TNM Definitions
AJCC Stage Groupings

The staging system for pancreatic exocrine cancer continues to evolve. The importance of staging beyond that of resectable and unresectable is uncertain since state-of-the-art treatment has demonstrated little impact on survival. To communicate a uniform definition of disease, however, knowledge of the extent of the disease is necessary. Cancers of the pancreas are commonly identified by the site of involvement within the pancreas. Surgical approaches differ for masses in the head, body, tail, or uncinate process of the pancreas.

The American Joint Committee on Cancer (AJCC) has designated staging by TNM classification.[1]

Primary tumor (T)

• TX: Primary tumor cannot be assessed
• T0: No evidence of primary tumor
• Tis: Carcinoma in situ
• T1: Tumor is limited to the pancreas and is 2 cm or less in greatest dimension
• T2: Tumor is limited to the pancreas and is more than 2 cm in greatest dimension
• T3: Tumor extends beyond the pancreas but without involvement of the celiac axis or the superior mesenteric artery
• T4: Tumor involves the celiac axis or the superior mesenteric artery (unresectable primary tumor)

Regional lymph nodes (N)

• NX: Regional lymph nodes cannot be assessed
• N0: No regional lymph node metastasis
• N1: Regional lymph node metastasis

Distant metastasis (M)

• MX: Distant metastasis cannot be assessed
• M0: No distant metastasis
• M1: Distant metastasis

Stage 0

• Tis, N0, M0

Stage IA

• T1, N0, M0

Stage IB

• T2, N0, M0

Stage IIA

• T3, N0, M0

Stage IIB

• T1, N1, M0
• T2, N1, M0
• T3, N1, M0

Stage III

• T4, any N, M0

Stage IV

• Any T, any N, M1

References

1. Exocrine pancreas. In: American Joint Committee on Cancer.: AJCC Cancer Staging Manual. 6th ed. New York, NY: Springer, 2002, pp 157-164.