Grades of pancreatic cancer

The grade of a cancer means how normal or abnormal the cells look under a microscope. It can give your doctor some idea of how the cancer might behave and your outlook (prognosis).

Most pancreatic cancers are the exocrine type. This means that they start in cells that produce pancreatic digestive juices. More than 80 out of 100 exocrine pancreatic cancers (more than 80%) are adenocarcinomas. Nearly all of these are ductal adenocarcinomas. 

What are the grades for pancreatic cancer?

There are 3 grades for exocrine pancreatic cancer:

Grade 1

The cancer cells look very like normal cells. They tend to grow slowly and are less likely to spread. They are also called low grade.

Grade 2

The cancer cells look more abnormal and tend to grow slightly faster. They are called intermediate grade.

Grade 3

The cancer cells look very abnormal. They are more likely to grow or spread quickly. They are also called high grade.


Differentiation means how developed or mature a cell is. Doctors might describe your pancreatic cancer as poorly or well differentiated. 

Doctors generally describe:

  • grade 1 cancer cells as well differentiated
  • grade 2 cancer cells as moderately differentiated
  • grade 3 cancer cells as poorly differentiated

Grading for pancreatic neuroendocrine neoplasms (NENs)

The pancreatic NEN grading system is a little different. This system looks at how normal or abnormal the cells are and also at how many cells are in the process of dividing.

A specialist doctor (pathologist) looks at the cells under a microscope and counts those that have started to split into two new cells (mitoses). They use a test called a Ki-67 test to see how many cells are almost ready to start splitting.

  • AJCC Cancer Staging Manual (8th edition)
    American Joint Committee on Cancer 
    Springer, 2017

  • Cancer of the Pancreas: European Society Medical Oncology Clinical Practice Guidelines
    M Ducreux and others
    Annals of Oncology, 2015. Volume 26, Supplement 5, Pages v56 to v68

  • Principles and practice of oncology (11th edition)
    VT De Vita, S Hellman and SA Rosenberg
    Lippincott, Williams and Wilkins, 2019

  • Gastroenteropancreatic neuroendocrine neoplasms: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up
    M. Pavel and others
    Annals of Oncology, July 2020. Volume 31, Issue 7, Pages 844 to 860 

Last reviewed: 
31 Mar 2023
Next review due: 
31 Mar 2023

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