Stages of pancreatic neuroendocrine tumours (pNETs)

Last medical review: January 2025

Pancreatic neuroendocrine tumours (pNETs) are staged differently than other pancreatic cancers.

The staging system used for pNETs is the TNM system. For pNETs there are 4 stages. Often the stages 1 to 4 are written as the Roman numerals I, II, III and IV. Generally, the higher the stage number, the more the cancer has spread.

Talk to your doctor if you have questions about staging. Find out more about staging cancer.

Stage 1

The tumour is 2 cm or smaller. It is only in the pancreas.

Stage 2

The tumour is 2 to 4 cm. It is only in the pancreas.

The tumour is 4 cm or larger. It is still in the pancreas or has grown into the duodenum or bile duct. The cancer has not spread to nearby lymph nodes.

Stage 3

The tumour can be any size. It has grown into nearby tissues or organs around the pancreas or has spread to nearby large blood vessels. The cancer has not spread to nearby lymph nodes.

The tumour can be any size. It may or may not have grown outside of pancreas. The cancer has spread to nearby lymph nodes.

Stage 4

The tumour can be any size. The cancer has spread to other parts of the body (called distant metastasis), such as to the liver. This is also called metastatic cancer.

Recurrent pNETs

Recurrent pNETs means that the cancer has come back after it has been treated. If it comes back in the same place that the cancer first started, it’s called local recurrence. If it comes back in tissues or lymph nodes close to where it first started, it’s called regional recurrence. It can also recur in another part of the body. This is called distant metastasis or distant recurrence.

Sylvia Asa, MD, PhD

Bergsland EK, Woltering EA, Rindi G, et al. Neuroendocrine tumors of the pancreas. Amin, MB (ed.). AJCC Cancer Staging Manual. 8th ed. Chicago, IL: American College of Surgeons; 2017: 34:407-419.
Cancer Research UK. Stages and Grades of Pancreatic NETs. 2021. https://www.cancerresearchuk.org/.
National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Neuroendocrine and Adrenal Tumors Version 2.2024. 2024.
Neuroendocrine Cancer UK. Neuroendocrine Cancer Virtual Patient Handbook. 2023. https://www.neuroendocrinecancer.org.uk/.
PDQ Adult Treatment Editorial Board. Pancreatic Neuroendocrine Tumors (Islet Cell Tumors) Treatment (PDQ®) – Health Professional Version. Bethesda, MD: National Cancer Institute; 2024. https://www.cancer.gov/.

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