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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 the 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 coloured 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 the 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 jaundice can be treated with medicines can cause undue delay and may result in the advancement of the disease which may preclude effective treatment.

Pancreatic surgeries are extremely complex and need a multidisciplinary team to treat ampullary cancers. Experienced high volume pancreatic surgery centres have the best postoperative results after successful surgeries. I have more than 15 years of experience in the field of pancreatic surgeries.

Authored by Dr. Deepak Varma, MBBS, MS (General Surgery)

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