Learn Ampullary Cancer symptoms, cause, and treatment. Ampullary Cancer is rare cancer that occurs in a body area that connects the common bile duct and pancreatic duct to the small intestine, known as the Ampulla of Vater.
Ampulla of Vater regulates the flow of pancreatic juice and bile into the intestine through contraction and relaxation of the sphincter of Oddi, the sphincter located at this junction. A patient with ampullary cancer suffers from jaundice, weight loss, nausea, loss of appetite and itching.
Ampullary cancer can be classified into two further types on the basis of their origin. One is true ampullary cancer that originates from the ampulla of Vater while the other is known as Periampullary cancers. Both originates from the pancreas, bile duct, or intestines close to the ampulla of Vater.
Some studies indicate that patients with ampullary cancers survival rates are better than those with periampullary cancer. Most patients with ampullary cancer present with jaundice. The tumor obstructs the flow of pancreatic and biliary juices into the intestine. This results in the development of a type of jaundice called obstructive jaundice.
Genetic factors play a major role in the development of ampullary cancer. In addition to this, there are other factors like cigarette smoking and presence of certain diseases could increase the risk of ampullary cancer.
Diagnosis of ampullary cancer is based on various tests including imaging studies, endoscopy, and biopsy. The cancer is then staged to determine the prognosis of the patient. Sometimes surgery is enough to remove it completely. In other cases, cancer may be difficult to remove due to its spread.
Ampullary Cancer Symptoms, Cause and Treatment
Ampullary Cancer is very rare and known as a cancer of the ampulla of Vater. Below you can find the causes, symptoms, and treatments of it. So keep reading.
Causes of Ampullary Cancer
Following are some important causes of Ampullary Cancer. In presence of following factors , risk of Ampullary Cancer increases to many folds, they include:
- Genetic factors appear to play a major role in the development of ampullary cancer. Patients with familial adenomatous polyposis have an increased risk of suffering from ampullary cancer. The incidence is higher in patients who have inflammatory bowel disease.
- Genetic alterations like K-ras mutations, mutations in tumor suppressor genes such as p53 DPC4/SMAD4, transforming growth factor-â-receptor-II (growth factor receptor TGF-âR-II) are associated with ampullary cancer.
- At the chromosomal level, loss of alleles of chromosome 17p and 18q are associated with ampullary cancer (55% and 36%).
- Other factors like cigarette smoking and diabetes mellitus may be associated with ampullary cancer.
Ampullary Cancer Symptoms and Signs
Symptoms of ampullary cancer occur due to obstruction to the flow of the pancreatic and biliary secretions into the intestine. They include:
- Intermittent or persistent jaundice
- Loss of appetite
- Weight loss
- Anemia with or without symptoms of bleeding from the digestive tract
- Abdominal pain
- Nausea and vomiting
- Acute pancreatitis
- Back pain, which may be a sign of advanced stage
- Diarrhea, which may be due to lack of pancreatic enzymes in the gut to digest the food.
Ampullary Cancer Diagnose
There are different techniques which are used to diagnose Ampullary cancer including imaging techniques, endoscopy, and biopsy. The diagnoses are based on patient history, physical examination, blood tests, endoscopy and non-invasive imaging studies. Following are some important techniques:
- Blood tests are usually used to estimation of hemoglobin content which can detect anemia caused by bleeding from the digestive tract.
- Liver function tests which include serum bilirubin, amylase, alkaline phosphatase and aminotransferase levels, and coagulation profile. The liver functions are affected in ampullary cancer.
- Urine tests indicate obstructive jaundice.
- Tumor markers are certain substances released into the blood that not surely but may indicate the presence of a particular tumor. Like carbohydrate antigen 19-9 (CA 19-9) may be elevated in ampullary cancer. Carcinoembryonic antigen (CEA) levels increase; however, it is elevated in other digestive tract cancers as well.
Ultrasound, CT scans and MRI with magnetic resonance help to rule out gallstones.
- Endoscopicultrasonography (EUS) is found to be a more sensitive tool for diagnosis and staging of ampullary cancer and can identify tumors less than 1 cm size. Endoscopy can be used to directly visualize cancer and obtain a biopsy sample.
Ampullary Cancer Treatment
Surgery is the primary treatment for ampullary cancer. Advanced cases may be treated with stents and palliative treatment. Treatment is largely based on the size and stage of the tumor. If an ampullary tumor is large in size or has spread, Whipple procedure is carried out. In this procedure, the lower half of the stomach, gallbladder, distal common bile duct, head of the pancreas, the upper parts of the small intestines and regional lymph nodes are removed. The remaining part of the stomach, biliary tree, and pancreas are attached to the cut end of the small intestine.