How is pancreatic cancer staged?

Updated: Oct 02, 2020
  • Author: Tomislav Dragovich, MD, PhD; Chief Editor: N Joseph Espat, MD, MS, FACS  more...
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Once an imaging modality has helped to establish a probable diagnosis of pancreatic cancer, the next issue is whether the lesion is amenable to surgical resection. Pancreatic masses are characterized as resectable, unresectable, or borderline resectable. The last designation, borderline resectable, is usually based on the experience and technical skill of the surgeon involved in treatment, as well as on the overall health of the patient and on his or her wishes.

Only 20% of all patients presenting with pancreatic cancer are ultimately found to have easily resectable tumors with no evidence of local advancement. Noncurative resections for pancreatic carcinoma provide no survival benefit. Thus, to avoid operating on patients who cannot benefit from the operation, accurate preoperative staging is very important.

Cancer of the exocrine pancreas is classified by the tumor, node, metastasis (TNM) staging system. The staging for pancreatic cancer was modified by the American Joint Committee on Cancer (AJCC) in 2002.

Go to Radiologic Diagnosis and Staging of Pancreatic Carcinoma for complete information on this topic.

AJCC staging of pancreatic tumors is as follows [58] :

Tumor (T)

See the list below:

  • TX - Primary tumor cannot be assessed

  • T0 - No evidence of primary tumor

  • Tis - Carcinoma in situ

  • T1 - Tumor limited to the pancreas, 2 cm or smaller in greatest dimension

  • T2 - Tumor limited to the pancreas, larger than 2 cm in greatest dimension

  • T3 - Tumor extension beyond the pancreas (eg, duodenum, bile duct, portal or superior mesenteric vein) but not involving the celiac axis or superior mesenteric artery

  • T4 - Tumor involves the celiac axis or superior mesenteric arteries

Regional lymph nodes (N)

See the list below:

  • NX - Regional lymph nodes cannot be assessed

  • N0 - No regional lymph node metastasis

  • N1 - Regional lymph node metastasis

Distant metastasis (M)

See the list below:

  • MX - Distant metastasis cannot be assessed

  • M0 - No distant metastasis

  • M1 - Distant metastasis

Stage grouping for pancreatic cancer is as follows:

  • Stage 0 - Tis, N0, M0

  • Stage IA - T1, N0, M0

  • Stage IB - T2, N0, M0

  • Stage IIA - T3, N0, M0

  • Stage IIB - T1-3, N1, M0

  • Stage III - T4, Any N, M0

  • Stage IV - Any T, Any N, M1

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