Pancreatic ductal adenocarcinoma (staging)

Last revised by Dr Jeremy Jones on 20 Sep 2021

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 superior mesenteric artery 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: N2 M0 with any T, or T4 with any N M0
  • stage IV: M1 with any T and N

ADVERTISEMENT: Supporters see fewer/no ads

Cases and figures

  • Case 1: T4 tumor
    Drag here to reorder.
  • Case 2: T3N1 tumor
    Drag here to reorder.
  • Case 3: T3N0M1
    Drag here to reorder.
  • Case 4: T3N0M1
    Drag here to reorder.
  • Case 5: T3N1M1
    Drag here to reorder.
  • Case 6: T4N1 tumor
    Drag here to reorder.
  • Updating… Please wait.

     Unable to process the form. Check for errors and try again.

     Thank you for updating your details.