According to AJCC 8th edition, Staging of 2cm size Pancreatic cancer if it involves portal vein is?
a) T1
b) T2
c) T3
d) T4
Ans: A Reference: AJCC 8th edition manual, pg. 340-344 Explanation:
AJCC 8th edition has brought the following changes with regard to carcinoma pancreas • T1 is subdivided into T1a, T1b and T1c based on size • T2 and T3 are categorized based on size and not on extrapancreatic involvement anymore • T4 is a radiological staging done by the relationship to vessels • Nodal staging has N1 and N2 subdivisions unlike before N1 alone
Tx No primary tumor could not be assessed Nx Regional nodes cannot be assessed T0 No evidence of primary tumor N0 No regional nodes Tis Carcinoma in situ includes Pan-IN 3, IPMN with high risk features T1 Tumor < or = 2 cm in greatest dimension T1a - < or = 0.5cm N1 One to three regional lymph nodes
T1b – 0.5 to 1 cm T1c – 1.0 to 2.0 cm T2 Tumor > 2cm but < or = 4 cm N2 Four or more lymph nodes T3 Tumor > 4cm in greatest dimension M0 No distant metastases T4 Tumor any size involvement of celiac axis, superior mesenteric artery and common hepatic artery M1 Distant metastases
• Portal vein or SMV involvement will not change the staging as per AJCC 7 and AJCC 8th edition. Staging Decided based on the Tumor size only. • Borderline resectable lesion is lesion involvement > 180 degrees of PV/SMV or <180 degree involvement of Coeliac axis/SMA.