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