What is Ampullary Carcinoma?

Ampullary carcinoma, also called carcinoma of the ampulla of Vater, is a type of malignant tumor which develops in a section of bile duct. This section is called the ampulla of Vater, and is located at the end of the duct which is shared by the gallbladder and pancreas. This duct empties into the duodenum of the small intestine. Ampulla carcinoma is uncommon; 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 which empties into the duodenum. If the tumor grows large enough, it may partially or fully 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 or she may also feel unable or unwilling to eat. Many of these symptoms are the result of the build-up of bilirubin. A physical examination may show that the gallbladder is enlarged and distended, and ultrasound will pinpoint the location of 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 jejunum of the small intestine, part of the common bile duct, and parts of the pancreas. In addition, the lymph nodes adjacent to this area may be removed.

Additional treatments for ampullary carcinoma include chemotherapy and radiation therapy. These therapies are commonly employed as adjuvant therapies following surgery. An adjuvant therapy is one which is used to enhance the efficacy of a primary treatment. In this case, radiation therapy or chemotherapy is used as an adjuvant treatment to kill any cancer cells which remain in the body after surgery. Alternatively, these therapies may be used as stand-alone treatments for patients who are not good candidates for surgery.

Pancreaticoduodenectomy is an invasive procedure which puts 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 post-operative patient care, this figure is now as low as 5%.

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