Pancreatic cancer staging
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aravind Reddy Kothagadi M.B.B.S[2]
Overview
The exocrine and endocrine tumors of the pancreas are staged with the help of a single pancreatic staging system. Staging of pancreatic cancer aids in determining the extent of the disease and helps in arriving at the diagnosis. Staging plays a major role in planning effective treatment and assessing the prognosis. Staging of pancreatic adenocarcinoma is done with the TNM staging system based on the results of imaging modalities such as CT, MRI, PET, TUS, endoscopic studies such as EUS and biopsy with ERCP. The American Joint Committee on Cancer (AJCC) TNM system is most often used to stage cancers of the pancreas based on the information from three variables, namley the T, N, and M. T - Indicates the size of the primary tumor and the extent of it's growth outside the pancreas and into nearby organs. N - Indicates the spread to the regional lymph nodes, where the cancers usually first spread. M - Indicates the metastasis (spread) of cancer to other parts (organs) of the body. The most common sites for the spread of pancreatic cancer are the liver, lungs, and the peritoneum.
Staging
- The exocrine and endocrine tumors of the pancreas are staged with the help of a single pancreatic staging system. Staging of pancreatic cancer aids in determining the extent of the disease and helps in arriving at the diagnosis. Staging plays a major role in planning effective treatment and assessing the prognosis. Staging of pancreatic adenocarcinoma is done with the TNM staging system based on the results of imaging modalities such as CT, MRI, PET, USG, endoscopic studies such as EUS and biopsy with ERCP.
- The American Joint Committee on Cancer (AJCC) TNM system is most often used to stage cancers of the pancreas based on the information from three variables, namley the T, N, and M:
- T - Indicates the size of the primary tumor and the extent of it's growth outside the pancreas and into nearby organs.
- N - Indicates the spread to the regional lymph nodes, where the cancers usually first spread.
- M - Indicates the metastasis (spread) of cancer to other parts (organs) of the body. The most common sites for the spread of pancreatic cancer are the liver, lungs, and the peritoneum.
- Stage grouping of pancreatic cancer:[1]
| Stage grouping of pancreatic cancer: | |||
|---|---|---|---|
| Primary tumor | |||
| Stage | T | N | M |
| 0 | Tis | N0 | M0 |
| IA | T1 | N0 | M0 |
| IB | T2 | N0 | M0 |
| IIA | T3 | N0 | M0 |
| IIB | T1 | N1 | M0 |
| T2 | N1 | M0 | |
| T3 | N1 | M0 | |
| III | T4 | Any N | M0 |
| IV | Any T | Any N | M1 |
| TNM Classification for Pancreatic Cancer: | |||
|---|---|---|---|
| Primary tumor | |||
| TX | Primary tumor cannot be assessed | ||
| T0 | No evidence of primary tumor | ||
| Tis | Carcinoma in situ | ||
| T1 | Tumor limited to the pancreas, ≤2 cm in greatest dimension | ||
| T2 | Tumor limited to the pancreas, >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 | |||
| NX | Regional lymph nodes cannot be assessed | ||
| N0 | No regional lymph node metastasis | ||
| N1 | Regional lymph node metastasis | ||
| Distant metastases | |||
| MX | Distant metastasis cannot be assessed | ||
| M0 | No distant metastasis | ||
| M1 | Distant metastasis | ||
**Key
Tis- Tumor in situ
- Staging and TNM (tumour, lymph node, metastasis) classification related to incidence, treatment, and prognosis: [2]
| Staging and TNM Classification related to Incidence, Treatment, and Prognosis | ||||
|---|---|---|---|---|
| Stage | TNM Classification | Clinical Classification | Incidence at diagnosis (%) | 5-year survival rate (%) |
| 0 | Tis, N0, M0 | Resectable | 7.5 | 15.2 |
| IA | T1, N0, M0 | — | — | — |
| IB | T2, N0, M0 | — | — | — |
| IIA | T3, N0, M0 | — | — | — |
| IIB | T1-3, N1, M0 | Locally advanced | 29.3 | 6.3 |
| III | T4, any N, M0 | — | — | — |
| IV | Any T, any N, M1 | Metastatic | 47.2 | 1.6 |
Refrences
- ↑ 1.0 1.1 Seufferlein T, Bachet JB, Van Cutsem E, Rougier P, ESMO Guidelines Working Group (2012). "Pancreatic adenocarcinoma: ESMO-ESDO Clinical Practice Guidelines for diagnosis, treatment and follow-up". Ann Oncol. 23 Suppl 7: vii33–40. doi:10.1093/annonc/mds224. PMID 22997452.
- ↑ 2.0 2.1 Bond-Smith G, Banga N, Hammond TM, Imber CJ (2012). "Pancreatic adenocarcinoma". BMJ. 344: e2476. doi:10.1136/bmj.e2476. PMID 22592847.