Pancreatic & Biliary Tract Cancer Staging
Criteria for TNM Pathologic Staging
Site |
Criteria |
Pancreas |
Complete/subtotal resection of pancreas and regional lymph nodes. |
Gallbladder |
Surgical exploration, examination of resected specimen, histologic confirmation of liver involvement, depth of invasion into/through wall, invasion into liver, other adjacent organs that are involved, assessment of regional nodes. |
Liver |
No criteria exist for pathologic staging of liver cancer. |
Extrahepatic bile ducts and ampulla of Vater |
Imaging, surgical exploration with examination of resected specimen and lymph nodes. |
TNM staging for liver, gallbladder, extrahepatic bile duct cancer applies only to carcinomas. TNM staging for pancreatic cancer applies only to carcinomas; islet cell tumors are excluded from the staging system.
Brief Summaries of 6th Edition Categories
Liver & Intrahepatic Bile Ducts
AJCC |
Definition |
T1 |
Solitary tumor without vascular invasion. |
T2 |
Solitary tumor with vascular invasion; or multiple tumors none more than 5 cm. |
T3 |
Multiple tumors more than 5 cm or tumor involving a major branch of the portal or hepatic vein(s). |
T4 |
Tumor(s) with direct invasion of adjacent organs other than the gallbladder or with perforation of visceral peritoneum. |
N1 |
Regional lymph node metastases. |
Gallbladder
AJCC |
Definition |
T1 |
Tumor invades lamina propria or muscle layer. |
T1a |
Tumor invades lamina propria. |
T1b |
Tumor invades muscle layer. |
T2 |
Tumor invades perimuscular connective tissue; (no extension beyond serosa or into liver). |
T3 |
Tumor perforates serosa and/or invades the liver and/or one other adjacent organ or structure. |
T4 |
Tumor invades main portal vein or hepatic artery or invades multiple extrahepatic organs or structures. |
N1 |
Regional lymph node metastasis. |
Extrahepatic Bile Ducts
AJCC |
Definition |
T1 |
Tumor confined to bile duct histologically. |
T2 |
Tumor invades beyond wall of bile duct. |
T3 |
Tumor invades liver, gallbladder, pancreas, and/or unilateral branches of portal vein or hepatic artery. |
T4 |
Tumor invades main portal vein or branches bilaterally, common hepatic artery, or other structures. |
N1 |
Regional lymph node metastasis. |
Ampulla of Vater
AJCC |
Definition |
T1 |
Limited to Ampulla or sphincter of Oddi. |
T2 |
Invades duodenal wall. |
T3 |
Invades pancreas |
T4 |
Invades peripancreatic soft tissues or other adjacent organs or structures |
N1 |
Regional lymph node metastases. |
Pancreas
AJCC |
Definition |
T1 |
Limited to pancreas =< 2 cm. |
T2 |
Limited to pancreas > 2 cm. |
T3 |
Beyond pancreas but without celiac axis or superior mesenteric artery involvement. |
T4 |
Involves celiac axis or superior mesenteric artery (unresectable primary). |
N1 |
Regional lymph node metastases. |
Collaborative Stage Elements
For more details on Collaborative Stage, see the Intro to Collaborative Staging module.