Ampulla of Vater
TNM staging

Author: Hanni Gulwani, M.D. (see Authors page)

Revised: 2 March 2016, last major update December 2012

Copyright: (c) 2003-2016,, Inc.

PubMed Search: TNM staging[title]
Cite this page: TNM staging. website. Accessed February 17th, 2018.
Definition / general
  • No change from AJCC 6th to AJCC 7th edition
  • Does not apply to carcinoid or other neuroendocrine tumors
Staging / staging classifications

Primary tumor (T)
    TX: Primary tumor cannot be assessed
    T0:No evidence of primary tumor
    Tis: Carcinoma in situ
    T1: Tumor limited to ampulla of Vater or sphincter of Oddi
    T2: Tumor invades duodenal wall
    T3: Tumor invades pancreas
    T4: Tumor invades peripancreatic soft tissues or other adjacent organs or structures

Regional lymph nodes (N)
    NX: Regional lymph node status cannot be assessed
    N0: No regional lymph node metastasis
    N1: Regional lymph node metastasis

  • Regional lymph nodes: peripancreatic, which includes lymph nodes along hepatic artery and portal vein
  • Optimal histologic examination requires a minimum of 12 lymph nodes

Distant metastasis (M)
    M0: No distant metastasis
    M1: Distant metastasis (specify site)

Extent of resection
    R0: Complete resection with gross/microscopically negative margins
    R1: Grossly negative, microscopically positive
    R2: Grossly and microscopically positive

  • Note: not part of TNM but prognostically of great significance

Stage groupings
    Stage 0: Tis N0 M0
    Stage 1A: T1 N0 M0
    Stage 1B: T2 N0 M0
    Stage 2A: T3 N0 M0
    Stage 2B: T1-T3 N1 M0
    Stage 3: T4, any N, M0
    Stage 4: Any T, any N, M1