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.

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)

Pancreatic pathology

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