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Neuroendocrine tumors of the duodenum and ampulla of Vater TNM staging AJCC version 9

Neuroendocrine tumors of the duodenum and ampulla of Vater TNM staging AJCC version 9
Primary tumor (T)*
T category T criteria
TX Primary tumor cannot be assessed
T1

Tumor invades the mucosa or submucosa only, and is ≤1 cm in greatest dimension (duodenal tumors);

Tumor ≤1 cm in greatest dimension and confined within the sphincter of Oddi (ampullary tumors)
T2

Tumor invades the muscularis propria or is >1 cm in greatest dimension (duodenal tumors);

Tumor invades through sphincter into duodenal submucosa or muscularis propria, or is >1 cm in greatest dimension (ampullary tumors)
T3 Tumor invades the pancreas or peripancreatic adipose tissue
T4 Tumor invades the visceral peritoneum (serosa) or other organs
NOTE: Multiple tumors should be designated as such (the largest tumor should be used to assign T category):
  • Use T(#); eg, pT3(4) N0 M0, or
  • Use the m suffix, T(m); eg, pT3(m) N0 M0

Primary tumor suffix

  • (m) Multiple synchronous primary tumors
Regional lymph nodes (N)*
N category N criteria
NX Regional lymph nodes cannot be assessed
N0 No tumor involvement of regional lymph node(s)
N1 Tumor involvement of regional lymph node(s)
Regional lymph nodes suffix
  • (f) FNA or core needle biopsy
Distant metastasis (M)*
M category M criteria
cM0 No distant metastasis
cM1 Distant metastasis
cM1a Metastasis confined to liver
cM1b Metastases in at least one extrahepatic site (eg, lung, ovary, nonregional lymph node, peritoneum, bone)
cM1c Both hepatic and extrahepatic metastases
pM1 Microscopic confirmation of distant metastasis
pM1a Microscopic confirmation of metastasis confined to liver
pM1b Microscopic confirmation of metastases in at least one extrahepatic site (eg, lung, ovary, nonregional lymph node, peritoneum, bone)
pM1c Microscopic confirmation of both hepatic and extrahepatic metastases
AJCC prognostic stage group is assigned based on the stage classification and categories chosen.*
Prognostic stage groups
When T is... And N is... And M is... Then the stage group is...
T1 NX, N0 M0 I
T2, T3 N0 M0 II
T4 N0 M0 III
Any T N1 M0 III
Any T Any N M1 IV

AJCC: American Joint Committee on Cancer; TNM: tumor, node, metastasis.

* AJCC data elements required for staging are identified with an asterisk.

Used with permission of the American College of Surgeons, Chicago, Illinois. The original source for this information is the AJCC Cancer Staging System, Version 9: Neuroendocrine Tumors of the Duodenum and Ampulla of Vater (2023).
Graphic 144872 Version 2.0