Summary Stage 2018: Pancreas
Summary Stage 2018
Notes
**Pancreas**
8000-8700, 8720-8790, 8971, 9700-9701
C250-C254, C257-C259
C250 Head of pancreas
C251 Body of pancreas
C252 Tail of pancreas
C253 Pancreatic duct
C254 Islets of Langerhans
C257 Other specified parts of pancreas
C258 Overlapping lesion of pancreas
C259 Pancreas, NOS
**Note 1:** The following sources were used in the development of this chapter
* SEER Extent of Disease 1988: Codes and Coding Instructions (3rd Edition, 1998) (https://seer.cancer.gov/archive/manuals/EOD10Dig.3rd.pdf)
* SEER Summary Staging Manual-2000: Codes and Coding Instructions (https://seer.cancer.gov/tools/ssm/)
* Collaborative Stage Data Collection System, version 02.05: https://cancerstaging.org/cstage/Pages/default.aspx
* Chapter 28 *Exocrine Pancreas*, in the AJCC Cancer Staging Manual, Eighth Edition (2017) published by Springer International Publishing. Used with permission of the American College of Surgeons, Chicago, Illinois.
* Chapter 34 *Neuroendocrine Tumors of the Pancreas*, in the AJCC Cancer Staging Manual, Eighth Edition (2017) published by Springer International Publishing. Used with permission of the American College of Surgeons, Chicago, Illinois.
**Note 2:** See the following chapters for the listed histologies
* 8710-8714, 8800-8934, 8940-8970, 8972-9137, 9141-9582: *Soft Tissue*
* 8935-8936: *GIST*
* 9140: *Kaposi Sarcoma*
**Note 3:** For tumors of the islet cells, determine which subsite of the pancreas is involved and use that primary site code. If the subsite cannot be determined, use the general code for Islets of Langerhans, C254.
**Note 4:** The terms “abutment,” “abut(s),” “encases,” or “encasement” of the major blood vessels can be interpreted as involvement of these structures.
| SS2018 |
Description |
| 0 |
In situ, intraepithelial, noninvasive
- High-grade pancreatic intraepithelial neoplasia (PanIn-3)
- Intraductal papillary mucinous neoplasm with high grade dysplasia
- Intraductal tubulopapillary neoplasm with high grade neoplasm
- Mucinous cystic neoplasm with high-grade dysplasia |
| 1 |
Localized only (localized, NOS)
- Confined to pancreas |
| 2 |
Regional by direct extension only
- All sites
+ Ampulla of Vater
+ Blood vessel(s) (major)
* Aortic artery
* Celiac artery
* Common hepatic artery
* Further contiguous extension to other major arteries
* Portal vein
* Superior mesenteric artery/vein
+ Duodenum
+ Extrahepatic bile duct(s)
+ Fixation to adjacent structure(s), NOS
+ Peripancreatic tissue, NOS
+ Stomach
- Pancreas Head (C250)
+ Adjacent stomach
+ Blood vessel(s) (major)
* Gastroduodenal artery
+ Transverse colon, including hepatic flexure
- Pancreas Body Tail (C251, C252)
+ Spleen
+ Splenic artery/vein
+ Splenic flexure |
| 3 |
Regional lymph node(s) involved only
- All sites
+ Anterior, NOS
+ Common hepatic artery
+ Hepatic, NOS
+ Inferior to head and body of pancreas
+ Lateral aortic (lumbar)
+ Pancreaticoduodenal (anterior, posterior)
+ Peripancreatic, NOS
+ Posterior, NOS
+ Proximal mesentery (anterior, posterior)
+ Retroperitoneal
+ Superior mesenteric
+ Superior to head and body of pancreas
+ Regional lymph node(s), NOS
* Lymph node(s), NOS
- Pancreas Head (C250)
+ Common bile duct (pericholedochal)
+ Lateral wall (right)
+ Portal vein
+ Pyloric (infrapyloric, retropyloric, subpyloric, suprapyloric)
+ Pyloric, NOS
- Pancreas Body Tail (C251, C252)
+ Gastroepiploic (gastro-omental, left)
+ Pancreaticosplenic (pancreaticolineal)
+ Splenic (artery, hilum, lineal)
+ Suprapancreatic |
| 4 |
Regional by BOTH direct extension AND regional lymph node(s) involved
- Codes (2) + (3) |
| 7 |
Distant site(s)/lymph node(s) involved
- Distant site(s) (including further contiguous extension to other organs)
+ All sites
* Adrenal gland/suprarenal gland
* Gallbladder
* Kidney
* Liver, including porta hepatis
* Mesenteric fat
* Mesentery
* Mesocolon
* Peritoneum
* Retroperitoneum
* Small intestine (excluding duodenum)
* Ureter
+ Pancreas Head (C250)
* Celiac
* Colon (other than transverse colon including hepatic flexure)
* Omentum
* Spleen
+ Pancreas Body Tail (C251, C252)
* Colon (other than splenic flexure)
* Diaphragm
- Distant lymph node(s), NOS
+ Pancreas Head (C250)
* Celiac
* Gastroepiploic (gastro-omental), left
* Pancreaticosplenic (pancreaticolienal)
* Splenic (lineal), NOS
* Splenic artery
* Splenic hilum
* Suprapancreatic
+ Pancreas Body Tail (C251, C252)
* Celiac
* Pericholedochal (common bile duct)
* Porta hepatic
* Pyloric (infrapyloric, retropyloric, subpyloric, suprapyloric)
- Distant metastasis, NOS
+ Carcinomatosis
+ Distant metastasis except distant lymph node(s)
+ Seeding of peritoneum, even if limited to the lesser sac region
+ Positive peritoneal cytology |
| 9 |
Unknown if extension or metastasis |
(1) Fritz AG, Ries LAG (eds). **SEER Extent of Disease 1988: Codes and Coding Instructions (3rd Edition, 1998)**, National Cancer Institute, NIH Pub. No. 98-2313, Bethesda, MD, 1998
(2) Young JL Jr, Roffers SD, Ries LAG, Fritz AG, Hurlbut AA (eds.). **SEER Summary Staging Manual-2000: Codes and Coding Instructions**, National Cancer Institute, NIH Pub. No. 01-4969, Bethesda, MD, 2001.
(3) Collaborative Stage Work Group of the American Joint Committee on Cancer. **Collaborative Stage Data Collection System User Documentation and Coding Instructions, version 02.05**. American Joint Committee on Cancer (Chicago, IL)
(4) Gress, D.M., Edge, S.B., Gershenwald, J.E., et al. **Principles of Cancer Staging**. In: Amin, M.B., Edge, S.B., Greene, F.L., et al. (Eds.) AJCC Cancer Staging Manual. 8th Ed. New York: Springer; 2017: 3-30
(5) Kakar, S., Pawlik, T.M., Vauthey, J.N., et al. **Exocrine Pancreas**. In: Amin, M.B., Edge, S.B., Greene, F.L., et al. (Eds.) AJCC Cancer Staging Manual. 8th Ed. New York: Springer; 2017: 337-347
(6) Bergsland, E.K., Woltering, E.A., Klimstra, D.S., et al. **Neuroendocrine Tumors of the Pancreas**. In: Amin, M.B., Edge, S.B., Greene, F.L., et al. (Eds.) AJCC Cancer Staging Manual. 8th Ed. New York: Springer; 2017: 407-419
