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Neuroendocrine tumors of the pancreas TNM staging AJCC version 9

Neuroendocrine tumors of the pancreas TNM staging AJCC version 9
Primary tumor (T)*
T category T criteria
TX Tumor cannot be assessed
T1 Tumor limited to the pancreas, ≤2 cm in greatest dimension
T2 Tumor limited to the pancreas, >2 cm but ≤4 cm in greatest dimension
T3 Tumor limited to the pancreas, >4 cm in greatest dimension; or tumor invading the duodenum, ampulla of Vater, or common bile duct
T4 Tumor invading adjacent organs (stomach, spleen, colon, adrenal gland) or the wall of large vessels (celiac axis, superior mesenteric artery/vein, splenic artery/vein, gastroduodenal artery/vein, portal vein)

Limited to the pancreas means there is no invasion of adjacent organs (stomach, spleen, colon, adrenal gland) or the wall of large vessels (celiac axis or the superior mesenteric artery). Extension of tumor into peripancreatic adipose tissue is NOT a basis for staging.

NOTE: Multiple tumors should be designated as such (the largest tumor should be used to assign T category):

  • Use T(#); eg, pT3(4) N0 M0, or
  • Use the m suffix, T(m); eg, pT3(m) N0 M0

Primary tumor suffix

  • (m) Multiple synchronous primary tumors
Regional lymph nodes (N)*
N category N criteria
NX Regional lymph nodes cannot be assessed
N0 No tumor involvement of regional lymph node(s)
N1 Tumor involvement of regional lymph node(s)
Regional lymph nodes suffix
  • (f) FNA or core needle biopsy
Distant metastasis (M)*
M category M criteria
cM0 No distant metastasis
cM1 Distant metastases
cM1a Metastasis confined to liver
cM1b Metastases in at least one extrahepatic site (eg, lung, ovary, nonregional lymph node, peritoneum, bone)
cM1c Both hepatic and extrahepatic metastases
pM1 Microscopic confirmation of distant metastases
pM1a Microscopic confirmation of metastasis confined to liver
pM1b Microscopic confirmation of metastases in at least one extrahepatic site (eg, lung, ovary, nonregional lymph node, peritoneum, bone)
pM1c Microscopic confirmation of both hepatic and extrahepatic metastases
AJCC prognostic stage group is assigned based on the stage classification and categories chosen.*
Prognostic stage groups
When T is... And N is... And M is... Then the stage group is...
T1 N0 M0 I
T2, T3 N0 M0 II
T4 N0 M0 III
Any T N1 M0 III
Any T Any N M1 IV

AJCC: American Joint Committee on Cancer; TNM: tumor, node, metastasis.

* AJCC data elements required for staging are identified with an asterisk.

Used with permission of the American College of Surgeons, Chicago, Illinois. The original source for this information is the AJCC Cancer Staging System, Version 9: Neuroendocrine Tumors of the Pancreas (2023).
Graphic 144876 Version 3.0