Ampullary cancer is a rare cancer that occurs in ampulla of Vater. Ampulla Vater is a finger-like an extension that protrudes into the duodenum into which the pancreatic and bile ductus open. Ampullary cancer blocks the ampulla water with tumour cells and obstructs the flow of pancreatic and biliary secretions into the intestine. As the secretions accumulate without free flow, jaundice can develop, which makes the skin appear yellow in colour.
The signs and symptoms of ampullary cancer are one and the same to that of the symptoms of bile and pancreatic duct blockage.
- Yellowish discoloration of skin and eyes
- Unusual weight loss
- Nausea and vomiting
- Gastrointestinal bleeding
- Loss of appetite
The common causes of ampullary cancer are as follows:
- Genetic factors
- Patients with a family history of adenomatous polyposis
- Patients with inflammatory bowel disease
- Mutations in tumor suppressor genes (p53, DPC4)
The factors that increase the risk of developing ampullary cancer include smoking, genetics and diabetes mellitus.
The first and foremost diagnosis is carried out by performing a physical examination. As the symptoms of ampullary cancer are same like jaundice, a physical examination is done. Later to confirm the possibility of ampullary cancer the doctor recommends for blood and urine testing, to evaluate the presence of markers of cancer.
A specific imaging tests such as computer tomography, ultrasound, and magnetic resonance imaging is performed to get the detailed understanding of the target area. These imaging studies show the presence of tumor inside the ampulla of Vater.
Endoscopy is performed to look for the ampulla, the procedure is also useful in collecting the sample to look for the cancer cells. For this, a thin long tube with a tiny camera is sent into the mouth, to enter the duodenum to view the ampulla of Vater.
Chest X-ray: X-ray is taken to check for the spread of cancer to the lungs.
Tests such as ERCP (endoscopic retrograde cholangiopancreatography) or MRCP (Magnetic resonance cholagiopancreatography) are also performed to view the pancreatic and bile ducts.
Based on the size, location, and spread of cancer, the doctor suggests the best suitable treatment strategy. Surgery remains the primary treatment for any cancer. However, advanced stages of ampullary cancer require stents and palliative care.
This procedure is performed if the ampullary tumor is large and already metastasized. In this procedure, the lower part of the stomach, gallbladder, head of the pancreas, surrounding lymph nodes and upper parts of the small intestine are removed. The left over parts is attached to the cut ends of the small bowel.
Biliary stents are small plastic or metal tubes inserted endoscopically into the bile ducts to clear the blockage. Biliary stents are also through a skin incision, this technique helps relieve jaundice that is caused due to the biliary obstruction.
Coping and support
Getting to know that you are diagnosed with ampullary cancer can make you feel depressed. But there is a great prognosis associated with ampullary cancer, surgical techniques, and other treatment options can give the best outcomes.