How is insulinoma staged?

Updated: May 31, 2020
  • Author: Zonera Ashraf Ali, MBBS; Chief Editor: Neetu Radhakrishnan, MD  more...
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Answer

A specific tumor-node-metastasis (TNM) staging system has not been validated yet for insulinomas. The American Joint Committee on Cancer (AJCC) staging for well-differentiated neuroendocrine tumors arising in the pancreas is used. [39, 40]

Primary tumor (T):

  • TX - Tumor cannot be assessed
  • T1 - Tumor limited to the pancreas and < 2 cm in size
  • T2 - Tumor limited to the pancreas and 2−4 cm in size
  • T3 - Tumor limited to the pancreas and > 4 cm in size; or tumor invading the duodenum or common bile duct
  • T4 - Tumor invading adjacent organs (stomach, spleen, colon, adrenal gland) or the wall of large vessels (celiac axis or the superior mesenteric artery)

Regional lymph Nodes (N):

  • NX - Regional lymph nodes cannot be assessed
  • N0 - No regional lymph node involvement
  • N1 - Regional lymph node involvement

Distant metastasis (M):

  • M0 - No distant metastasis
  • M1 - Distant metastases
  • M1a - Metastasis confined to liver
  • M1b - Metastases in at least one extrahepatic site (eg, lung, ovary, nonregional lymph node, peritoneum, bone)
  • M1c - Both hepatic and extrahepatic metastases

AJCC prognostic stage groups are shown in the table below.

Table. AJCC Prognostic Stage Groups (Open Table in a new window)

Stage

T

N

M

I

T1

N0

M0

II

T2

N0

M0

T3

N0

M0

III

T4

N0

M0

Any T

N1

M0

IV

Any T

Any N

M1


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