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Pancreatic Cancer Treatment (PDQ®): Treatment - Health Professional Information [NCI] - 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
a Reprinted 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.
b This also includes the pancreatic intraepithelial neoplasia (PanIN)-3 classification.
0Tis, N0, M0Tis = Carcinomain situ.b
N0 = No regional lymph node metastasis.
M0 = No distant metastasis.

Table 2. Definitions of TNM Stages IA and IBa

StageTNMDescriptionIllustration
a Reprinted 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.
IA
T1, N0, M0
T1 = Tumor limited to the pancreas, ≤2 cm in greatest dimension.

cdr0000687928.jpg
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
a Reprinted 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.
IIA
T3, N0, M0
T3 = Tumor extends beyond the pancreas but without involvement of the celiac axis or the superior mesenteric artery.

cdr0000687932.jpg
N0 = No regional lymph node metastasis.
M0 = No distant metastasis.

Table 4. Definitions of TNM Stage IIBa

StageTNMDescriptionIllustration
a Reprinted 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.
IIB
T1, N1, M0
T1 = Tumor limited to the pancreas, ≤2 cm in greatest dimension.

cdr0000742418.jpg
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.
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