Description

Ampullary cancer is cancer that begins as a growth of the cells in the ampulla of Vater. The ampulla of Vater is located where your bile duct and pancreatic duct join and empty into the small intestine. Ampullary (AM-co-la-ree) cancer is rare.

Ampullary cancer forms near many other parts of the digestive system. This includes the liver, the pancreas and the small intestine. When ampullary cancer grows, it may affect these other organs.

Ampullary cancer treatment often involves surgery to remove the cancer. The treatment may also include radiation therapy and chemotherapy to kill cancer cells.

Symptoms

The signs and symptoms of cancer ampullary may include:

  • Yellowing of the skin and whites of the eyes, called jaundice.
  • The diarrhea.
  • Clay-colored stools.
  • The Abdominal pain.
  • Fever.
  • Blood in the stool.
  • Nausea.
  • Vomiting.
  • The loss of weight.

When to see a doctor

Make an appointment with a doctor or other health care professional if you have any persistent symptoms that worry you.

Causes

It is not clear what causes the cancer ampullary.

Ampullary cancer occurs when the cells in the ampulla of Vater develop changes in their DNA. A cell's DNA contains the instructions that tell a cell what to do. In healthy cells, the DNA contains the instructions to grow and multiply at a set rate. The instructions that tell cells to die at a set time. In cancer cells, changes that are given different instructions. The changes, to tell the cancer cells to make many more cells quickly. Cancer cells can continue living when healthy cells would die. This makes too many cells.

The cancer cells may form a mass called a tumor. The tumor can grow to invade and destroy healthy body tissue. At the time, cancer cells can break off and spread to other parts of the body. When cancer spreads, it is called metastatic cancer.

Risk factors

Factors that may increase the risk of cancer ampullary include:

  • The increase of the age. Ampullary cancer is more common in adults older than 70 years.
  • The changes in the DNA that are run in families. Some changes in the DNA that is passed from parents may increase your risk of cancer ampullary and other types of cancer. Examples include changes in DNA that are associated with Lynch syndrome, familial adenomatous polyposis, also called FAP and peutz-jeghers syndrome.

There is no way to prevent the cancer ampullary.

Diagnosis

Tests and procedures used to diagnose cancer ampullary include:

Pass a thin, flexible tube through the throat, which is called endoscopy

Endoscopy is a procedure to examine the digestive system. Using a long, thin tube with a small camera, called an endoscope. The endoscope passes through the throat to the stomach and in the small intestine. Allows the health care team to see the ampulla of Vater.

The special tools can be passed through the endoscope to collect a sample of tissue for analysis.

Endoscopy can also be used to create images. For example, endoscopic ultrasound can help in capturing images of cancer ampullary.

Sometimes a dye is injected into the bile duct through endoscopy. This procedure is called an endoscopic retrograde cholangiopancreatography. The dye shows up on x-rays. It can help to look for blockages in the bile duct or the pancreatic duct.

Imaging tests

Imaging tests create pictures of the body. You can show the location and size of ampullary cancer. Imaging tests can help health professionals to understand more about cancer and to determine if it has spread beyond the ampulla of Vater.

Imaging tests may include:

  • Endoscopic ultrasound.
  • Endoscopic retrograde cholangiopancreatography.
  • Magnetic resonance cholangiopancreatography.
  • Computed tomography.

The removal of a sample of tissue for testing, called a biopsy

A biopsy is a procedure to remove a sample of tissue for testing in a lab. The sample is analyzed in a laboratory to see if it is cancer. Other special tests to give more details on the cancer cells. Health care teams use this information to make a treatment plan.

Treatment

Ampullary cancer treatment often begins with surgery to remove the cancer. Other treatments may include chemotherapy and radiation. These treatments may be performed before or after surgery. The best treatment for your cancer ampullary depends on several factors. These include the size of the cancer, your overall health and your preferences.

Surgery

Surgical options may include:

  • The surgery to remove the cancer and nearby structures. The Whipple procedure, also known as a pancreaticoduodenectomy, involves the removal of the cancer by removing the head of the pancreas. The surgeon also removes a portion of the small intestine, gallbladder, and part of the bile duct. The Whipple procedure can be done through a large incision in the abdomen. You can also make use of a number of small incisions.
  • Surgery for very small cancers. For very small ampullary cancers and pre-cancerous tumors, it may be possible to remove the cancer with tools that passes through an endoscope. This is called endoscopic sinus surgery.
  • The surgery for the placement of a stent. Sometimes the goal of surgery is to make you feel more comfortable. If you have jaundice, surgery may be used to place a small wire mesh tube, called a stent in the bile ducts. This tube helps drain the fluid that causes a yellowing of the skin and eyes.

Other treatments

Other treatments may be used, including:

  • Combined chemotherapy and radiation therapy.Chemotherapy treats the cancer with strong medications. Radiation therapy treats cancer with powerful rays of energy. The energy can come from X-rays, protons or other sources. Used together, these treatments can be more effective for the cancer ampullary. Combined chemotherapy and radiation may be used before surgery, to make it more likely that a cancer can be completely removed during an operation. The combined treatment also may be used after surgery to destroy any cancer cells that may remain.
  • The chemotherapy alone. Chemotherapy is sometimes used after surgery to destroy any cancer cells that may remain. In people with advanced ampullary cancer, chemotherapy may be used alone to slow the growth of cancer.
  • The targeted therapy. Targeted therapy uses drugs that attack specific chemicals in cancer cells. By blocking these chemicals, specific treatments can cause cancer cells to die. Targeted therapy is used for the treatment of ampullary cancer that spreads to other parts of the body or comes back after treatment. It is only used in certain situations.
  • Immunotherapy. Immunotherapy is a treatment with a drug that helps the immune system destroy cancer cells. The immune system fights diseases by attacking the germs and other cells that should not be in the body. Cancer cells survive by hiding from the immune system. Immunotherapy helps the cells of the immune system find and kill cancer cells. May be an option for the treatment of ampullary cancer that spreads to other parts of the body or comes back after treatment. Immunotherapy is used only in certain situations.

Combined chemotherapy and radiation therapy. Chemotherapy treats the cancer with strong medications. Radiation therapy treats cancer with powerful rays of energy. The energy can come from X-rays, protons or other sources. Used together, these treatments can be more effective for the cancer ampullary.

Combined chemotherapy and radiation may be used before surgery, to make it more likely that a cancer can be completely removed during an operation. The combined treatment also may be used after surgery to destroy any cancer cells that may remain.

Palliative care

Palliative care is a special type of health care that helps you feel better when you have a serious illness. If you have cancer, palliative care can help relieve the pain and other symptoms. A health care team that may include doctors, nurses and other specially trained health professionals providing palliative care. The care team's goal is to improve the quality of life for you and your family.

Palliative care specialists work with you, your family and your care team. They provide an extra layer of support, while you have cancer treatment. You can have palliative care at the same time that you are getting strong cancer treatments, such as surgery, chemotherapy or radiation therapy.

The use of palliative care with other treatments can help people with cancer feel better and live longer.

Coping and support

With time, you will find what helps you to deal with the uncertainty and distress of a cancer diagnosis. Until then, you can find help for:

  • Learn enough about the cancer ampullary to make decisions about your care. Ask your health care team about your cancer, including your test results, treatment options, and, if you like, your prognosis. As you learn more about ampullary cancer, you can be more confident in making treatment choices.
  • Keep friends and family close. Keep your close relationships strong will help you deal with your cancer ampullary. Friends and family can provide the practical support you need, such as help to take care of your house if you're in the hospital. And that you can serve as emotional support when you feel overwhelmed by the fact of having cancer.
  • Find someone to talk to.Find someone who is willing to listen to you talk about your hopes and fears. This can be a friend or family member. The concern and understanding of a counselor, medical social worker, clergy member or cancer support group may also be useful. Ask your health care team about support groups in your area. Other sources of information are the National Cancer Institute and the American Cancer Society.

Find someone to talk to. Find someone who is willing to listen to you talk about your hopes and fears. This can be a friend or family member. The concern and understanding of a counselor, medical social worker, clergy member or cancer support group may also be useful.

Ask your health care team about support groups in your area. Other sources of information are the National Cancer Institute and the American Cancer Society.

Preparing for your appointment

Make an appointment with a doctor or other health care professional if you have any symptoms that worry you.

If your healthcare provider thinks you might have cancer, ampullary, you may be referred to a specialist. This could be a doctor who specializes in the treatment of diseases and conditions of the digestive system, called a gastroenterologist. If a diagnosis of cancer, you may also be referred to a doctor who specializes in the treatment of cancer. This doctor is called an oncologist.

Because appointments can be brief, it is a good idea to be prepared. Here's some information to help you prepare.

What you can do

  • Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there is anything that you need to do in advance, such as restrict your diet.
  • Write down any symptoms you're experiencing, including any that do not seem to be related to the reason for which you scheduled the appointment.
  • Write down key personal information, including major stresses or recent life changes.
  • Make a list of all medications, vitamins or supplements you are taking and the dose.
  • Have a family member or friend. Sometimes it can be difficult to remember all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.
  • Write questions to ask their health care team.

Your time with your health care team is limited, so preparing a list of questions can help you make the most of their time together. A list of questions from most important to least important in case time runs out. For ampullary cancer, some basic questions to ask include:

  • What is likely causing my symptoms?
  • Other that the most likely cause, what are other possible causes of the symptoms?
  • What tests do I need?
  • What is the best course of action?
  • What are the alternatives to the primary approach you're suggesting?
  • I have other health conditions. How can I best manage them together?
  • There are restrictions that must be followed?
  • You should see a specialist?
  • Are there brochures or other printed material I can have? What sites do you recommend?

Do not hesitate to ask other questions.

What to expect from your doctor

Be prepared to answer questions, such as:

  • When did your symptoms begin?
  • The symptoms been continuous or occasional?
  • How severe are the symptoms?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?
Symptoms and treatment of cancer Ampullary