Editing Pancreatic neuroendocrine tumours (section)

== '''Pathophysiology/staging''' ==

* Malignancy in PNETs can only be determined by the presence of metastases
* Grading - WHO staging system (includes all NETs regardless of site of origin or functional hormone secretion and classifies based on differentiation and grade)
** Low grade - G1
** Intermediate - G2
** High grade - G3 (3% of all PNETs)
** ''This is the most important prognostic indicator''
** ''If functioning, likely well-differentiated''
* Tend to metastasise to the liver, and often does not spread beyond the liver
* The less common functional tumours tend to be more aggressive


'''Neuroendocrine tumours of the pancreas TNM staging AJCC UICC 8th edition'''
{| class="wikitable"
|'''Primary tumour (T)'''
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|'''T category'''
|'''T criteria'''
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|TX
|Tumor cannot be assessed
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|T1
|Tumor limited to the pancreas,* <2 cm
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|T2
|Tumor limited to the pancreas,* 2 to 4 cm
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|T3
|Tumor limited to the pancreas,* >4 cm; or tumor invading the duodenum or common bile duct
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|T4
|Tumor invading adjacent organs (stomach, spleen, colon, adrenal gland) or the wall of large vessels (celiac axis or the superior mesenteric artery)
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|* ''Limited to the pancreas'' means there is no invasion of adjacent organs (stomach, spleen, colon, adrenal gland) or the wall of large vessels (celiac axis or the superior mesenteric artery). Extension of tumor into peripancreatic adipose tissue is NOT a basis for staging.

''NOTE:'' Multiple tumors should be designated as such (the largest tumor should be used to assign T category):

** If the number of tumors is known, use T(#); eg, pT3(4) N0 M0.
** If the number of tumors is unavailable or too numerous, use the ''m'' suffix, T(m); eg, pT3(m) N0 M0.
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|'''Regional lymph nodes (N)'''
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|'''N category'''
|'''N criteria'''
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|NX
|Regional lymph nodes cannot be assessed
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|N0
|No regional lymph node involvement
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|N1
|Regional lymph node involvement
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|'''Distant metastasis (M)'''
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|'''M category'''
|'''M criteria'''
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|M0
|No distant metastasis
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|M1
|Distant metastases
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|M1a
|Metastasis confined to liver
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|M1b
|Metastases in at least one extrahepatic site (eg, lung, ovary, nonregional lymph node, peritoneum, bone)
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|M1c
|Both hepatic and extrahepatic metastases
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|'''Prognostic stage groups'''
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|'''When T is...'''
|'''And N is...'''
|'''And M is...'''
|'''Then the stage group is...'''
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|T1
|N0
|M0
|I
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|T2
|N0
|M0
|II
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|T3
|N0
|M0
|II
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|T4
|N0
|M0
|III
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|Any T
|N1
|M0
|III
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|Any T
|Any N
|M1
|IV
|}