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.  As of 2010 (7th edition AJCC), both exocrine and endocrine tumours of the pancreas are now staged using the same staging system 1.

As a majority of tumours 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 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)
Practical points for staging
  • stage I: primary disease is confined to the pancreas with no lymphadenopathy or distant metastasis
  • stage IIa: primary disease extending beyond pancreas without vascular involvement, lymphadenopathy, or metastasis
  • stage IIb: presence of regional lymphadenopathy 
  • stage III: vascular involvement 
  • stage IV: distant metastasis 
Pancreatic pathology
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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

Cases and figures

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    Case 1: T4 tumour
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    Case 2: T3N1 tumour
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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 tumour
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