Ampullary carcinoma is a rare malignant tumor that develops in the bile duct’s ampulla of Vater. Symptoms include jaundice, nausea, vomiting, and weight loss. Treatment involves surgery, chemotherapy, and radiation therapy, but surgery can lead to complications.
Ampullary carcinoma, also called ampulla of Vater carcinoma, is a type of malignant tumor that develops in a section of the bile duct. This section is called the ampulla of Vater and is located at the end of the duct that is shared by the gallbladder and pancreas. This duct flows into the duodenum of the small intestine. Ampulla carcinoma is rare; in the United States, for example, only 0.2% of all gastrointestinal cancers are of this type.
Many symptoms of ampullary carcinoma develop due to blockage of the duct that flows into the duodenum. If the tumor becomes large enough, it can partially or completely block the duct, preventing the flow of bile through the duct. This in turn causes a bile pigment called bilirubin to build up in the body.
A person with ampullary carcinoma will typically experience symptoms such as nausea, vomiting, jaundice, diarrhea, fever, and weight loss. He may also feel unable or unwilling to eat. Many of these symptoms are the result of bilirubin buildup. A physical exam may show that the gallbladder is enlarged and distended, and ultrasound will pinpoint the location of the bile duct blockage.
The standard treatment for ampullary carcinoma is a type of surgery called a pancreaticoduodenectomy or a Whipple procedure. During this surgery, the gallbladder is removed, along with portions of the small intestine jejunum, part of the common bile duct, and parts of the pancreas. Also, lymph nodes adjacent to this area can be removed.
Additional treatments for ampullary carcinoma include chemotherapy and radiation therapy. These therapies are commonly employed as adjuvant therapies after surgery. An adjuvant therapy is one used to improve the effectiveness of a primary treatment. In this case, radiation therapy or chemotherapy is used as an adjuvant treatment to kill any cancer cells that remain in the body after surgery. Alternatively, these therapies can be used as stand-alone treatments for patients who are not good candidates for surgery.
Pancreaticoduodenectomy is an invasive procedure that subjects the patient to considerable physical stress. For this reason, the mortality rate has been historically high, with up to 20% of patients dying after surgery. Due to improvements in surgical practices and post-operative patient care, this figure is now reduced to 5%.
About 65% of patients experience complications after surgery. Possible complications of the surgery include pneumonia, abdominal infection, and development of abscesses. Some people can develop diabetes, pancreatic dysfunction, or gastrointestinal dysfunction. These conditions are not possible immediate consequences of surgery, but can develop over the following months and years.
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