Pancreatic Cancer TNM Staging Classification


The pancreatic cancer TNM staging helps to determine the disease prognosis and to select an appropriate treatment strategy. It is the most commonly used for pancreatic cancer staging.

“T” stands for “Tumor Size”, “N” for “Lymph Nodes”, and “M” for “Metastasis”. Numbers and/or letters after T (is, 1, 2, 3, and 4), N (0 and 1), and M (0 and 1) provide more details about each of these factors. Once T, N, and M categories are determined, this information is combined to assign an overall stage (from 0 to IV).

Tis – Pre-cancerous or cancer cells present only in the superficial layer of pancreatic duct cells

T1 – Cancer cells limited to pancreas and measures </=2 cm in largest dimension

T2 – Cancer cells limited to pancreas and measures >2 cm in largest dimension

T3 – Cancer cells have invaded the nearby organs such as duodenum, spleen, left kidney/adrenal gland, or splenic vein/superior mesenteric vein/portal vein

T4 – Cancer has invaded into the superior mesenteric artery or celiac artery 

pancreatic cancer tnm staging infographic
Pancreatic Cancer T Staging

N0 – No involvement of regional lymph nodes by cancer

N1 – Cancer has spread to nearby lymph nodes

M0 – No spread of cancer to distant organs

M1 – Cancer that has spread to the distant organs such as lungs, bones, liver, peritoneum, and brain

pancreatic cancer N and M staging infographic
Pancreatic Cancer N and M staging system

Pancreatic Cancer TNM staging classification:

0 Tis N0 M0  
IA T1 N0 M0  
IB T2 N0 M0  
IIA T3 N0 M0  
IIB T1-3 N1 M0  
  T4 N0-1 M0  
IV Any T Any N M1  

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Watch the video below where Cancerbro explains the TNM STAGING of pancreatic cancer.

Video Transcript:

CancerBro, in my treatment summary, it was mentioned T2 N1 M0. What does that mean?

TNM is the staging system used for pancreatic cancer.

It is called as T1 when the tumor is less than 2 cm in size.

T2 when the tumor is 2 to 4 cm in size.

And T3, when the tumor is more than 4 cm in size.

In T1 to T3 disease, the tumor may be limited to the pancreas and may be located in the head of the pancreas. Or tail, or any other part of the pancreas.

Or else, it may extend beyond the pancreas to involve the adjacent structures.

In this figure, cancer in the head of the pancreas invades the duodenum.

Here, cancer in the pancreatic tail invades the spleen.

Here it extends to the left kidney and suprarenal gland.

It may also extend also extend above, to involve splenic artery.

Or behind, to invade the superior mesenteric vein.

Or splenic vein.

Or portal vein.

Now we come to the T4 disease. In this figure, cancer has spread beyond the pancreas, to involve the common hepatic artery.

Infiltration into the coeliac artery is also T4 disease.

So is the involvement of the superior mesenteric artery.

Now we come to the N staging or the nodal staging for pancreatic cancer.

It is called as node positive disease if cancer extends to involve the regional lymph nodes.

Regional lymph nodes may be different for the head, body, and the tail of the pancreas.

Lastly, we come to the M staging or the metastatic staging for pancreatic cancer. It is called as M1 when there is a spread of the tumor to distant organs.

In this figure, it has spread to the peritoneum, in form of multiple peritoneal deposits.

And here, it has spread to the liver in form of multiple nodular deposits.

This figure shows the spread of the tumor to the lungs.

Very rarely, it may also spread to brain or bones.

So this was the TNM staging for pancreatic cancer.

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