Σταδιοποίηση σε Ca Ενδοκρινούς Μοίρας του Παγκρέατος

Ca Παγκρέατος – Ενδοκρινής μοίρα

AJCC Stages

Stages

T

N

M

0

Tis

N0

M0

IA

T1

N0

M0

IB

T2

N0

M0

IIA

T3

N0

M0

IIB

T1

N1

M0

T2

N1

M0

T3

N1

M0

III

T4

Any N

M0

IV

Any T

Any N

M1

(T) Primary Tumor

TX

Primary tumor cannot be assessed

T0

No evidence of primary tumor

Tis

Carcinoma in situ*

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)

*This also includes the "PanInIII" classification.

(N) Regional Lymph Nodes

NX

Regional lymph nodes cannot be assessed

N0

No regional lymph node metastasis

N1

Regional lymph node metastasis

(M) Distant Metastasis

M0

No distant metastasis

M1

Distant metastasis

Χαρακτηριστικά Επέκτασης

Local spread

• Very unusual in syndromic tumors due to early detection
• More likely in nonsyndromic tumors
• Local spread to peripancreatic structures
  • Retroperitoneum, duodenum, adrenal gland, kidney, and spleen
  • Vascular involvement of superior mesenteric vessels, celiac artery and its branches, portal and splenic veins

Nodal metastases

• Unusual in syndromic PNET and in small tumor
• Regional lymph nodes include
  • Head and neck of pancreas
    • Nodes along common bile duct

• Nodes along common hepatic artery
• Nodes along portal vein
• Nodes along posterior and anterior pancreaticoduodenal arcade
• Nodes along superior mesenteric vein
• Nodes along right side of superior mesenteric artery
• Body and tail of pancreas
  • Nodes along common hepatic artery
  • Nodes along celiac axis
  • Nodes along splenic artery
  • Nodes within splenic hilum

Distant metastases

• Liver is most common site for metastatic PNET
• Other sites include lung, bone, mediastinum, skin, and heart

Κατηγοριοποίηση (Ιστολογικοί Τύποι)

• All endocrine tumors are hormonally active to variable degree
• Typically divided depending on clinical and biochemical manifestations into
  • Syndromic (hyperfunctioning, 65-70%)
    • Insulinoma
    • Gastrinoma
    • Glucagonoma
    • VIPoma
    • Somatostatinoma
    • Others
  • Nonsyndromic (nonhyperfunctioning, 30-35%)

• Classification of PNET as benign or malignant is not consistent
  • All PNET irrespective of benign or malignant classification should be staged using this system
• Carcinoid tumors of pancreas are also included in this staging schema
  • Carcinoid tumor
  • Atypical carcinoid
  • Composite carcinoid (combined with adenocarcinoma)
  • Adenocarcinoid