Carcinoid syndrome staging

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Parminder Dhingra, M.D. [2]

Staging

Definitions of TNM

The American Joint Committee on Cancer (AJCC) has designated staging by TNM classification to define neuroendocrine tumors

Neuroendocrine Tumors: Stomach

Primary Tumor (T)

• TX-Primary tumor cannot be assessed

• T0-No evidence of primary tumor

• Tis-Carcinoma in situ/dysplasia (tumor size <0.5 mm), confined to mucosa

• T1-Tumor invades lamina propria or submucosa and ≤1 cm in size

• T2-Tumor invades muscularis propria or >1 cm in size

• T3-Tumor penetrates subserosa

• T4-Tumor invades visceral peritoneum (serosal) or other organs or adjacent structures

For any T, add (m) for multiple tumors

Regional Lymph Nodes (N)

• NX-Regional lymph nodes cannot be assessed

• N0-No regional lymph node metastasis

• N1-Regional lymph node metastasis

Distant Metastases (M)

• M0-No distant metastases
• M1-Distant metastasis

Neuroendocrine Tumors: Duodenum/Ampulla/Jejunum/Ileum

Primary Tumor (T)

• TX-Primary tumor cannot be assessed

• T0-No evidence of primary tumor

• T1-Tumor invades lamina propria or submucosa and size ≤1 cmb (small intestinal tumors); tumor ≤1 cm (ampullary tumors)

• T2-Tumor invades muscularis propria or size >1 cm (small intestinal tumors); tumor >1 cm (ampullary tumors)

• T3-Tumor invades through the muscularis propria into subserosal tissue without penetration of overlying serosa (jejunal or ileal tumors) or invades pancreas or retroperitoneum (ampullary or duodenal tumors) or into nonperitonealized tissue

• T4-Tumor invades visceral peritoneum (serosa) or invades other organs

For any T, add (m) for multiple tumors

Neuroendocrine Tumors: Colon or Rectum

T	Primary tumor
TX	Primary tumor cannot be assessed
T0	No evidence of primary tumor
T1	Tumor invades lamina propria or submucosa and size ≤2 cm
T1a	Tumor size <1 cm in greatest dimension
T1b	Tumor size 1–2 cm in greatest dimension
T2	Tumor invades muscularis propria or size >2 cm with invasion of lamina propria or submucosa
T3	Tumor invades through the muscularis propria into the subserosa or into nonperitonealized pericolic or perirectal tissues
T4	Tumor invades peritoneum or other organs
	For any T, add (m) for multiple tumors