Staging of pancreatic adenocarcinoma

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 (8 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 8 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 .

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 .

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