Stage Information for Pancreatic Neuroendocrine Tumors (Islet Cell Tumors)
Definitions of TNM
Current Clinical Trials
Note: The American Joint Committee on Cancer has published the 7th edition of the AJCC Cancer Staging Manual, which for the first time incorporates pancreatic neuroendocrine tumors in the same staging system as pancreatic exocrine tumors.[1] The classification of these tumors as benign versus malignant is not always consistent, so the AJCC recommends that all pancreatic neuroendocrine tumors be staged using this system and reported to cancer registries. It also recommends that the protocol developed by the College of American Pathologists for endocrine pancreatic tumors be used to examine and stage specimens.[2]
Definitions of TNMThe American Joint Committee on Cancer has designated staging by TNM classification to define pancreatic neuroendocrine tumors (islet cell tumors).[1]
Table 2. Primary Tumor (T)a| TX | Primary tumor cannot be assessed. |
| T0 | No evidence of primary tumor. |
| Tis | Carcinoma in situ.b |
| T1 | Tumor limited to the pancreas, ≤2 cm in greatest dimension. |
| T2 | Tumor limited to the pancreas, >2 cm in greatest dimension. |
| T3 | Tumor extends beyond the pancreas but without involvement of the celiac axis or the superior mesenteric artery. |
| T4 | Tumor involves the celiac axis or the superior mesenteric artery (unresectable primary tumor). |
| aReprinted with permission from AJCC: Exocrine and endocrine pancreas. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 241-9. | |
| bThis also includes the "PanInIII" classification. |
Table 3. Regional Lymph Nodes (N)a
| aReprinted with permission from AJCC: Exocrine and endocrine pancreas. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 241-9. | |
| NX | Regional lymph nodes cannot be assessed. |
| N0 | No regional lymph node metastasis. |
| N1 | Regional lymph node metastasis. |
Table 4. Distant Metastasis (M)a
| aReprinted with permission from AJCC: Exocrine and endocrine pancreas. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 241-9. | |
| M0 | No distant metastasis. |
| M1 | Distant metastasis. |
Table 5. Anatomic Stage/Prognostic Groupsa
| Stage | T | N | M |
| aReprinted with permission from AJCC: Exocrine and endocrine pancreas. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 241-9. | |||
| 0 | Tis | N0 | M0 |
| IA | T1 | N0 | M0 |
| IB | T2 | N0 | M0 |
| IIA | T3 | N0 | M0 |
| IIB | T1 | N1 | M0 |
| T2 | N1 | M0 | |
| T3 | N1 | M0 | |
| III | T4 | Any N | M0 |
| IV | Any T | Any N | M1 |
Histologic Grade (G)a
A two-, three-, or four-grade system may be used. If a grading system is not specified, generally the following system is used:
Table 6. Histologic Grading Systema| GX | Grade cannot be assessed. |
| G1 | Well differentiated. |
| G2 | Moderately differentiated. |
| G3 | Poorly differentiated. |
| G4 | Undifferentiated. |
| G = grade | |
| aReprinted with permission from AJCC: Exocrine and endocrine pancreas. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 241-9. |
Current Clinical Trials
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with islet cell carcinoma. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.
References
- Exocrine and endocrine pancreas. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 241-9.
- Washington K, Tang LH, Berlin J, et al.: Protocol for the examination of specimens from patients with carcinoma of the endocrine pancreas. Northfield, Il: College of American Pathologists, 2011. Available online. Last accessed February 7, 2012.
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