Radiation Oncology/Ampulla

Ampulla of Vater


  • 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.


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