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Pancreatic Neuroendocrine Tumors (Islet Cell Tumors) Treatment (PDQ®)

  • Last Modified: 03/07/2014

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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 TNM

The 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
TXPrimary tumor cannot be assessed.
T0No evidence of primary tumor.
TisCarcinoma in situ.b
T1Tumor limited to the pancreas, ≤2 cm in greatest dimension.
T2Tumor limited to the pancreas, >2 cm in greatest dimension.
T3Tumor extends beyond the pancreas but without involvement of the celiac axis or the superior mesenteric artery.
T4Tumor 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.
NXRegional lymph nodes cannot be assessed.
N0No regional lymph node metastasis.
N1Regional 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.
M0No distant metastasis.
M1Distant 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.
0TisN0M0
IAT1N0M0
IBT2N0M0
IIAT3N0M0
IIBT1N1M0
T2N1M0
T3N1M0
IIIT4Any NM0
IVAny TAny NM1

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
GXGrade cannot be assessed.
G1Well differentiated.
G2Moderately differentiated.
G3Poorly differentiated.
G4Undifferentiated.

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
  1. 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. 

  2. 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 October 21, 2013.