Radiology Tutor

by Jonathan Colledge
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Pancreatic cancer TNM staging (UICC/AJCC 7th edition)

T

N

M

TNM staging =

Overall staging =

Note where the tumour is: head (to the right of the confluence of the SMV and portal vein), body (from head to left margin of aorta), or tail (to the left of the aorta).

T1 tumours are ≤2 cm and limited to the pancreas
T2 tumours are >2 cm and also limited to the pancreas
T3 tumours are not limited to the pancreas, but do not ivolve the vessels (coeliac axis or SMA). Involvement of the common bile duct is extrapancreatic and therefore T3.
T4 tumours imvolve the coeliac axis or SMA

The regional lymph nodes of the head of the pancreas are defined in the AJCC Cancer Staging Manual(1) as:

Nodes associated with the common bile duct, common hepatic artery, portal vein, posterior and anterior pancreaticoduodenal arcades, the superior mesenteric vein and right lateral wall of the superior mesenteric artery.

The regional lymph nodes of the body and tail of the pancreas are defined in the AJCC Cancer Staging Manual(1) as:

Lymph nodes along the common hepatic artery, celiac axis, splenic artery, and splenic hilum.

Involved non-regional nodes are classed as metastases.

Roman numeral staging

Stage 0 is carcinoma in situ with no nodal or metastatic disease. Stage IV disease is any tumour or nodal disease with metastases.

Stages I and II are resectable and stages III and IV are not. However, portal vein and SMV invasion (T3) are not complete contra-indications to surgery and tumour abutment (<180° of the arterial wall) of the SMA or short segment involvement of the hepatic artery can still be resectable.(2)

References

  1. AJCC Cancer Staging Manual. (Springer, 2011).
  2. Varadhachary, G. R. et al. Borderline resectable pancreatic cancer: definitions, management, and role of preoperative therapy. Ann. Surg. Oncol. 13, 1035–1046 (2006).

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