Ampullary cancer – Causes, Symptoms, Treatment and Risk factors

Ampullary cancer is one of the rarest cancers that affect your ampulla of Vater. The ampulla of Vater is a small opening that enters the duodenum, where the bile duct and the pancreatic duct join the small intestine.

The spot where the pancreas and the bile duct release their secretions into the intestine is called the ampulla of Vater.

Overview  

Ampullary cancer forms near the digestive system. It can grow and affect other organs like the liver, small intestine and pancreas.

To remove Ampullary cancer from the body may require surgery, where even a margin of healthy tissue is to be removed.

The survival rate of Ampullary cancer ranges from 20 to 75%. The survival rate also depends on how far cancer has spread.

Cause of Ampullary cancer

Doctors and researchers are still not sure of the causes of Ampullary cancer. Cancer normally occurs when there is a mutation in the cells.  

These mutated cells start to multiply, and uncontrolled growth is observed. They form a lump called a tumour.

Tumours can spread to other organs and infect other organs by the mechanism of metastasis.

Stages of Ampullary cancer

There are five stages of cancer. Stage 0, stage 1, stage 2, stage 3, stage 4.

In stage 0, there is no presence of cancer. The cells are healthy.

Stage 1  

The tumour can be observed near the inner layer of the small intestine and not in the Sphincter of Oddi. The Sphincter of Oddi is the smooth muscle that surrounds the bile duct and pancreatic duct.

Stage 2  

In stage 2, the tumour spreads to the middle layer of the small intestine. There is a possibility of it spreading to the Sphincter of Oddi.

Stage 3

In stage 3 of Ampullary cancer, the tumour spreads to the outer wall of the small intestines, and the organ is fully infilterated .

Stage 4  

Stage 4 is where the tumour outgrows the small intestines and starts to spread to other organs.

The tumour spread is denoted by a parameter called grade. The grade describes how much the tumour has affected the organ or the cell.  

Lower graded cells are less affected by the tumour, and they act like normal cells.

Higher graded cells look like normal cells, but they act abnormally. They start to grow fast and spread to other organs.  

The grade of cancer helps to anticipate how fast the cancer is growing and how long it takes to affect the other organs.

Symptoms of Ampullary cancer

People with Ampullary cancer exhibit different symptoms depending on their stage and grade of cancer.  

Jaundice  

People with Ampullary cancer usually have Jaundice. It is the yellow colouration of the eyes and skin.

Jaundice is caused when the tumour blocks the bile duct. So, the bile will not be able to move into the intestine and gets mixed into the bloodstream.

When bile gets mixed with the bloodstream, it causes yellow colouration in the skin.

Clay-coloured stools

Clay-coloured stools are one of the predominant symptoms of Ampullary cancer. The bile is blocked from getting entered into the intestine.

This causes putty-coloured or clay-coloured stools. When the urine is tested with a dipstick, it indicates an absence of urobilinogen.

The concentration of conjugated and unconjugated serum bilirubin is high in Ampullary cancer, which causes abnormal stool and urine colour.

Abdominal pain

Ampullary cancer’s early clinical symptoms are non-specific such as abdominal pain.  

The biliary obstruction that clinically signifies Jaundice can also be a cause of abdominal pain.

Fever  

Fever is one of the common symptoms of cancer. The tumour may cause some infection and manifest fever.

The other symptoms of Ampullary cancer are,

Bleeding from the rectum  

It is reported that one-third of the patients with Ampullary cancer experience rectal bleeding. The blood from the tumour passes into the intestines and causes Anaemia.

The other common symptoms include:

• Nausea  
• Vomiting  

Weight loss

Weight loss is a common symptom in people diagnosed with cancer. Weight loss is due to inadequate appetite.  

Unexplained weight loss is the first and most visible sign of Ampullary cancer.

When to see a doctor

Always be watchful about your health. If there is unexplained weight loss accompanied by the above-mentioned symptoms consult your doctor immediately.

This does not mean that you are suffering from Ampullary cancer. However, it is always better for your doctor to diagnose and give you updates about your health.

When you experience new symptoms or any manifestation of fever, immediately consult your doctor.

Treatment of Ampullary cancer 

The treatment differs from one person to another depending on the stage and grade of cancer.

The aim of the treatment can be to cure cancer, control the growth or cope with the pain.  

The treatment will be decided by your doctor depending on your cancer.

Endoscopic surgery

Endoscopic surgery is a minimally invasive surgery. Endoscopic surgery is suggested when your tumour is very small or for the removal of precancerous tumours.

A small tool will be passed through your oesophagus and stomach. It will be attached with a video camera to look at the ampulla. This device also helps to take samples to study the morphology of cancer.

Whipple procedure

Whipple procedure is a standard procedure to remove cancer. It involves a complex surgery called Pancreaticoduodenectomy.  

It involves the removal of the tumour in the affected region of the ampulla of Vater. The commonly affected regions are the duodenum, gallbladder, lymph nodes, bile duct and pancreas.

The Whipple procedure is the most common treatment for Ampullary cancer, and people treated using this procedure have shown a five-year survival rate ranging from 20 to 70%.

The survival rate also depends on the progression of the tumour.

Chemotherapy

Chemotherapy is an approach that is a targeted therapy to kill cancer cells. It is a non-invasive method of treatment.

Chemotherapy is usually handled by your doctor to kill the remaining cancer cells after surgery.

Chemotherapy also helps to slow down the growth of tumour cells.  

Radiation therapy

Radiation therapy involves high-energy x-rays combined with other particles to kill cancer cells.

Radiation therapy is used for treatment and to kill cancer cells. It is also used to reduce the pain of advanced cancer.

Radiation therapy uses powerful beams of energy to target cancer cells. It is also used to shrink the tumour.

Doctors may also recommend radiation therapy to have better control over cancer.

Treatments focused on reducing uncomfortable symptoms

Supportive therapy or palliative therapy is usually administered to cancer patients to reduce the uncomfortable symptoms caused by cancer.

The aim is to improve the quality of life and reduce pain post-cancer treatment. The treatment can be offered at home or hospital.

Ampullary cancer causes other complications such as Jaundice and other pain. Sometimes cancer may settle down, but the symptoms have not been reduced.

It also helps to open the blockage in the bile duct or to remove fluid from the abdomen or pain killers to reduce the pain.

So, doctors may recommend treatments to reduce the symptoms.

Risk factors of Ampullary cancer

Risk factor defines your increased chance of getting a particular disease. Doctors and researchers are still not sure of the reason for cancer development.

The risk factors of Ampullary cancer are still unknown.

Your age  

People above 70 can be seen affected with Ampullary cancer. The Ampullary cancer risk factor increases with age.

Being male

Males are more susceptible to Ampullary cancer compared to females. The other risk factors associated with Ampullary cancer are smoking and overconsumption of alcohol.

Inherited syndromes that increase cancer risk

The Ampullary cancer risk factor increases with hereditary conditions. Gene mutation makes people more prone to Ampullary cancer.

Complications of Ampullary cancer

Complications are common in any treatment, and it can vary from person depending on their age and stage of cancer.

Wound infections

Wound infections are common in the postoperative stage. Studies have revealed that the wound infection rate was 6%.

Blood clots

Data reported in the BMC surgery journal reported that patients who underwent Pancreaticoduodenectomy had more blood loss than patients who underwent local ampullectomy.

Delayed gastric emptying

Delayed gastric emptying is one of the common complications for patients who underwent the Whipple procedure.  Delayed gastric emptying does not have any effect on mortality, but it affects the quality of life and also causes metabolic deterioration.

Nasogastric intubation with conservative methods is sufficient to treat patients with post-operative surgery. Intra-abdominal collections cause difficulty in gastric emptying. It was resolved by using drainage under the radiologic guidance.

Anastomotic leak

The crucial step is the drainage of the pancreatic remnant to the gastrointestinal tract. The main risk involved in the anastomotic breakdown.  

These leaks can be a benign course and may require maintenance in intraoperatively placed drains.  

The major cause of postoperative mortality is retroperitoneal sepsis with abscess formation or destruction of surrounding tissue and blood vessels with severe haemorrhage.

Prevention of Ampullary cancer

Doctors and researchers are still not clear about cancer formation and its related risk factors. There are no evident prevention methods for Ampullary cancer.

Conclusion

The reason for cancer formation is uncertain, and there is no proper evidence. It is always better to consume healthy food, have a regular check-up routine and consult your doctor if you have any irregular or inappropriate symptoms.

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