Σταδιοποίηση σε Ca Φύματος του Vater

Ca Φύματος του Vater

AJCC Stages

Stages

T

N

M

0

Tis

N0

M0

IA

T1

N0

M0

IB

T2

N0

M0

IIA

T3

N0

M0

IIB

T1

N1

M0

T2

N1

M0

T3

N1

M0

III

T4

Any N

M0

IV

Any T

Any N

M1

(T) Primary Tumor

TX

Primary tumor cannot be assessed

T0

No evidence of primary tumor

Tis

Carcinoma in situ

T1

Tumor limited to the ampulla of Vater or sphincter of Oddi

T2

Tumor invades duodenal wall

T3

Tumor invades pancreas

T4

Tumor invades peripancreatic soft tissues or other adjacent organs or structures other than pancreas

(N) Regional Lymph Nodes

NX

Regional lymph nodes cannot be assessed

N0

No regional lymph node metastasis

N1

Regional lymph node metastasis

(M) Distant Metastasis

M0

No distant metastasis

M1

Distant metastasis

Χαρακτηριστικά Επέκτασης

Local spread

• Spread to duodenum and pancreas is common
• Can also spread along common bile duct

Lymphatic spread

• Ampullary cancer mainly spreads to posterior pancreaticoduodenal nodes, then to inferior pancreaticoduodenal node group, and finally to paraaortic nodes
• Nodal metastases present at diagnosis in 35%
  • Incidence of lymph node metastasis increases with advanced T disease

• T1-T2 (8-22%)
• T3-T4 (60-69%)
• Rate of lymph node metastasis is low in tumors not extending beyond sphincter of Oddi

Distant metastases

• Rare at presentation
  • Common sites are liver, distant lymph nodes, peritoneum, lungs, and bones

Κατηγοριοποίηση (Ιστολογικοί Τύποι)

Adenocarcinoma is most common type

• Carcinoma in situ
• Adenocarcinoma, not otherwise specified (NOS)
• Adenocarcinoma, intestinal type
• Adenocarcinoma, pancreatobiliary type
• Mucinous adenocarcinoma
• Clear cell adenocarcinoma
• Signet ring cell carcinoma
• Adenosquamous carcinoma
• Squamous cell carcinoma
• Small cell (oat cell) carcinoma

• Undifferentiated carcinoma
  • Spindle and giant cell types
  • Small cell types
• Papillomatosis
• Papillary carcinoma, noninvasive
• Papillary carcinoma, invasive
• Carcinoma, NOS

Malignant mesenchymal tumors, (rare) include

• Embryonal rhabdomyosarcoma
• Leiomyosarcoma
• Malignant fibrous histiocytoma