Small intestine & ampulla
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Staging-small intestine carcinoma
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Pathologic TNM staging of carcinomas of small bowel, AJCC 8th edition
Definition / general
- Carcinomas, including neuroendocrine carcinomas, of the duodenum,
jejunum and ileum are covered by this staging system
- Use this system for duodenal / ampullary neuroendocrine tumors and this system for
jejunum / ileum neuroendocrine tumors
Essential features
- AJCC 7th edition staging was sunset on December 31, 2017; as of January 1, 2018, use of the
AJCC, 8th Edition, 2018 is mandatory
ICD coding
- C17.9: malignant neoplasm of small intestine, unspecified
Primary tumor (pT)
- TX: primary tumor cannot be assessed
- T0: no evidence of primary tumor
- Tis: high grade dysplasia / carcinoma in situ
- T1: tumor invades the lamina propria or submucosa
- T1a: tumor invades the lamina propria
- T1b: tumor invades the submucosa
- T2: tumor invades the muscularis propria
- T3: tumor invades through the muscularis propria into the subserosa or
extends into nonperitonealized perimuscular tissue (mesentery or
retroperitoneum) without serosal penetration
- T4: tumor perforates the visceral peritoneum or directly invades other
organs or structures (e.g., other loops of small intestine, mesentery of
adjacent loops of bowel and abdominal wall by way of serosa; for
duodenum only, invasion of pancreas or bile duct)
Notes:
- For jejunal / ileal pT3 tumors, the nonperitonealized perimuscular tissue is
part of the mesentery
- For duodenal pT3 tumors in areas lacking serosa,
the nonperitonealized perimuscular tissue is part of the interface with the
pancreas
Regional lymph nodes (pN):
- NX: regional lymph nodes cannot be assessed
- N0: no regional lymph node metastasis
- N1: metastasis in one or two regional lymph nodes
- N2: metastasis in three or more regional lymph nodes
Notes:
- Regional lymph nodes for the nonampullary duodenum include the
retropancreatic, hepatic artery, inferior pancreaticoduodenal and superior
mesenteric nodes
- Regional lymph nodes for the jejunum or ileum include the mesenteric and
superior mesenteric nodes; for the terminal ileum, the cecal and ileocolic
nodes are also included
Stage grouping
- Stage 0:Tis N0 M0
- Stage I:T1 - 2 N0 M0
- Stage IIA:T3 N0 M0
- Stage IIB:T4 N0 M0
- Stage IIIA:any T N1 M0
- Stage IIIB:any T N2 M0
- Stage IV:any T any N M1
Registry data collection variables
- Primary tumor site (duodenum, jejunum, ileum)
- Number of lymph nodes examined
- Presurgical CEA
- LVI
- Microsatellite instability
- Tumor grade
- Presence of disease
- Personal or family history of familial GI malignancies (familial
adenomatous polyposis, Lynch syndrome, Peutz-Jeghers syndrome)
Histologic grade
- GX: grade cannot be assessed
- G1: well differentiated
- G2: moderately differentiated
- G3: poorly differentiated
Board review style question #1
Based on AJCC eighth edition criteria, a jejunal adenocarcinoma extending
through the muscularis propria into the adjacent mesentery but without
perforating the serosa would be staged as which of the following?
- pT1
- pT2
- pT3
- pT4
Board review style answer #1
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