TNM_Pancreas v.1
The American Joint Committee on Cancer (AJCC) TNM staging system reports on the severity of pancreatic cancer based on tumor, lymph node and metastasis characteristics.
The American Joint Committee on Cancer (AJCC) TNM staging system reports on the severity of pancreatic cancer based on tumor, lymph node and metastasis characteristics. The characteristics of the size of the tumour, the extent of spread to local lymph nodes and body organs. These aspects are captured in 3 ways that make up the mnemonic TNM: T: Tumour size; N: Number of regional lymph nodes affected and M: whether the cancer has spread/metastasised beyond the primary organ and regional nodes. Each major category is further subdivided to help classify the picture further. These subdivisions are given suffixes or numbered as shown below.
The acronyms, T, N and M are subdivided into subsections and lettered as shown below: T TX: Primary tumor cannot be assessed T0: No evidence of primary tumor Tis: Carcinoma in situ T1: Tumor limited to pancreas, ≤2 cm in greatest dimension T2: Tumor limited to pancreas, >2 cm in greatest dimension T3: Tumor extends beyond pancreas but without involving celiac axis or Superior Mesenteric Artery (SMA) T4: Tumor involves celiac axis or SMA (unresectable primary) N: NX: Regional lymph nodes cannot be assessed N0: No regional lymph node metastasis N1: Regional lymph node metastasis M: M0: No distant metastasis M1: Distant metastasis Then the staging combines the 3 subdivisions as described above to produce classifications shown: Stage 0: TisN0M0 The tumor is confined to the top layers of pancreatic duct cells and has not invaded deeper tissues. It has not spread outside of the pancreas. These tumors are sometimes referred to as pancreatic carcinoma in situ or pancreatic intraepithelial neoplasia III (PanIn III). Stage IA: T1N0M0 The tumor is confined to the pancreas and is 2 cm across or smaller (T1). The cancer has not spread to nearby lymph nodes (N0) or distant sites (M0). Stage IB: T2N0M0 The tumor is confined to the pancreas and is larger than 2 cm across (T2). The cancer has not spread to nearby lymph nodes (N0) or distant sites (M0). Stage IIA: T3N0M0 The tumor is growing outside the pancreas but not into major blood vessels or nerves (T3). The cancer has not spread to nearby lymph nodes (N0) or distant sites (M0). Stage IIB: T1-T3N1M0 The tumor is either confined to the pancreas or growing outside the pancreas but not into major blood vessels or nerves (T1-T3). The cancer has spread to nearby lymph nodes (N1) but not to distant sites (M0). Stage III: T4AnyNM0 The tumor is growing outside the pancreas and into nearby major blood vessels or nerves (T4). The cancer may or may not have spread to nearby lymph nodes (Any N). It has not spread to distant sites (M0). Stage IV: AnyTAnyNM1 The cancer has spread to distant sites (M1). Stage 5-year survival rate IA 14% IB 12% IIA 7% IIB 5% III 3% IV 1%
TNM staging requires supporting evidence from high quality advanced imaging and extensive lymph node evaluation. Other aspects such as tumour grading, whether resectable of not and/or extent of surgical resection should also be taken into account to get a more accurate rounded picture.
Ref. 1: Exocrine and endocrine pancreas. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 241-9. Ref. 2: NIH National Cancer Institute Pancreatic Cancer Treatment (PDQ®)–Health Professional Version. Updated: February 5, 2016. Accessed: 5/18/2016Tempero MA, et al. Pancreatic Adenocarcinoma. J Natl Compr Canc
OBSERVATION.tnm_pancreas_staging.v1, EVALUATION.tnm_pancreas_assessment.v1
