What is ampullary carcinoma?

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 empties into the duodenum of the small intestine. Blister 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 as a result of blockage of the duct that empties into the duodenum. If the tumor grows large enough, it can partially or completely block the duct, preventing the flow of bile through the duct. This in turn causes a build up of a bile pigment called bilirubin in the body.

A person with ampullary carcinoma will typically experience symptoms such as nausea, vomiting, jaundice, diarrhea, fever, and weight loss. He or she 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 determine the location of the bile duct blockage.

The standard treatment for ampullary carcinoma is a type of surgery called pancreaticoduodenectomy either Whipple's procedure . During this surgery, the gallbladder is removed, along with portions of the small intestine's jejunum, part of the common bile duct, and parts of the pancreas. In addition, lymph nodes adjacent to this area may be removed.

Additional treatments for ampullary carcinoma include chemotherapy and radiation therapy. These therapies are commonly used as adjunctive therapies after surgery. An adjuvant therapy is one that is used to improve the effectiveness of a primary treatment. In this case, radiation therapy or chemotherapy is used as adjuvant treatment to kill 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 places considerable physical stress on the patient. For this reason, the mortality rate has historically been high, with up to 20% of patients dying after surgery. Due to improvements in surgical practices and postoperative patient care, this figure is now as low as 5%.

About 65% of patients experience complications after surgery. Possible complications of surgery include pneumonia, abdominal infection, and abscess development. Some people may develop diabetes, pancreatic dysfunction, or gastrointestinal dysfunction. These conditions are not possible immediate consequences of the surgery, but may develop in the months and years that follow.

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