names both directly.
The first is malabsorption. Poor enzyme output causes malnutrition. NCI says enzyme replacement can help.
The second is pain. NCI lists nerve blocks at the celiac axis as an approach. 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
Words to know
Tap any term to see what it means.
Common questions
What does borderline resectable mean?
It means there is contact between the tumor and nearby vessels, of a degree that makes complete removal uncertain but not impossible. Which vessel, how much of its circumference is involved and whether a vein can be rebuilt all matter, and the judgement is made by a multidisciplinary team rather than by a single rule.
Why ask how many of these operations my surgeon does?
NCI says whether a tumor can be removed may vary with surgical judgment and experience. Ask the surgeon and the hospital for their yearly counts, and get a second surgical opinion if the answer is small.
What is endoscopic ultrasound for?
A probe is passed into the gut and takes close-range images. It can also take a tissue sample, so ask whether you need one before treatment starts.
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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How this page was created
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. We do not employ clinicians and do not intend to — our work 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 checked line by line against the sources listed on it. That confirms the sources support what the page says. 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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