Staging of Neuroendocrine Tumors
If you were diagnosed with a neuroendocrine tumor (NET), your oncologist will need to determine the stage of your cancer. Staging describes how large the tumor is, whether it has spread to nearby lymph nodes, and whether it is affecting other areas of the body. The staging process helps your oncologist choose the most appropriate treatment options for you.
If you have questions about staging or your pathology report, your Compass Oncology care team is here to help you understand every aspect of your diagnosis.
Staging Systems for Neuroendocrine Tumors
Many gastrointestinal (GI) and pancreatic neuroendocrine tumors are staged using the American Joint Committee on Cancer (AJCC) TNM system. This system evaluates three key factors:
- Tumor (T): How large is the primary tumor, and where is it located?
- Node (N): Has the tumor spread to nearby lymph nodes? If so, where and how many?
- Metastasis (M): Has the cancer spread to distant organs? If so, where and how much?
These three categories are combined to determine an overall stage, ranging from Stage I through Stage IV.
Gastrointestinal Tract Neuroendocrine Tumor Stages
Neuroendocrine tumors that develop in the gastrointestinal tract are staged differently than other types of GI cancer. This includes NETs of the:
- Stomach
- Duodenum and ampulla of Vater (parts of the small intestine)
- Jejunum and ileum (parts of the small intestine)
- Appendix
- Colon and rectum
Each location has its own unique staging criteria. Generally, the higher the stage number, the more the cancer has spread.
- Stage I: There is a small tumor, and it has not spread elsewhere.
- Stage II: The tumor is larger and has grown as far as the subserosa, which is behind the layer of muscle in the stomach. The cancer has not spread to the lymph nodes or elsewhere in the body.
- Stage III: The tumor is any size, and the cancer has spread to regional lymph nodes. Or, the tumor has spread to the outside of the stomach, but the cancer has not spread to the lymph nodes or elsewhere.
- Stage IV: There is distant metastasis.
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Stage I: There is a small tumor, and it has not spread elsewhere.
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Stage II: The tumor is larger than 1 cm, or it has grown as far as the pancreas. The cancer has not spread to the lymph nodes or elsewhere in the body.
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Stage III: The tumor is any size, and the cancer has spread to regional lymph nodes. Or, the tumor has spread to the peritoneum or other organs, but the cancer has not spread to the lymph nodes or elsewhere.
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Stage IV: There is distant metastasis.
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Stage I: There is a small tumor, and it has not spread elsewhere.
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Stage II: The tumor is larger than 1 cm and has grown as far as the subserosa, which is behind the layer of muscle in the small intestine. The cancer has not spread to the lymph nodes or elsewhere in the body.
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Stage III: The tumor is any size, and the cancer has spread to regional lymph nodes. Or, the tumor has spread to the peritoneum or to other organs or structures, but the cancer has not spread to the lymph nodes or elsewhere.
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Stage IV: There is distant metastasis.
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Stage I: There is a tumor of 2 cm or less, and it has not spread elsewhere.
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Stage II: The tumor is larger than 2 cm and has grown as far as the membrane that connects the appendix to the abdominal wall. The cancer has not spread to the lymph nodes or elsewhere in the body.
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Stage III: The tumor is any size, and the cancer has spread to regional lymph nodes. Or, the tumor has spread to the peritoneum or beyond, but the cancer has not spread to the lymph nodes or elsewhere.
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Stage IV: There is distant metastasis.
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Stage I: There is a tumor of 2 cm or less, and it has not spread elsewhere.
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Stage II: Stage II is divided into stages IIA and IIB:
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Stage IIA: The tumor has grown into the muscle. Or it is more than 2 cm in size and has invaded the lamina propria or submucosa. The cancer has not spread.
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Stage IIB: The tumor has spread through the muscle and into the subserosal tissue behind it. The cancer has not spread to the lymph nodes or elsewhere in the body.
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Stage III: Stage III is divided into stages IIIA and IIIB:
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Stage IIIA: The tumor has spread to the peritoneum or has invaded nearby organs or structures, but the cancer has not spread to the lymph nodes or elsewhere.
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Stage IIIB: The tumor is any size, and the cancer has spread to regional lymph nodes.
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Stage IV: There is distant metastasis.
Stomach
- Stage I: There is a small tumor, and it has not spread elsewhere.
- Stage II: The tumor is larger and has grown as far as the subserosa, which is behind the layer of muscle in the stomach. The cancer has not spread to the lymph nodes or elsewhere in the body.
- Stage III: The tumor is any size, and the cancer has spread to regional lymph nodes. Or, the tumor has spread to the outside of the stomach, but the cancer has not spread to the lymph nodes or elsewhere.
- Stage IV: There is distant metastasis.
Duodenum and ampulla of Vater (small intestine)
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Stage I: There is a small tumor, and it has not spread elsewhere.
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Stage II: The tumor is larger than 1 cm, or it has grown as far as the pancreas. The cancer has not spread to the lymph nodes or elsewhere in the body.
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Stage III: The tumor is any size, and the cancer has spread to regional lymph nodes. Or, the tumor has spread to the peritoneum or other organs, but the cancer has not spread to the lymph nodes or elsewhere.
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Stage IV: There is distant metastasis.
Jejunum and ileum (small intestine)
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Stage I: There is a small tumor, and it has not spread elsewhere.
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Stage II: The tumor is larger than 1 cm and has grown as far as the subserosa, which is behind the layer of muscle in the small intestine. The cancer has not spread to the lymph nodes or elsewhere in the body.
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Stage III: The tumor is any size, and the cancer has spread to regional lymph nodes. Or, the tumor has spread to the peritoneum or to other organs or structures, but the cancer has not spread to the lymph nodes or elsewhere.
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Stage IV: There is distant metastasis.
Appendix
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Stage I: There is a tumor of 2 cm or less, and it has not spread elsewhere.
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Stage II: The tumor is larger than 2 cm and has grown as far as the membrane that connects the appendix to the abdominal wall. The cancer has not spread to the lymph nodes or elsewhere in the body.
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Stage III: The tumor is any size, and the cancer has spread to regional lymph nodes. Or, the tumor has spread to the peritoneum or beyond, but the cancer has not spread to the lymph nodes or elsewhere.
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Stage IV: There is distant metastasis.
Colon and rectum
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Stage I: There is a tumor of 2 cm or less, and it has not spread elsewhere.
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Stage II: Stage II is divided into stages IIA and IIB:
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Stage IIA: The tumor has grown into the muscle. Or it is more than 2 cm in size and has invaded the lamina propria or submucosa. The cancer has not spread.
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Stage IIB: The tumor has spread through the muscle and into the subserosal tissue behind it. The cancer has not spread to the lymph nodes or elsewhere in the body.
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Stage III: Stage III is divided into stages IIIA and IIIB:
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Stage IIIA: The tumor has spread to the peritoneum or has invaded nearby organs or structures, but the cancer has not spread to the lymph nodes or elsewhere.
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Stage IIIB: The tumor is any size, and the cancer has spread to regional lymph nodes.
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Stage IV: There is distant metastasis.
Pancreatic NET Staging
Pancreatic NETs also use a four-stage system.
- Stage I: There is a small tumor in the pancreas, and it has not spread elsewhere in the body.
- Stage II: The tumor is larger and has not spread to the regional lymph nodes or elsewhere in the body.
- Stage III: The tumor is any size and has spread to the regional lymph nodes. Or, the tumor has spread to the stomach, spleen, colon, or adrenal gland, or the wall of the celiac axis or the superior mesenteric artery. Still, it has not spread to the regional lymph nodes or anywhere else.
- Stage IV: There is distant metastasis.
Determining a Neuroendocrine Tumor Treatment Plan
At Compass Oncology, we understand that no two neuroendocrine tumors are exactly alike and that patients may require very different treatment approaches. Request an appointment with a cancer specialist at any of our locations throughout Portland and Vancouver. Our cancer care team can answer questions specific to your individual diagnosis and provide a second opinion on treatment for neuroendocrine tumors.
