Radiation Oncology/Pancreas/Staging

Pancreatic Cancer Staging

AJCC 7th Edition (2010)
Primary Tumor:

• T1 - confined to pancreas, 2 cm or less
• T2 - confined to pancreas, > 2 cm
• T3 - extends beyond pancreas
• T4 - invades SMA or celiac axis (unresectable primary tumor)

Regional Lymph Nodes:

• N0 - no
• N1 - yes
• NX - regional lymph nodes cannot be assessed

Note 1

Histopathological assessment of minimum 12 regional lymph nodes is recommended. However, in cases where surgery results in examination of less than the ideal minimum number, N staging is performed if at least one node has been examined.

Note 2

Direct extension of primary tumor into regional node is classified as node positive.

Distant Metastases:

• M0 - none
• M1 - yes

Stage Grouping:

• IA - T1 N0
• IB - T2 N0
• IIA - T3 N0
• IIB - T1-3 N1
• III - T4 Any N
• IV - M1

Changes from the 6th Edition:

• Now staging includes neuroendocrine tumors of the pancreas (including carcinoid)
• No changes in TNM or Overall Stage

Instead of using the AJCC staging system, many simply divide pancreatic cancer into resectable, unresectable, and metastatic.

Older staging systems

AJCC 6th Edition (2002)

• Same as AJCC 7th Edition for TNM
• Excluded neuroendocrine tumors