Pancreas
Miscellaneous
TNM staging of exocrine tumors of the pancreas

Author: Raul S. Gonzalez, M.D.
Editor-in-Chief Review: Debra Zynger, M.D.

Revised: 17 September 2018, last major update July 2018

Copyright: (c) 2003-2018, PathologyOutlines.com, Inc.

PubMed Search: TNM staging of exocrine tumors of the pancreas

Cite this page: Gonzalez, R.S. TNM staging of exocrine tumors of the pancreas. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/pancreastnm.html. Accessed November 21st, 2018.

Pathologic TNM staging of exocrine tumors of the pancreas, AJCC 8th edition
Definition / general
  • All exocrine tumors of the pancreas (including any lesion designated as carcinoma, as well as solid papillary neoplasm and pancreaticoblastoma) are covered by this staging system
  • Not covered by this staging system are well differentiated neuroendocrine tumors at this location (use the pancreas neuroendocrine staging system instead)
  • The 8th edition staging has been shown to be more prognostically relevant than the 7th edition staging for pancreatic ductal adenocarcinoma (Pancreas 2018;47:742)
Essential features
  • AJCC 7th edition staging was sunset on December 31, 2017; as of January 1, 2018, use of the AJCC, 8th Edition, 2018 is mandatory
ICD-10 coding
  • C25.9: malignant neoplasm of pancreas, unspecified
Primary tumor (pT)
  • TX: primary tumor cannot be assessed
  • Tis: carcinoma in situ (this includes high grade pancreatic intraepithelial neoplasia, intraductal papillary mucinous neoplasm with high grade dysplasia, intraductal tubulopapillary neoplasm with high grade dysplasia and mucinous cystic neoplasm with high grade dysplasia)
  • T1: tumor ≤ 2 cm in greatest dimension
    • T1a: tumor ≤ 0.5 cm in greatest dimension
    • T1b: tumor > 0.5 and < 1 cm in greatest dimension
    • T1c: tumor 1 - 2 cm in greatest dimension
  • T2: tumor > 2 cm and ≤ 4 cm in greatest dimension
  • T3: tumor > 4 cm in greatest dimension
  • T4: tumor involves celiac axis, superior mesenteric artery or common hepatic artery, regardless of size
Regional lymph nodes (pN)
  • NX: regional lymph nodes cannot be assessed
  • N0: no regional lymph node involvement
  • N1: metastasis in one to three regional lymph nodes
  • N2: metastasis in four or more regional lymph nodes

Notes:
  • Regional lymph nodes depend on tumor site
    • For tumors of the head or neck of the pancreas, regional nodes include common bile duct, common hepatic artery, portal vein, pyloric, posterior and anterior pancreatoduodenal arcades, superior mesenteric vein and right lateral wall of superior mesenteric vein nodes
    • For tumors of the body or tail of the pancreas, regional nodes include common hepatic artery, celiac axis, splenic artery and splenic hilum nodes
  • Minimum of 12 lymph nodes must be recovered for lymph node staging to be considered accurate in curative resections
Distant metastasis (pM)
  • M0: no distant metastasis
  • M1: distant metastasis
Prefixes
  • y: preoperative radiotherapy or chemotherapy
  • r: recurrent tumor stage
Stage grouping
  • Stage IA:T1 N0 M0
  • Stage IB:T2 N0 M0
  • Stage IIA:T3 N0 M0
  • Stage IIB:T1 - 3 N1 M0
  • Stage III:T1 - 3 N2 M0
  • T4 Any N M0
  • Stage IV:any T any N M1

Registry data collection variables
Histologic grade
  • GX: grade cannot be assessed
  • G1: well differentiated
  • G2: moderately differentiated
  • G3: poorly differentiated
Board review question #1
Under 8th edition AJCC staging criteria, which of the following would categorize a pancreatic ductal adenocarcinoma as pT3?

  1. Involvement of the duodenum
  2. Involvement of the peripancreatic fat
  3. Involvement of the superior mesenteric artery
  4. Size > 4 cm
Board review answer #1
D. Size > 4 cm