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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 TNM

The American Joint Committee on Cancer has designated staging by TNM classification to define pancreatic cancer.[1]

Table 1. Primary Tumor (T)a

^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 "PanInIII" classification.
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).

Table 2. Regional Lymph Nodes (N)a

^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.
NX	Regional lymph nodes cannot be assessed.
N0	No regional lymph node metastasis.
N1	Regional lymph node metastasis.

Table 3. Distant Metastasis (M)a

^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.
M0	No distant metastasis.
M1	Distant metastasis.

Table 4. Anatomic Stage/Prognostic Groupsa

^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.
Stage	T	N	M
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.

WebMD Public Information from the National Cancer Institute

Last Updated: May 16, 2012

This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information.