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The ampulla of Vater is the site where the pancreatic duct and bile duct join and drain into the small intestine. Cancer generally starts from the DNA mutation of the normal cells. The mutation of cell causes uncontrolled duplication resulting in a formation of a mass of cells also known as a tumor. This tumor then begins to invade and destroy the healthy tissues. Ampullary cancer is a rare form of cancer and its cause is unknown. It can affect other nearby organs in the digestive system, including liver, pancreas and small intestine.
Signs and symptoms
The following are the signs and symptoms of ampullary cancer:
- Jaundice (yellowish discoloration of the skin and eyes) is the most common symptom due to cancerous mass compressing the bile duct and causing the blockage.
- Fever
- Nausea or vomiting
- Abdominal pain
- Weight loss
- Pale/ clay-colored stool
- Rectal bleeding
If you have any of these signs and symptoms and it worries you, please consult a doctor.
Risk factors
The following are the risk factors of ampullary cancer:
- Old age. Common in people older than 70 years old
- Gender. Men are more prone to having ampullary cancer.
- Some inherited syndromes. Familial disorders may pose an increased risk of developing ampullary cancer such as familial adenomatous polyposis and Lynch syndrome (also called hereditary nonpolyposis colorectal cancer).
Diagnosis
The following procedure can diagnose ampullary cancer:
- Endoscopy. An investigation consisting of a flexible thin tube connected to a tiny camera which will be inserted into a patient’s mouth passing through the esophagus and stomach, and into the duodenum to look at the ampulla of Vater. The endoscopy may also be used to insert surgical instruments and take a sample of body tissue for examination under a microscope to check for cancer. To find the blockage, the doctor may inject the dye into the bile duct through the procedure called Endoscopic Retrograde Cholangiopancreatography (ERCP), then use X-rays to watch the flow of the dye to see where the blockage is.
- Imaging tests. Various types of imaging such as endoscopic ultrasound, endoscopic retrograde cholangiopancreatography (ERCP), magnetic resonance cholangiopancreatography (MRCP) and computerized tomography (CT) scan may be done as diagnostic tests to create images of the ampulla of Vater and measure if the ampullary cancer has spread or not.
- Testing cancer cells in the laboratory. Using an endoscopy or by doing surgery, a sample of the cancer cells will be removed and checked in the laboratory to study its characteristics to provide proper treatment and determine the prognosis.
Treatment
Treatment options for ampullary cancer are as follows:
- Surgery. The Whipple procedure (also called a pancreaticoduodenectomy) is an operation which will remove the head of the pancreas, the duodenum (the primary part of small intestine), the gallbladder and portions of the bile duct. This surgery can be done by creating a big abdominal incision or by a smaller incision (minimally invasive surgery).
- Minimally invasive surgery. If the ampullary cancer and precancerous tumors are small, it can be done endoscopically by inserting surgical instruments through the endoscope and reach for the affected area.
- Combined chemotherapy and radiation. Combining chemotherapy (using drugs to kill cancer cells) and radiation therapy (uses energy beams like protons and X-rays to kill cancer cells) may be a more effective treatment option for ampullary cancer. They can be utilized prior to surgery to make sure that cancers are completely eradicated during surgery, or after surgery to destroy remaining cancer cells.
- Chemotherapy Usually done after surgery to destroy remaining cancer cells. In situations where the ampullary cancer is already in its advanced stage, chemotherapy is used to slow down cancer growth.
- Treatment to reduce pain and discomfort. To be able to make you feel more comfortable and manage the pain is the main goal when other treatments have failed. One option to achieve this goal is by surgically installing a stent (small tube) in your bile duct to prevent the tube from collapsing hence this will reduce jaundice and other symptoms.
