Ampullary cancera disease where abnormal cells split without control and spread to other nearby body tissue and/or organs is a carcinomacancer arising from tissues that line organs that develops in the gastrointestinal tract. More specifically, it arises from the ampulla of Vater, which is a small opening where the bile and pancreatic ducts empty into the small intestinea section of the gastrointestinal tract that recieves food from the stomach and absorbs the nutrients from food, also called small bowel.
Ampullary cancer is a type of periampullary cancer. This is defined as a group of tumours that grow in close proximity to the ampulla of Vater in areas such as the pancreasa long, flat organ that sits between the stomach and the spine that plays a key role in digestion and blood sugar regulation, duodenum (the first segment of the small intestine) and the bile duct. However, unlike other periampullary cancers, symptoms of ampullary cancer tend to occur earlier in the disease and has a better prognosisto predict how a disease/condition may progress and what the outcome might be. It is also difficult to distinguish from other periampullary cancer preoperatively.
While it is most common in adults over 70 years old and is more prevalent in men, people of any gender can develop this disease at any age.
Treatment
If ampullary cancer is detected, it will be staged and graded based on size, metastasiswhen the cancer has spread to other parts of the body, also known as mets, and how the cancer cellsthe basic structural and functional unit of all living things look under the microscope. Stagingthe process of determining how big the cancer is, where it started and if it has spread to other areas and grading helps your doctors determine the best treatment for you.
Cancers can be staged using the TNM staging system:
- T (tumoura tissue mass that forms from groups of unhealthy cells) indicates the size and depth of the tumour.
- N (nodea small lump or mass of tissue in your body) indicates whether the cancer has spread to nearby lymph nodessmall bean-shaped structures that filters harmful substances from lymph fluid.
- M (metastasis) indicates whether the cancer has spread to other parts of the body.
This system can also be used in combination with a numerical value, from stage 0 – IV:
- Stage 0: this stage describes cancer cells in the place of origin (or ‘in situ’) that have not spread to nearby tissuea group of cells that work together to perform a function.
- Stage I: cancer cells have begun to spread to nearby tissue. It is not deeply embedded into nearby tissue and has not spread to lymph nodes. This stage is also known as early-stage cancer.
- Stage II: cancer cells have grown deeper into nearby tissue. Lymph nodes may or may not be affected. This is also known as localisedaffecting only one area of body cancer.
- Stage III: the cancer has become larger and has grown deeper into nearby tissue. Lymph nodes are generally affected at this stage. This is also classified as localised cancer.
- Stage IV: the cancer has spread to other tissues and organs in the body. This is also known as advancedat a late stage, far along or metastatic cancer.
Cancers can also be graded based on the rate of growth and how likely they are to spread:
- Gradea description of how abnormal cancer cells and tissue look under a microscope when compared to healthy cells I: cancer cells present as slightly abnormal and are usually slow growing. This is also known as a low-grade tumour.
- Grade II: cancer cells present as abnormal and grow faster than grade I cancers. This is also known as an intermediate-grade tumour.
- Grade III: cancer cells present as very abnormal and grow quickly. This is also known as a high-grade tumour.
Once your tumour has been staged and graded, your doctor may recommend genetic testinga procedure that analyses DNA to identify changes in genes, chromosomes and proteins, which can be used to analyse tumour DNA to help determine which treatment has the greatest chance of success, which analyses your tumour DNA and can help determine which treatment has the greatest chance of success. They will then discuss the most appropriate course of treatment for you.
Treatment is dependent on several factors, including location, stage of disease and overall health. There is no one treatment option for this type of cancer, due to the rarity of the disease.
Treatment options for ampullary cancer may include:
- Surgerytreatment involving removal of cancerous tissue and/or tumours and a margin of healthy tissue around it to reduce recurrence, potentially including pancreaticoduodenectomyremoval of part of the pancreas (generally the head), the first part of the small intestine (duodenum), part of the stomach, the gallbladder, and part of the common bile duct; also known as a Whipple procedure or Whipple procedureremoval of part of the pancreas (generally the head), the first part of the small intestine (duodenum), part of the stomach, the gallbladder, and part of the common bile duct; also known as a pancreaticoduodenectomy.
- Radiation therapya treatment that uses controlled doses of radiation to damage or kill cancer cells.
- Chemotherapya cancer treatment that uses drugs to kill or slow the growth of cancer cells, while minimising damage to healthy cells.
- Therapeutic embolisationa treatment that aims to reduce blood flow to the cancer and ultimately reduce cancer growth.
- Clinical trialsresearch studies performed to test new treatments, tests or procedures and evaluate their effectiveness on various diseases.
- Palliative carea variety of practices and exercises used to provide pain relief and improve quality of life without curing the disease.
Risk factors
Because of how rare ampullary cancer is, there are few identifiable riskthe possibility that something bad will happen factors for this disease. The risk factors that have been determined for this disease are:
- Being over 70 years of age.
- Being male.
- Inherited gastrointestinal conditions (such as familial adenomatous polyposis and hereditary nonpolyposis colorectalrelating to the colon or rectum in the large bowel/intestine cancer (Lynch syndrome)).
Not everyone with these risk factors will develop the disease, and some people who have the disease may have none of these risk factors. See your general practitioner (GP) if you are concerned.
Symptoms
The symptoms of ampullary cancer will vary depending on stage and whether the tumour has metastasised (spread to other parts of the body). Some of these symptoms include:
- Jaundiceyellowing of the skin and the whites of the eyes.
- Unexplained weight loss/loss of appetite.
- Abdominal and/or back pain.
- Pale, clay-coloured stools.
- Rectal bleeding.
- Fever.
- Nauseato feel sick or likely to vomit and/or vomiting.
- Pruritusitchiness, wanting to scratch.
- Diarrhoeafrequent discharge of watery or loose stools from the body.
- Pancreatitisinflammation of the pancreas.
Not everyone with the symptoms above will have cancer but see your GP if you are concerned.
Diagnosis
If your doctor suspects you have ampullary cancer, they may order the following tests to confirm the diagnosisthe process of identifying a disease based on signs and symptoms, patient history and medical test results and refer you to a specialist for treatment:
- Physical examinationan examination of your current symptoms, affected area(s) and overall medical history.
- Imagingtests that create detailed images of areas inside the body tests, potentially including:
- Ultrasounda type of medical imaging that uses soundwaves to create detailed images of the body .
- MRI (magnetic resonance imaging)a type of medical imaging that uses radiowaves, a strong magnet and computer technology to create detailed images of the body.
- CT (computed tomography) scana type of medical imaging that uses x-rays and computer technology to create detailed images of the body.
- Endoscopic ultrasoundan ultrasound taken during an endoscopy.
- Blood teststesting done to measure the levels of certain substances in the blood.
- Endoscopya procedure that involves inserting a long, flexible tube with a light and small camera (endoscope) into the body to view internal organs.
- Biopsyremoval of a section of tissue to analyse for cancer cells.
