Pancreatic cancer (staging)
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At the time the article was created Frank Gaillard had no recorded disclosures.
View Frank Gaillard's current disclosuresAt the time the article was last revised Rohit Sharma had no financial relationships to ineligible companies to disclose.
View Rohit Sharma's current disclosures- Staging of pancreatic adenocarcinoma
- Staging of pancreatic adenocarcinomas
- Pancreatic tumours staging system
- Pancreatic ductal adenocarcinoma (staging)
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
References
- 1. Stephen Edge, David R. Byrd, Carolyn C. Compton et al. AJCC Cancer Staging Handbook. (2011) ISBN: 9780387884424 - Google Books
- 2. Bipat S, Phoa S, van Delden O et al. Ultrasonography, Computed Tomography and Magnetic Resonance Imaging for Diagnosis and Determining Resectability of Pancreatic Adenocarcinoma: A Meta-Analysis. J Comput Assist Tomogr. 2005;29(4):438-45. doi:10.1097/01.rct.0000164513.23407.b3 - Pubmed
- 3. Chun Y, Pawlik T, Vauthey J. 8th Edition of the AJCC Cancer Staging Manual: Pancreas and Hepatobiliary Cancers. Ann Surg Oncol. 2018;25(4):845-7. doi:10.1245/s10434-017-6025-x - Pubmed
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