Radiation Oncology/Pancreas/Staging

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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[edit]

AJCC 6th Edition (2002)

  • Same as AJCC 7th Edition for TNM
  • Excluded neuroendocrine tumors