Ampullary Cancer

Ampulla of Vater

The liver, gallbladder and pancreas produce important fluids to help you digest food. These fluids are carried through the common bile duct to the small intestine. The last centimetre of the common bile duct is called the Ampulla of Vater.

Ampullary Cancer

Ampullary cancer begins when normal cells in the Ampulla of Vater change and start to grow out of control. A mass of cells can form called a tumour.

At first, the cells are precancerous, meaning they are abnormal cells but not cancer yet. If the precancerous cells change into cancer or malignant cells, they can spread deeper or to other areas in the body. This condition is called ampullary cancer.

A tumour blocking the Ampulla of Vater can interfere with fluids entering the small intestine. Because these fluids (such as bile) can build up in your blood, they can cause jaundice or yellow skin.

Symptoms of Ampullary Cancer

• Weight loss
• Nausea or vomiting
• Jaundice (yellow skin)
• Severe itching (pruritus)
• Abdomen pain
• Diarrhea (runny stool)
• Fever (temperature of 37.5o Celsius or higher)

What does stage mean?

Once a diagnosis of cancer has been made, the cancer will be given a stage. Stage is used to describe:

• Where the cancer is located
• If or where it has spread
• If it is affecting other organs in the body (like the bile duct)

There are 5 stages for ampullary cancer:

Stage 0:

There is no sign of cancer in the Ampulla of Vater.

Stage 1:

Stage 2:

Stage 3:

The tumour has spread into the outer wall of the small intestine.

Stage 4:

The tumour has spread from the small intestine to other organs such as the pancreas or lymph nodes.

hat does grade mean?

Grade describes how much the tumour looks and acts like normal tissue under a microscope. There are 4 grades (Grade 1 to Grade 4).

Lower grade cells look and act similar to normal cells. They are slow-growing and less likely to spread.

Higher grade cells look and act abnormally. They grow faster and are more likely to spread. The grade of cancer can help predict how quickly the cancer might grow.

Treatment of Ampullary Cancer

The type of treatment you receive will depend on many factors such as the tumour type, size, stage and grade. Treatment for ampullary cancer can be used separately or together.

There are 3 main types of treatment:

1. Surgery: Surgery is the most common treatment for ampullary cancer. It involves making a small cut in the abdomen to remove the tumour and part of the pancreas. The lymph nodes may also be removed to see if the tumour has spread. If the tumour is large or has spread, your doctor may recommend a Whipple procedure or pancreaticoduodenal resection (please see “Other medical terms to know”).
2. Chemotherapy: Chemotherapy is the use of drugs to kill or control cancer cells. Chemotherapy is often used soon after surgery to improve longer term control. It is most commonly used when surgery is not offered because cancer is found more widely spread than surgery can control.
3. Radiation therapy: Radiation therapy is the use of high-energy x-rays or other particles to kill cancer cells. Radiation therapy can be used for treatment or to control the symptoms and pain of advanced cancer. Your doctor may recommend radiation therapy after surgery to have better control over the cancer.
4. Supportive and Palliative therapy: Palliative therapy is treatment given to help control or reduce symptoms caused by advanced cancer. The focus of care is on quality of life and comfort and can be offered by a team at the hospital or at home. Other supportive care considered include procedures to relieve blockage in the bile ducts or bowel to ease pain and prevent jaundice or bowel blockage. This can be done by either placing a tube or, sometimes, a biliary or bowel bypass operation. Other supports can include removing fluid from the abdomen with a needle ( paracentesis) or pain medicines to relieve discomfort.