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