Radiation Oncology/Ampulla

Ampulla of Vater

Background

 * Must be distinguished from other periampullary tumors, including tumors arising in the pancreatic head and the distal common bile duct.
 * Primary tumors of the ampulla are uncommon (15-25% of periampullary tumors). However, tumors of the ampulla of Vater make up a large percentage of duodenal tumors.

Staging
AJCC 7th Edition (2009) Primary Tumor:
 * Tis - carcinoma in situ
 * T1 - limited to ampulla of Vater or sphincter of Oddi
 * T2 - invades duodenal wall
 * T3 - invades pancreas
 * T4 - invades peripancreatic soft tissues or other adjacent organs or structures

Regional Lymph Nodes:
 * N0 - none
 * N1 - yes
 * Regional nodes: peripancreatic, including lymph nodes along hepatic artery and portal vein

Distant Metastases:
 * M0 - none
 * M1 - yes

Stage Grouping:
 * IA - T1 N0
 * IB - T2 N0
 * IIA - T3 N0
 * IIB - T1-3 N1
 * III - T4
 * IV - M1

Older staging systems
AJCC 6th Edition (2002) No changes compared to 7th edition