Stage Information for Pancreatic Cancer
AJCC Stage Groupings and TNM Definitions
The staging system for pancreatic exocrine cancer continues to evolve. The importance of staging beyond establishing whether a tumor is resectable is uncertain since state-of-the-art treatment has demonstrated little impact on survival. However, knowledge of the extent of the disease is necessary to communicate a uniform definition of disease.
AJCC Stage Groupings and TNM Definitions The American Joint Committee on Cancer (AJCC) has designated staging by TNM classification.[1]
Table 1. Definitions of TNM Stage 0a| Stage | TNM | Description |
| 0 | Tis, N0, M0 | Tis = Carcinoma in situ.b |
| N0 = No regional lymph node metastasis. |
| M0 = No distant metastasis. |
| aReprinted with permission from AJCC: Exocrine and endocrine pancreas. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 241-9. |
| bThis also includes the pancreatic intraepithelial neoplasia (PanIN)-3 classification. |
Table 2. Definitions of TNM Stages IA and IBa| Stage | TNM | Description | Illustration |
| aReprinted with permission from AJCC: Exocrine and endocrine pancreas. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 241-9. |
| IA | T1, N0, M0 | T1 = Tumor limited to the pancreas, ≤2 cm in greatest dimension. | |
| N0 = No regional lymph node metastasis. |
| M0 = No distant metastasis. |
| IB | T2, N0, M0 | T2 = Tumor limited to the pancreas, >2 cm in greatest dimension. |
| N0 = No regional lymph node metastasis. |
| M0 = No distant metastasis. |
Table 3. Definitions of TNM Stage IIAa| Stage | TNM | Description | Illustration |
| aReprinted with permission from AJCC: Exocrine and endocrine pancreas. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 241-9. |
| IIA | T3, N0, M0 | T3 = Tumor extends beyond the pancreas but without involvement of the celiac axis or the superior mesenteric artery. | |
| N0 = No regional lymph node metastasis. |
| M0 = No distant metastasis. |
Table 4. Definitions of TNM Stage IIBa| Stage | TNM | Description | Illustration |
| aReprinted with permission from AJCC: Exocrine and endocrine pancreas. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 241-9. |
| IIB | T1, N1, M0 | T1 = Tumor limited to the pancreas, ≤2 cm in greatest dimension. | |
| N1 = Regional lymph node metastasis. |
| M0 = No distant metastasis. |
| T2, N1, M0 | T2 = Tumor limited to the pancreas, >2 cm in greatest dimension. |
| N1 = Regional lymph node metastasis. |
| M0 = No distant metastasis. |
| T3, N1, M0 | T3 = Tumor extends beyond the pancreas but without involvement of the celiac axis or the superior mesenteric artery. |
| N1 = Regional lymph node metastasis. |
| M0 = No distant metastasis. |
Table 5. Definitions of TNM Stage IIIa| Stage | TNM | Description | Illustration |
| aReprinted with permission from AJCC: Exocrine and endocrine pancreas. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 241-9. |
| III | T4, Any N, M0 | T4 = Tumor involves the celiac axis or the superior mesenteric artery (unresectable primary tumor). | |
| NX = Regional lymph nodes cannot be assessed. |
| N0 = No regional lymph node metastasis. |
| N1 = Regional lymph node metastasis. |
| M0 = No distant metastasis. |
Table 6. Definitions of TNM Stage IVa| Stage | TNM | Description | Illustration |
| IV | Any T, Any N, M1 | TX = Primary tumor cannot be assessed. | |
| T0 = No evidence of primary tumor. |
| Tis = Carcinoma in situ.b |
| T1 = Tumor limited to the pancreas, ≤2 cm in greatest dimension. |
| T2 = Tumor limited to the pancreas, >2 cm in greatest dimension. |
| T3 = Tumor extends beyond the pancreas but without involvement of the celiac axis or the superior mesenteric artery. |
| T4 = Tumor involves the celiac axis or the superior mesenteric artery (unresectable primary tumor). |
| NX = Regional lymph nodes cannot be assessed. |
| N0 = No regional lymph node metastasis. |
| N1 = Regional lymph node metastasis. |
| M1 = Distant metastasis. |
| aReprinted with permission from AJCC: Exocrine and endocrine pancreas. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 241-9. |
| bThis also includes the pancreatic intraepithelial neoplasia (PanIN)-3 classification. |
References - Exocrine and endocrine pancreas. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 241-9.
Last Modified: 05/17/2013
