Presentation of ampullary cancer
Ampullary cancer is a cancer that arises from the Ampulla Vater. The Ampulla Vater is a nipple like projection into the duodenum (the first portion of the intestine) into which the pancreatic and bile ducts open. All of the pancreatic and biliary secretion enter the duodenum through the Ampulla Vater.
Blockage of the Ampulla Vater by the tumor leads to obstruction of drainage of the pancreatic and biliary secretions into the intestine. Blockage of drainage of bile into the duodenum leads to the development of jaundice; since the bile cannot drain into the intestine it accumulates into the bloodstream causing yellowness of the skin.
Patients with ampullary cancer typically present with obstructive jaundice. Frequently the patient will undergo an endoscopy or an ERCP at which time an ulcerating tumor will be identified at the ampulla. The workup for an ampullary cancer at USC is similar to that for pancreatic cancer. This link will take you to the page that describes the work up of an ampullary cancer
Premalignant lesions that may give rise to an ampullary cancer
In patients with an ampullary cancer, a pre-existing benign adenoma (growth of the ampulla Vater) is often found. The incidence of this adenoma is higher in patients who have inflammatory bowel disease. This adenoma, often called a villous adenoma, should be completely excised to prevent future cancerous change in this tumor.
A villous adenoma may be excised by surgical or endoscopic techniques. Small villous adenomas can be snared during endoscopy. It is important though that the gastroenterologist is able to completely excised to tumor. If remnants of the tumor are left behind then these may undergo malignant change in the future.
Surgical resection of the adenoma is required if the tumor is not amenable to removal by endoscopic techniques. At USC we offer a specialized organ preserving procedure in which the tumor is completely excised in the duodenum and the bile and the pancreatic ducts are then reimplanted into the duodenum. As a consequence of this type of surgery, more radical operations such as a Whipple operation is avoided for these benign (non-cancerous) lesions.
Treatment of ampullary cancer
The surgical treatment for ampullary cancer is a pylorus preserving Whipple operation. Ampullary tumors are associated with an excellent prognosis and if the tumor is limited to the duodenal mucosa without any invasion into the adjacent pancreas then the five-year survival may be as high as 90 percent.
At USC we have developed a laparoscopic procedure for the Whipple operation that we offer to selected patients with an ampullary cancer where the cancer is limited to the wall of the intestine without any invasion into the surrounding pancreas. Laparoscopic surgery utilizes minimally invasive techniques and is associated with a much more rapid recovery, diminish requirements for pain medication in the postoperative period and early return to work compared to conventional open surgery.
Because of the excellent prognosis associated with an ampullary cancer, aggressive surgical treatment should be offered to the patient at a center that performs a high volume of pancreatic surgery and the Whipple operation.