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Pancreatic Cancer Treatment (PDQ®)

Stage Information for Pancreatic Cancer

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
StageTNMDescription
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.
0Tis, N0, M0Tis = Carcinoma in situ.b
N0 = No regional lymph node metastasis.
M0 = No distant metastasis.
Table 2. Definitions of TNM Stages IA and IBa
StageTNMDescriptionIllustration
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.
Stage I pancreatic cancer; drawing on the left shows that stage IA pancreatic cancer is smaller than 2 centimeters. The drawing on the right shows that stage IB pancreatic cancer is larger than 2 centimeters. An inset shows that a 2 centimeter tumor is about the size of a peanut. The duodenum is also shown.
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
StageTNMDescriptionIllustration
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.
Stage IIA pancreatic cancer; drawing shows cancer in the pancreas and duodenum. The bile duct and pancreatic duct are also shown.
N0 = No regional lymph node metastasis.
M0 = No distant metastasis.
Table 4. Definitions of TNM Stage IIBa
StageTNMDescriptionIllustration
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.
Stage IIB pancreatic cancer; drawing shows cancer in the pancreas and in nearby lymph nodes. Also shown are the bile duct, pancreatic duct, and duodenum.
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
StageTNMDescriptionIllustration
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).
Stage III pancreatic cancer; drawing shows cancer in the pancreas, common hepatic artery, and portal vein. Also shown are the celiac axis (trunk), bile duct, pancreatic duct, duodenum, and superior mesenteric artery.
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
StageTNMDescriptionIllustration
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.
IVAny T, Any N, M1TX = Primary tumor cannot be assessed.
Stage IV pancreatic cancer; drawing shows cancer has spread beyond the pancreas. Inset shows cancer spreading through the blood and lymph nodes to the lung, liver, peritoneal cavity, and other parts of the body.
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.

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.
  • Updated: July 31, 2014