Ampullary Cancer

Ampullary cancer is a rare form of gastrointestinal cancer that forms in the ampulla of Vater.

Ampulla of Vater is a region in the duodenum where the bile duct and pancreatic duct join and open into the intestine.

Cancer in this region blocks the duct that drains bile into intestine, leading to jaundice. This is the most obvious feature of ampullary cancer. It is diagnosed by endoscopy.

Surgery is one of the most common treatment modality in this form of cancer.

If the cancer has spread to other parts, stenting helps to remove obstruction of the duct. Treatment of ampullary cancer has a good prognosis. 

Symptoms of ampullary cancer are caused by the obstruction of the duct that carries bile. Some of the common signs and symptoms of this cancer include

• Persistent or temporary jaundice
• Lack of appetite
• Weight loss
• Anemia with or without gastrointestinal bleeding
• Abdominal pain
• Nausea and vomiting
• Acute pancreatitis
• Fever
• Diarrhea
• Back pain

Indigestion and diarrhea are caused by lack of pancreatic enzymes that digest food in the intestine.

On physical examination, the gall bladder is felt as a distended bag.

Back pain is one of the symptoms of advanced stage of ampullary cancer.

The actual cause of Ampullary cancer is poorly understood.

Genetic factors play an important role in the development of ampullary cancer.

This cancer is found to be more common among patients with inflammatory bowel disease.

The risk of this cancer is more among patients with familial adenomatous polyposis.

Genetic mutations increase the chance of tumor growth.

Smoking and diabetes are also risk factors for ampullary cancer. 

Making a diagnosis of Ampullary cancer is done by Endoscopy, biopsy, and blood tests.

Patient history and physical examination help to check for major signs of cancer.

Blood tests

Anemia is one of the symptoms resulting from gastrointestinal bleeding. Anemia is detected by measuring the hemoglobin levels in blood. Blood tests also assess the functioning of liver. It measures serum bilirubin, alkaline phosphatase, amylase, and amino transferase levels, all of which are affected in ampullary cancer.

Urine analysis

This test is used to check for jaundice caused by obstruction of bile ducts.

Tumor markers

Increased levels of certain markers indicate presence of tumor. But, these markers are not specific for ampullary cancer.

Imaging studies

Ultrasound, MRI, CT scan, and chest X-ray helps to visualize the internal organs. Ultrasound helps to rule out chance of gallstones that block drainage of bile. It also helps to identify the stage of cancer. CT scans are used to visualize the signs around ampulla of Vater. MRI is the most sensitive imaging technique used to detect ampullary cancer.

Endoscopy

This procedure helps to obtain tissue sample for biopsy and also to visualize cancer in the region of ampulla.

Treatment is based on the size of the tumor and the stage of ampullary cancer.

Early stages of cancer and smaller sized tumors are removed by surgery. Large sized tumors and cancer that has spread to other regions are removed by Whipple procedure.

In this procedure, parts in and around the ampulla are removed. This includes lower parts of stomach, gall bladder, ending parts of common bile duct, head of pancreas, and upper part of small intestine.

In advanced stages of ampullary cancer, biliary stents are used to remove the obstruction of bile duct. Stents are placed in position through endoscopy or a skin incision.

It is still not clear whether chemotherapy or radiotherapy has significant effect in alleviating the symptoms of ampullary cancer. 

There are no known preventive measures for ampullary cancer, as the actual cause of the condition is not known.

Treating medical conditions that increase the risk of this cancer helps to prevent ampullary cancer to a certain extent. 

There is very limited knowledge about the alternative and homeopathic remedies of ampullary cancer, mostly due to its rarity. 

Support of family and friends during the different stages of cancer help the person to cope better with Ampullary cancer. 

Treatment of ampullary cancer has a good prognosis.

Pancreatic fistula, wound infection, hemorrhage, intra-abdominal abscess, and ulceration are some of the complications associated with Ampullary cancer.