Ampullary cancer

Ampullary cancer is a rare gastrointestinal cancer of the ampulla of Vater, an area where the bile duct and pancreatic ducts join and empty into the small intestine. Ampullary cancers are often confused with periampullary cancers that originate in the pancreas, bile duct, or intestines close to the ampulla of Vater. Ampullary cancers have better survival rate than periampullary cancers.

Causes

  • Genetic factors play a significant role in the ampullary cancer development. Patients with adenomatous polyposis and inflammatory bowel disease are at increased risk of suffering from ampullary cancer.
  • Alterations in genes such as K-ras mutations, mutations in tumor suppressor genes such as p53 DPC4/SMAD4, are associated with ampullary cancer.
  • Loss of alleles of chromosomes 17p and 18q contribute to 55% to 36% of ampullary cancer cases.

Risk factors

Smoking, history of health conditions primarily related to the gastrointestinal system, and diabetes mellitus increases the risk of ampullary cancers.

When to seek medical advice?

Consult your doctor when you experience:

  • Severe chest pain
  • Shortness of breath
  • Unable to get out of bed for more than 24 hours
  • Blood in stools or vomiting

Complications

The complications depend on the severity of the disease. The possible complications are bleeding, nausea, and vomiting.

Jaundice is the most common ampullary cancer symptom. This is because the tumor blocking the ampulla of Vater interferes with drainage of the pancreatic and biliary secretions into the intestine, resulting in accumulation of bile in the blood stream. The other symptoms of ampullary cancer include:

  • Loss of appetite and weight loss
  • Severe abdominal and back pain
  • Gastrointestinal bleeding which may lead to anemia
  • Pruritus (skin itchiness), associated with jaundice
  • Nausea, vomiting, and diarrhea
  • Pancreatitis (inflammation of the pancreas)
  • Pale, greasy stools
Ampullary cancers account for 0.2% of tumors of gastrointestinal tract

The doctors provide appropriate treatment depending on the size and stage of your tumor.

Surgery : If the tumor is large and has spread to other parts, Whipple procedure may be recommended. In this surgical technique, the lower part of the stomach that includes gall bladder, distal common bile duct, head of the pancreas, the upper part of the small intestine and regional lymph nodes are removed. The other part of the stomach that includes biliary tree, and pancreas are attached to the cut end of the small intestine.
Chemotherapy : This is usually recommended when surgery does not manage the condition in case of severe cancer. Fluorouracil is the drug of choice for high-risk tumors of the ampulla of Vater.

To relieve jaundice caused due to obstruction of cancer, biliary stents are placed endoscopically or through skin incisions.

Radiotherapy is usually not recommended for this type of cancer.

The 5-year survival rate has reported with up to 30% to 50% of the patients which is greater than pancreatic cancer

Jaundice is the most common symptom that leads the doctors to look for ampullary cancer as a possibility. The diagnosis of ampullary cancer is based on patient history and physical examination.

Tests and procedures for diagnosing ampulalry cancer include:

Blood tests

These are usually used to estimate the hemoglobin content which can detect anemia caused by gastrointestinal bleeding.

Liver function tests

The tests help to determine the levels of serum bilirubin, alkaline phosphatase, and aminotransferase as these levels are affected by ampullary cancer.

Urine analysis

These tests indicate obstructive jaundice.

Endoscopy

A thin flexible tube which has a fiber-optic video camera is passed down your throat, into your esophagus and stomach and also into the duodenum to look at the ampulla directly. In some cases, the sample is also taken to look for the cancer cells.

Endoscopicultrasonography is the more sensitive tool for diagnosis of Ampullary cancer and it detects the tumors less than 1 cm size.

Tumor markers

TThese are substances released into the blood that may (not surely) indicate the presence of a particular tumor.

Imaging studies

Ultrasound, CT scan, and MRI scan are used to determine the presence of gallstones.

Tips that help in coping with ampullary cancer

  • Balance rest and activities
  • Plan your important activities when your energy levels are high
  • Eat a balanced diet that includes proteins such as fish, meat, eggs, cheese, milk, and nuts.
  • Drink about 8 to 10 glasses of water per day. You can even take fruit juices, but not ALCOHOL.

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