Radiation Oncology/Pancreas/Staging

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 AJCC 6th Edition (2002) Same as AJCC 7th Edition for TNM Excluded neuroendocrine tumors