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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.
