Tumor-Node-Metastasis Staging of Pancreatic Adenocarcinoma

Abstract

Accurate disease staging of patients with pancreatic cancer is essential to divide patients into prognostic subgroups, to allow delivery of stage-specific therapies, and to facili- tate meaningful discussions between physicians and patients regarding management and expected outcomes. The tumor-node-metastasis staging system of the American Joint Com- mission on Cancer has undergone significant revisions over the past 2 decades. In its current form, the system places an emphasis on preoperative clinical staging and facilitates division of patients with pancreatic cancer into 4 groups based on a determination of local resectability and the presence or absence of distant disease as determined on high-quality cross-sectional imag- ing. A modern understanding of local tumor factors that influence technical resectability is incor- porated into the algorithm. In this review, we examine the American Joint Commission on Cancer staging system, describe the rationale for its use, and demonstrate how it is a clinically relevant tool for the staging and management of patients with pancreatic cancer. (CA Cancer J Clin 2008;58:111-125.) © American Cancer Society, Inc., 2008. To earn free CME credit for successfully completing the online quiz based on this article, go to http://CME.AmCancerSoc.org.