03/07/2025
Overview of Cancer of the Ampulla of Vater
📌 Overview
Ampullary cancer is a rare gastrointestinal malignancy, accounting for 0.2–0.5% of all GI cancers and approximately 0.49 cases per 100,000 population.
It arises from the Ampulla of Vater, the anatomical site where the common bile duct and pancreatic duct converge and drain into the duodenum.
🔍 Clinical Presentation
Due to its strategic location, ampullary cancer often causes early symptoms:
- Obstructive jaundice (yellow skin, dark urine, pale stools)
- Itching, abdominal pain, nausea or vomiting (duodenal obstruction)
- Gastrointestinal bleeding (less common)
- Weight loss, fatigue, or anorexia
🧪 Diagnostic Workup
Blood tests: Elevated bilirubin, GGT, ALP. Tumor markers:
* CA 19-9 (sensitive for pancreatic origin)
* CEA (often elevated in biliary cancers)
* Combined marker assessment increases diagnostic accuracy (\~86%)
🩻Imaging:
* Ultrasound: Detects biliary dilation
* CT scan: Assesses lymph nodes, metastasis
* MRI with contrast (≥1.5T): Best for detailed anatomy and soft tissue contrast
* MRCP / ERCP: Visualizes biliary tree; allows for biopsy
* Endoscopic biopsy (via ERCP or endoscopic ultrasound) is the gold standard for diagnosis.
🧬 Histopathology
* Most are adenocarcinomas
* Two main subtypes:
1. Intestinal type – better prognosis
2. Pancreatobiliary type – poorer prognosis
🛠️ Treatment
* Surgical resection (Whipple procedure – pancreaticoduodenectomy) is the treatment of choice if operable.
* If not resectable:
- Palliative surgery: e.g., biliary bypass
- Stenting to relieve obstruction
* Adjuvant chemotherapy or chemoradiation may be considered based on staging and pathology.
📈 Prognosis
* Survival highly depends on stage, lymph node status, and histological subtype.
* 5-year survival rate after complete surgical resection ranges from 20% to 75%
* Better for intestinal-type tumors and early-stage disease
✅ Conclusion
Although rare, ampullary cancer often presents early due to biliary obstruction, giving it a better prognosis than pancreatic or biliary cancers.
Prompt diagnosis via imaging and biopsy, followed by surgical intervention, is key to improving long-term outcomes.
of the Ampulla of Vater
