Periampullary cancer

Cancer that forms near the ampulla of Vater

Overview

Diagram of the biliary system, showing the location of the ampulla of Vater.

Periampullary cancer refers to a group of malignancies that arise in the region of the ampulla of Vater, where the bile duct and pancreatic duct empty into the duodenum. This area is anatomically complex and includes the distal bile duct, the ampulla itself, the duodenum, and the head of the pancreas.

Types

Periampullary cancers can be classified based on their origin:

• Ampullary cancer: Originates from the ampulla of Vater.
• Pancreatic cancer: Specifically, cancers arising from the head of the pancreas.
• Distal bile duct cancer: Arises from the distal portion of the bile duct.
• Duodenal cancer: Originates from the duodenum near the ampulla.

Symptoms

The symptoms of periampullary cancer can vary depending on the specific location and type of cancer, but common symptoms include:

• Jaundice: Yellowing of the skin and eyes due to bile duct obstruction.
• Abdominal pain: Often in the upper abdomen or back.
• Weight loss: Unintentional and significant.
• Nausea and vomiting.
• Pruritus: Itching due to bile salt accumulation.

Diagnosis

Diagnosis of periampullary cancer typically involves a combination of imaging studies and endoscopic procedures:

• Endoscopic retrograde cholangiopancreatography (ERCP): Allows for direct visualization and biopsy of the ampulla.
• Magnetic resonance cholangiopancreatography (MRCP): Non-invasive imaging of the bile and pancreatic ducts.
• Computed tomography (CT) scan: Provides detailed images of the abdomen.
• Endoscopic ultrasound (EUS): Useful for assessing the extent of the tumor and obtaining tissue samples.

Treatment

The primary treatment for periampullary cancer is surgical resection, often involving a procedure known as the Whipple procedure (pancreaticoduodenectomy). This surgery involves the removal of the head of the pancreas, the duodenum, the gallbladder, and part of the bile duct.

Adjuvant therapies may include:

• Chemotherapy: To target any remaining cancer cells post-surgery.
• Radiation therapy: Sometimes used in conjunction with chemotherapy.

Prognosis

The prognosis for periampullary cancer varies depending on the type and stage of the cancer at diagnosis. Generally, ampullary cancers have a better prognosis compared to pancreatic cancers due to earlier presentation and resectability.

Related pages

• Pancreatic cancer
• Bile duct cancer
• Duodenal cancer
• Jaundice