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Pancreatic Cancer Treatment (PDQ®)

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Stage Information for Pancreatic Cancer

AJCC Stage Groupings and TNM Definitions

The staging system for pancreatic exocrine cancer continues to evolve. The importance of staging beyond establishing whether a tumor is resectable is uncertain since state-of-the-art treatment has demonstrated little impact on survival. However, knowledge of the extent of the disease is necessary to communicate a uniform definition of disease.

AJCC Stage Groupings and TNM Definitions

The American Joint Committee on Cancer (AJCC) has designated staging by TNM classification.[1]

Table 1. Definitions of TNM Stage 0a
Stage TNM Description 
0Tis, N0, M0Tis = Carcinoma in situ.b
N0 = No regional lymph node metastasis.
M0 = No distant metastasis.

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 pancreatic intraepithelial neoplasia (PanIN)-3 classification.

Table 2. Definitions of TNM Stages IA and IBa
Stage TNM Description  Illustration 
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.
IAT1, N0, M0T1 = Tumor limited to the pancreas, ≤2 cm in greatest dimension.
N0 = No regional lymph node metastasis.
M0 = No distant metastasis.
IBT2, N0, M0T2 = Tumor limited to the pancreas, >2 cm in greatest dimension.
N0 = No regional lymph node metastasis.
M0 = No distant metastasis.

Table 3. Definitions of TNM Stage IIAa
Stage TNM Description Illustration 
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.
IIAT3, N0, M0T3 = Tumor extends beyond the pancreas but without involvement of the celiac axis or the superior mesenteric artery.
N0 = No regional lymph node metastasis.
M0 = No distant metastasis.

Table 4. Definitions of TNM Stage IIBa
Stage TNM Description Illustration 
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.
IIBT1, N1, M0T1 = Tumor limited to the pancreas, ≤2 cm in greatest dimension.
N1 = Regional lymph node metastasis.
M0 = No distant metastasis.
T2, N1, M0T2 = Tumor limited to the pancreas, >2 cm in greatest dimension.
N1 = Regional lymph node metastasis.
M0 = No distant metastasis.
T3, N1, M0T3 = Tumor extends beyond the pancreas but without involvement of the celiac axis or the superior mesenteric artery.
N1 = Regional lymph node metastasis.
M0 = No distant metastasis.

Table 5. Definitions of TNM Stage IIIa
Stage TNM Description Illustration 
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.
IIIT4, Any N, M0T4 = Tumor involves the celiac axis or the superior mesenteric artery (unresectable primary tumor).
NX = Regional lymph nodes cannot be assessed.
N0 = No regional lymph node metastasis.
N1 = Regional lymph node metastasis.
M0 = No distant metastasis.

Table 6. Definitions of TNM Stage IVa
Stage TNM Description Illustration 
IVAny T, Any N, M1TX = 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).
NX = Regional lymph nodes cannot be assessed.
N0 = No regional lymph node metastasis.
N1 = Regional lymph node metastasis.
M1 = Distant metastasis.

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 pancreatic intraepithelial neoplasia (PanIN)-3 classification.

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.