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Pancreatic ductal adenocarcinoma staging

Both endocrine and exocrine tumours of the pancreas are now staged by a single pancreatic staging system.

Staging of pancreatic ductal adenocarcinoma is with the TNM system, and as a majority of tumours are not-resectable, this is mostly achieved with imaging (typically CT scan) although laparoscopy is often required to confirm resectability 1-2.

Primary tumour staging (T)
  • Tx, T0, Tis : see TNM system
  • T1 - tumour < 2 cm in greatest dimension, limited to pancreas
  • T2 - tumour > 2 cm in greatest dimension, limited to pancreas
  • T3 - extension beyond pancreas, no involvement of SMA or coeliac axis
  • T4 - involvement of SMA or coeliac axis
Regional lymph nodes (N)
  • Nx - nodes cannot be assessed
  • N0 - no evidence of nodal involvement
  • N1 - regional nodal metastases present
Metastases (M)
  • Mx - presence of metastases cannot be assessed
  • M0 - no evidence of metastases
  • M1 - distant metastases present
Stage groupings
  • stage 0  - Tis N0 M0
  • stage Ia - T1 N0 M0
  • stage Ib - T2 N0 M0
  • stage IIa - T3 N0 M0
  • stage IIb - T1, T2 or T3  with N1 M0
  • stage III - T4 and M0 (any N)
  • stage IV - M1 (any T any N)

See also

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