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Ampullary Cancer

Ampullary cancer

Cancer of the ampulla of Vater is called ampullary cancer or ampullary carcinoma. It arises in the farthest portion of the common bile duct passing through the ampullary papilla and wall of the duodenum. Ampullary carcinomas are rare types of gastrointestinal cancers. The disease is characterized by the blockage of the passage of bile duct into the intestine thus building up bilirubin leading to one of the main symptoms of ampullary cancer, jaundice.

Signs and symptoms

Anorexia

Jaundice

Pruritus

Vomiting

Nausea

Weight loss

Fever

Clay colored stools

Diagnosis

Liver function tests prothrombin time, direct and indirect bilirubin, transaminases, alkaline phosphatase

CEA and CA 19-9 serum tumour markers

Imaging studies:

Abdominal ultrasound: for the evaluation of the pancreatic ducts and bile duct

Dilatation of ducts to check for extrahepatic obstruction

Pancreatic duct dilatation

CT scan of the abdomen and pelvis: to evaluate the region for possible metastases

ERCP or endoscopic retrograde cholangiopancreatography: for the evaluation of ductal architecture, irregular narrowing of pancreatic ducts, displacement or destruction of main pancreatic duct and its branches

PET or PET-CT scans: Positron emission tomography for imaging the metabolic activity of a tumour

Treatment

Ampullary carcinoma is routinely treated with pancreaticoduodenal resection otherwise known as Whipple procedure. An en bloc resection of the gastric antrum and duodenum along with portions of the gallbladder, jejunum, distal bile duct; the head and neck of the pancreas; and regional lymph nodes are conducted. Ampullary cancer is a relatively slow growing cancer. If treated early with surgical removal, it can be cured. A delay in consulting the doctor, thinking that the jaundice can be treated with medicines can cause undue delay and may result in advancement of the desease which may preclude effective treatment.

Pancreatic surgeries are extremely complex and need a multidisciplinary team to treat ampullary cancers. Experienced high volume pancreatic surgery centers have the best post operative results after successful psurgeries. Dr Deepak Varma has more than 15 years of experience in the field of pancreatic surgeries.