Participation by representatives from collaborating societies on the expert panel does not necessarily imply individual or society endorsement of the final document. Reprint requests to: publications@acr.org Staging of Pancreatic Ductal Adenocarcinoma Key determinants of tumor stage can be summarized as follows: Stage IV disease is the presence of any distant metastases, stage III disease is any T4 disease, stage IIA disease is T3 disease with no distant metastases or nodal involvement, stage IIB disease is T1 through T3 disease with nodal involvement, stage IA is T1 disease without nodal involvement, and stage IB is T2 disease without nodal involvement. Treatment options include surgery, radiation therapy, and chemotherapy. Radical surgical resection offers potentially curative therapy, though it is seldom achieved. Furthermore, the general procedure-related morbidity rate is high at 20% and mortality rate is 1% to 4% [10,11]. Less than 20% of patients are candidates for surgery. For those undergoing surgery, the cancer is often too extensive for removal. Adjuvant chemotherapy with gemcitabine or chemoradiation after surgery has been reported by some to improve survival, but this is controversial due to conflicting published results [12-15]. Use of combination systemic therapy with gemcitabine and the targeted anticancer drug erlotinib, has been suggested to slightly increase survival in patients with advanced cancer [1]. Cure rates are highest for tumors that are truly localized to the pancreas (without extension beyond the pancreatic capsule or lymph node metastases). Surgical resection of small, localized tumors, (measuring <2 cm in maximum diameter), are associated with a survival rate of 18% to 24% [16]. Decisive factors determining tumor resectability include presence of distant metastases, and vascular involvement particularly the celiac axis, superior mesenteric artery (SMA), superior mesenteric vein (SMV), and portal vein (PV).
Staging of Pancreatic Ductal Adenocarcinoma. Participation by representatives from collaborating societies on the expert panel does not necessarily imply individual or society endorsement of the final document. Reprint requests to: publications@acr.org Staging of Pancreatic Ductal Adenocarcinoma Key determinants of tumor stage can be summarized as follows: Stage IV disease is the presence of any distant metastases, stage III disease is any T4 disease, stage IIA disease is T3 disease with no distant metastases or nodal involvement, stage IIB disease is T1 through T3 disease with nodal involvement, stage IA is T1 disease without nodal involvement, and stage IB is T2 disease without nodal involvement. Treatment options include surgery, radiation therapy, and chemotherapy. Radical surgical resection offers potentially curative therapy, though it is seldom achieved. Furthermore, the general procedure-related morbidity rate is high at 20% and mortality rate is 1% to 4% [10,11]. Less than 20% of patients are candidates for surgery. For those undergoing surgery, the cancer is often too extensive for removal. Adjuvant chemotherapy with gemcitabine or chemoradiation after surgery has been reported by some to improve survival, but this is controversial due to conflicting published results [12-15]. Use of combination systemic therapy with gemcitabine and the targeted anticancer drug erlotinib, has been suggested to slightly increase survival in patients with advanced cancer [1]. Cure rates are highest for tumors that are truly localized to the pancreas (without extension beyond the pancreatic capsule or lymph node metastases). Surgical resection of small, localized tumors, (measuring <2 cm in maximum diameter), are associated with a survival rate of 18% to 24% [16]. Decisive factors determining tumor resectability include presence of distant metastases, and vascular involvement particularly the celiac axis, superior mesenteric artery (SMA), superior mesenteric vein (SMV), and portal vein (PV).