Last Modified: 02/10/2012
Stage Information for Pancreatic Cancer
The staging system for pancreatic exocrine cancer continues to evolve. The importance of staging beyond that of resectable and unresectable is uncertain since state-of-the-art treatment has demonstrated little impact on survival. To communicate a uniform definition of disease, however, knowledge of the extent of the disease is necessary. Cancers of the pancreas are commonly identified by the site of involvement within the pancreas. Surgical approaches differ for masses in the head, body, tail, or uncinate process of the pancreas.
Definitions of TNMThe American Joint Committee on Cancer has designated staging by TNM classification to define pancreatic cancer.[1]
Table 1. 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 2. 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 3. 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 4. 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 |
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.