Pancreatic cancer (staging)

Last revised by Rohit Sharma on 20 Mar 2024

Staging of pancreatic cancer (i.e. ductal adenocarcinoma) is traditionally performed according to the American Joint Committee on Cancer (AJCC) / Union for International Cancer Control (IUCC) TNM system

In the 2017 new edition (8th edition) AJCC published various major changes including exocrine and endocrine tumors of the pancreas are now staged using different staging systems. The following is for the staging of pancreatic adenocarcinoma. In the 8th edition of AJCC, T staging has become more size-based rather than descriptive-based, resectability has been omitted from T4 category, and the number and not just the presence of the regional lymph nodes defines the N stage of disease 1,3

As the majority of tumors are non-resectable, staging is primarily achieved with imaging, although laparoscopy is often required to confirm resectability. CT is the preferred modality for assessing resectability 2.

Primary tumor staging (T)
  • Tx, T0, Tis: see TNM system

  • T1: tumor ≤2 cm in greatest dimension

    • T1a: tumor ≤0.5 cm in greatest dimension

    • T1b: tumor >0.5 cm and <1 cm in greatest dimension

    • T1c: tumor 1-2 cm in greatest dimension

  • T2: tumor >2 cm in greatest dimension but less than ≤4 cm

  • T3: tumor >4 cm in greatest dimension

  • T4: involvement of celiac axis, superior mesenteric artery and/or common hepatic artery

Regional lymph nodes (N)
  • Nx: nodes cannot be assessed

  • N0: no evidence of nodal involvement

  • N1: 1-3 regional node metastases present

  • N2: 4 or more regional node 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: N2 M0 with any T, or T4 with any N M0

  • stage IV: M1 with any T and N

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