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]


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.


  • 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:[2] [1]
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


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


  1. 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. 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.