Ampullary Cancers

Ampullary Cancers

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Overview

Ampullary cancer is a rare cancer that develops in an area of your digestive system known as the ampulla of Vater. The ampulla of Vater is located where the bile duct and pancreatic duct join and empty into the small intestine. Ampullary cancer forms near many other parts of the digestive system like the pancreas, liver, and small intestine.

What are the symptoms of Ampullary cancer?

Signs and symptoms of ampullary cancer may include:

  • Yellowing of the eyes and skin (jaundice)
  • Pain in abdomen
  • Clay-colored stools
  • Fever
  • Nausea/vomiting
  • Weight loss
  • Bleeding from the rectum

What causes ampullary cancer?

The exact cause of ampullary cancer is not known. Generally, cancer starts when cells develop changes in their DNA. Uncontrolled multiplication of abnormal cells leads to accumulation of the cells. This forms a tumor that may invade and destroy normal body tissue.

What is the risk associated with Ampullary cancer?

  • Age: People older than 70 are at more risk.
  • Gender: Men are more likely to develop ampullary cancer as compared to females.
  • Inherited syndromes that increase cancer risk: Certain gene mutations passed from generation to generation can significantly increase the risk of ampullary cancer. The most common inherited syndromes which increase ampullary cancer risk are familial adenomatous polyposis and Lynch syndrome.

How is Ampullary cancer diagnosed?

  • Endoscopy: In this procedure, a doctor passes a long and flexible tube with a light and tiny camera fitted at the end of the tube into your mouth, down to your stomach, and small bowel. This will help your doctor look inside your digestive tract to examine the lining and help identify any abnormality.
  • Endoscopic retrograde cholangiopancreatography (ERCP): This procedure is used to x-ray the ducts (tubes), which take bile from the liver to the gallbladder and from there to the small intestine. This helps in finding any abnormality.
  • Imaging tests: Imaging tests helps the doctor understand more about your cancer and determine whether it has spread beyond the ampulla of Vater. These tests may include magnetic resonance cholangiopancreatography and computerized tomography, endoscopic ultrasound, endoscopic retrograde cholangiopancreatography, etc.
  • Testing cancer cells in the laboratory: During an endoscopic procedure or surgery, a tissue sample is taken and sent to the laboratory to look for characteristics that might guide the treatment and prognosis of the condition.

What are the stages of Ampullary cancer?

Ampullary cancer has been categorized into five stages:

  • Stage 0: There is no sign of cancer.
  • Stage 1: The tumor is present only in the inner layer of the small intestine.
  • Stage 2: The tumor at this stage has spread to the middle layer of the small intestine and possibly to the Sphincter of Oddi.
  • Stage 3: The tumor has now spread into the outer wall of the small intestine.
  • Stage 4: The tumor has spread from the small intestine to other organs like the pancreas or lymph nodes.

How is Ampullary cancer treated?

Treatment depends upon the type of ampullary cancer you have, the stage of cancer, and the patient’s age. Types of treatment for cancer can be either local or systemic:

  • Local treatments: These treatment options focus on removing, destroying, or controlling cancer cells in a specific area. Radiation therapy and surgery are local treatments.
  • Systemic treatments: These types of treatments destroy or control cancer cells that might have travelled all over the body. When taken by injection or pill, chemotherapy is a systemic treatment. You may be recommended a combination of treatments depending upon the severity of the condition.

The primary treatment for ampullary cancer is a surgery where the tumor is removed. The Whipple procedure is also called a pancreaticoduodenectomy. This is a major surgery where the surgeon removes cancer in the affected part of the ampulla of Vater. Tissue adjacent to the tumor site is often removed as well. These include the lower half of the stomach, the duodenum, the head of the pancreas, the gallbladder, and lymph nodes.

Patients who cannot have a Whipple procedure may need to undergo less complex surgery or another treatment procedure (such as using a laser to kill the cancer cells). Some doctors may also advise other treatments like chemotherapy or radiation therapy after surgery. The treatment options for ampullary cancer may include:

  • Surgical removal of the pancreas and small intestine: A Whipple procedure is also called a pancreaticoduodenectomy. It is done to treat cancer and various other pancreatic, bile duct, and intestine disorders. It is the most commonly used surgery to treat pancreatic cancer confined to the head of the pancreas. After performing the Whipple procedure, the surgeon reconnects the remaining organs to allow the digestion of food normally post-surgery. The Whipple procedure can be done as open or minimally invasive surgery.
  • Combined chemotherapy and radiation: Chemotherapy utilizes drugs to kill cancer cells, and radiation therapy utilizes energy beams, such as X-rays and protons to kill cancer cells. In the case of ampullary cancers, a combination of chemotherapy and radiation therapy may prove more effective.
  • Chemotherapy: Chemotherapy uses drugs that stop the cancer cells from multiplying, either by killing the cancer cells or by inhibiting them from multiplying. These drugs are administered through the vein or can be given in the form of pills.
  • Treatment to manage pain and discomfort: If other treatment methods aren't helping, your doctor may suggest treatments that make you more comfortable. Various other treatments like acupuncture, etc., help the person dealing with pain.

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