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Pancreatic ductal adenocarcinoma (staging)

Staging of pancreatic ductal adenocarcinoma is traditionally done according to American Joint Committee on Cancer (AJCC) / Union for International Cancer Control (IUCC) TNM system.  In 2017 new edition (8th edition) AJCC published with some major changes; now exocrine and endocrine tumors of the pancreas are staged using different staging systems. The following is for staging of adenocarcinoma of the pancreas. 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 not just the presence of the regional lymph nodes defining the N stage of disease 1,3

As a majority of tumors are non-resectable, staging is mostly 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
  • T2: tumor >2 cm in greatest dimension but less than ≤ 4 cm
  • T3: tumor >4 cm in greatest dimension
  • T4: involvement of SMA or celiac axis
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:  any T N2 M0, or T4 any N
  • stage IV:  M1 (any T any N)
Pancreatic pathology

Article information

rID: 6737
Section: Staging
Tag: refs
Synonyms or Alternate Spellings:
  • Pancreatic cancer staging
  • Staging of pancreatic adenocarcinoma
  • Staging of pancreatic adenocarcinomas
  • Pancreatic tumours staging system

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Cases and figures

  • Case 1: T4 tumor
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  • Case 2: T3N1 tumor
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  • Case 3: T3N0M1
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  • Case 4: T3N0M1
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  • Case 5: T3N1M1
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  • Case 6: T4N1 tumor
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