Ampullary Cancer Staging

Learn about ampullary cancer staging

Ampullary cancer, also referred to as ampullary carcinoma, is a rare type of gastrointestinal cancer which affects the ampulla of Vater. In this article we'll explain each ampullary cancer staging and categorization.

The ampulla of Vater is the area at the end of the common bile duct where it passes into the duodenum, which is the first part of the small intestine.

Symptoms of ampullary cancer

The biggest indicator of ampullary cancer is signs of obstruction in the bile or pancreatic ducts.

Symptoms include

  • Jaundice (yellowing of the skin)
  • Pain in abdomen
  • Dyspepsia (pain in the belly, bloating, regurgitation of food, excessive burping, nausea, and heartburn)
  • Fever or chills
  • Pancreatitis
  • Nausea
  • Diarrhea
  • Vomiting
  • Weight loss

Ampullary cancer staging

The severity of ampullary cancer is categorized into six stages, each being defined by the severity of symptoms.

Stage 1A

Tumor is limited to the ampulla of Vater or sphincter of Oddi (the valve surrounding the ampulla of Vater which controls the flow of bile from the liver and pancreas into the duodenum).

Stage 1B

Tumor is invading the duodenal wall.

Stage 2A

Tumor has invaded the pancreas.

Stage 2B

Tumor is in the ampulla of Vater or sphincter of Oddi, or the duodenal wall or pancreas, and regional lymph node metastasis has occurred; this is when cancer cells have broken away from the main tumor and entered the blood stream.

Stage 3

Tumor has invaded peripancreatic tissues or other organs or structures adjacent to the area. Regional lymph node metastasis may or may not have occurred.

Stage 4

The tumor could be in any stage outlined above, regional lymph node metastasis may or may not have occurred, and distant metastasis has occurred, meaning that cancer cells have traveled to an area of the body completely separate from the tumor site.

Grading of ampullary cancer

Grades are designed to describe how the cancerous tumor cells look and act underneath a microscope. A biopsy can help doctors to examine the cells and give them one of four grades.

Lower grade cells look a lot like normal cells and they are relatively slow-growing. For this reason, the cancer is less likely to spread to other parts of the body. Higher grade tumor cells look abnormal and behave abnormally. They tend to grow very quickly and are therefore more likely to spread than lower grade cells. By identifying the grade of cells, doctors can estimate the rate at which the cancer is developing and assess the risk of it spreading.

Treatment options for ampullary cancer

The type of treatment recommended for patients will vary depending on ampullary cancer staging, as well as the size of the tumor and the grade of its cells. Sometimes more than one treatment will be recommended.


The most common treatment for ampullary cancer is surgery to remove the tumor and part of the pancreas. If the tumor has spread to the lymph nodes, these may also be removed.

For large tumors which have invaded the wider area, it may be necessary to undergo a Whipple procedure. This is where the head of the pancreas, the gallbladder, the duodenum and part of the bile duct and stomach are removed. The tail of the pancreas and the remaining bile duct and stomach are then reattached to allow for normal digestion.


Aggressive drugs may be used to help kill or at least control the spread of cancer cells. It is frequently used after surgery in an attempt to eliminate any remaining cancer cells and alleviate the spread of cells. It's also often used in instances where the cancer is so widespread across multiple areas that surgery would not be a practical solution.

Radiation therapy

Also often used after surgery, radiation therapy uses high-energy x-rays to kills cancer cells. It may be able to eliminate cancer cells or at least control them and help to manage pain in the more advanced stages of the diseases.

Supportive care procedures

Some patients may undergo additional procedures which don't necessarily work to eliminate or manage the spread of cancer, but instead help to manage symptoms, prevent further complications and relieve pain.

In the case of ampullary cancer, this may include relieving blockages in the bile ducts or bowel, or removing a build up of fluid in the abdominal cavity.

Last Reviewed:
August 23, 2017
Last Updated:
October 12, 2017