Table 6. Definitions of TNM Stage IVa

StageTNMDescriptionIllustration
IVAny T, Any N, M1TX = Primary tumor cannot be assessed.
Stage IV pancreatic cancer; drawing shows other parts of the body where pancreatic cancer may spread, including the lung, liver, and peritoneal cavity. An inset shows cancer cells spreading from the pancreas, through the blood and lymph system, to another part of the body where metastatic cancer has formed.
T0 = No evidence of primary tumor.
Tis = Carcinoma in situ.b
T1 = Tumor limited to the pancreas, ≤2 cm in greatest dimension.
T2 = Tumor limited to the pancreas, >2 cm in greatest dimension.
T3 = Tumor extends beyond the pancreas but without involvement of the celiac axis or the superior mesenteric artery.
T4 = Tumor involves the celiac axis or the superior mesenteric artery (unresectable primary tumor).
NX = Regional lymph nodes cannot be assessed.
N0 = No regional lymph node metastasis.
N1 = Regional lymph node metastasis.
M1 = Distant metastasis.

aReprinted with permission from AJCC: Exocrine and endocrine pancreas. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 241-9.

bThis also includes the pancreatic intraepithelial neoplasia (PanIN)-3 classification.

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