AMPULLARY CANCER

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Know more about Ampullary Carcinoma

Definition of Ampullary Carcinoma

Ampullary Carcinoma is a type of cancer, that occurs in a specialized area of your digestive tract, the Ampulla of Vater. The ampulla is where the bile duct and pancreatic duct join to open into the duodenum – the initial segment of small intestine. Thus ampullary cancer can arise from any of the tissues of the bile duct, pancreatic duct or the duodenum and accordingly the behavior of these cancers varies based on the tissue of origin.

Causes of Ampullary Cancer

These are the following reasons, by which this particular cancer is formed in your body

  • Genetic - Few people have one of their family members affected with pancreatic or other types of cancer. Its basically due to different types of mutations affecting different genes.
  • Cigarette smoking - Risk of pancreatic cancer increases with number of cigarettes smoked per day and duration of smoking.
  • Age factor – Elderly people above 60 years have an increased risk of developing pancreatic cancer.
  • Obesity and sedentary lifestyle – Excess body weight is one of the major risk factors, and this combined with sedentary life style increases the risk of pancreatic and few other forms of cancer.
  • Diet – A diet high in fruits and vegetables is considered protective against most forms of cancer and a diet high in smoked and processed fat and meat has a particularly high risk of cancer.
  • Familial adenomatous Polyposis - A disorder characterized by polyps within the intestines, and at the ampulla, with increased risk of intestinal cancer and ampullary cancer as well.

Symptoms of Ampullary Cancer

Some of the common symptoms seen in patients with ampullary cancer include

  • Loss of appetite and loss of weight
  • Jaundice – Yellowish discoloration of skin, eyes and urine
  • Pale / clay colored stools
  • Tarry stools
  • Nausea, vomiting
  • Fever , chills
  • Upper abdomen pain that radiates towards the back
  • Fatigue

Diagnosis

Apart from a thorough history and physical examination, following tests may need to be done in a patient with suspected ampullary cancer. They include

Blood tests

Blood tests will reveal anemia due to blood loss, and will show abnormalities like elevated Bilirubin – marker of jaundice and increased levels of enzymes related to the liver like SGOT, SGPT and ALP. A marker of pancreatic or bile duct cancer is a protein named CA 19.9 which may be elevated in most cases

Imaging tests

Common imaging tests that a physician uses to diagnose ampullary cancer include – USG abdomen, CT scan abdomen and MRI. These tests will provide information regarding the size of the tumour. They will also let your physician know if the disease is early or fairly advanced and whether any surgical cure is possible.

Endoscopic Ultrasound and Biopsy

This is again an endoscopic procedure, where in your physician passes a long tube down your throat, and it traverses to the part of your gut – the duodenum. This tube is fitted with a camera and mini ultrasound probe at its tip, thus can help in proper visualization of the area of involvement by the cancer and local extent of the disease. This is Endoscopic Ultrasound scan. A needle or forceps can simultaneously be used to take biopsies from suspicious areas.

Treatment options

Surgery is the primary option, for you to get rid of ampullary cancer.Whipple’s procedure – This major surgery involves removal of the head of the pancreas along with the adjacent duodenum, lower aspect of bile duct, a portion of stomach and surrounding lymph nodes. The remaining structures are reconstructed back.Ampullectomy – This procedure usually reserved for elderly patients involves removal of the ampulla only and is done if the tumour is in early stages.The physician may consider using plastic stents to relieve jaundice if tumour is fairly advanced or to relieve jaundice temporarily before surgery.Chemotherapy or Radiation therapy may also be used after surgery or before surgery depending on the stage and size of the tumour .

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