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Ampulla of Vater


TNM staging

Reviewer: Hanni Gulwani, M.D. (see Reviewers page)
Revised: 11 December 2012, last major update August 2012
Copyright: (c) 2003-2012, PathologyOutlines.com, Inc.


● No change from AJCC 6th to AJCC 7th edition
● Does not apply to carcinoid or other neuroendocrine tumors

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

End of Ampulla of Vater > Miscellaneous > TNM staging

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