Pancreas

TNM 7 classification

TNM 6 classification

1. Rules for Classification

The classification applies only to carcinomas of the exocrine pancreas. There should be histological or cytological confirmation of the disease.

The following are the procedures for assessing T, N, and M categories.

T categories. Physical examination, imaging, and/or surgical exploration
N categories. Physical examination, imaging, and/or surgical exploration
M categories. Physical examination, imaging, and/or surgical exploration

2. Anatomical Subsites

1. Head of pancreas (C25.0)
2. Body of pancreas (C25.1)
3. Tail of pancreas (C25.2)

3. Regional Lymph Nodes

The regional lymph nodes are the peripancreatic nodes, which may be subdivided as follows:

Superior Superior to head and body Inferior Inferior to head and body Anterior Anterior pancreaticoduodenal, pyloric (for tumours of head only), and proximal mesenteric Posterior Posterior pancreaticoduodenal, common bile duct, and proximal mesenteric Splenic Hilum of spleen and tail of pancreas (for tumours of body and tail only) Coeliac (for tumours of head only)

4. TNM Clinical Classification

4.1. T - Primary Tumour
TX. Primary tumour cannot be assessed
T0. No evidence of primary tumour
Tis. Carcinoma in situ
T1. Tumour limited to pancreas, 2 cm or less in greatest dimension
T2. Tumour limited to pancreas, more than 2 cm in greatest dimension
T3. Tumour extends beyond pancreas, but without involvement of coeliac axis or superior mesenteric artery
T4. Tumour involves coeliac axis or superior mesenteric artery

4.2. N - Regional Lymph Nodes

NX. Regional lymph nodes cannot be assessed
N0. No regional lymph node metastasis
N1. Regional lymph node metastasis

4.3. M - Distant Metastasis

MX. Distant metastasis cannot be assessed
M0. No distant metastasis
M1. Distant metastasis

5. pTNM Pathological Classification

The pT, pN, and pM categories correspond to the T, N, and M categories.

pN0. Histological examination of a regional lymphadenectomy specimen will ordinarily include 10 or more lymph nodes. If the lymph nodes are negative, but the number ordinarily examined is not met, classify as pN0.

6. G Histopathological Grading

See definitions on Digestive System.

7. Stage Grouping

Stage 0 Tis N0 M0 Stage IA T1 N0 M0 Stage IB T2 N0 M0 Stage IIA T3 N0 M0 Stage IIB T1, T2, T3 N1 M0 Stage III T4 Any N M0 Stage IV Any T Any N M1

8. Summary

Pancreas T1 Limited to pancreas ≤2 cm T2 Limited to pancreas >2 cm T3 Beyond pancreas T4 Coeliac axis or superior mesenteric artery N1 Regional