Periampullary Cancer1

Periampullary Cancer
Case
 Patient Manzoor Hussain, 62 years old, resident of
Chungi Massuda, presented in emergency on 21st
of August with the complaints of yellowing of
eyes, darkening of urine and clay coloured stool
for the past 40 days. He also noticed a weight loss
of 17 kg in the past month. Initial diagnosis of
some kind of a cancer was made.
Examination
 Onexamination, jaundice was present.
Gallbladder was also palpable. All other
examination was normal.
Investigations
 Basic Investigations were performed
 Triphasic enhanced CT scan of abdomen and pelvis
with contrast was performed. On CT, there was
distended gallbladder with internal dense
contents with dilated intra and extra biliary
radicles.
Definition
 Periampullary cancer is a term used to
refer to cancer that occurs in the vicinity
of the ampulla of Vater. This includes
cancer affecting the head of the pancreas,
distal bile duct (cholangiocarcinoma),
duodenum, and ampulla. These cancers
are grouped together because they share
similar clinical features and treatment
options.
Types
Periampullary cancer refers to different types of
cancer that occur around the ampulla of Vater.
These types of cancer include:
Pancreatic cancer: a cancer that originates in the
pancreas. You can read more about it read about it
here .
 Distalbile duct cancer (cholangiocarcinoma): a
cancer that arises from the lining of the
lowermost part of the bile duct, where it passes
through the pancreas, joins the pancreatic duct,
And ends in the intestine.
Duodenal cancer: a cancer that arises from the
lining of the duodenal mucosa.
 Ampullary cancer: a cancer that arises from the
lining of the ampulla of Vater.
Risk Factors
 There are many risk factors contributing to the
development of these adenocarcinomas. Some of
them are following:
 1. Age
 2. Smoking
 3. Alcohol
 4. Family History and Hereditary Problems
 5. Parasite Infestation
 6. Gallstones
 7. Diabetes
 8. Obesity
Signs and Symptoms
Jaundice (yellowing of skin, eyes and urine with
pale stools)
Itching
Abdominal pain
Weight loss and loss of appetite
Recurrent vomiting
Black stools
 Anaemia
Diagnosis and Staging
 Once suspected, a high resolution thin cut tri
phasic CT scan is done.
 CBC and RFTs are also performed.
 Side viewing endoscopy: it is a procedure in which
a thin flexible tube is passed into your intestine
through your mouth. It has a camera at the tip of
the tube and a view of the ampulla is obtained,
showing any cancerous growth.
 Biopsy: if a tumour is found at the ampulla, then
a small sample from it is obtained called as biopsy
and examined under microscope confirming the
diagnosis.
 Endoscopic ultrasound (EUS):It aids diagnosis in
cases where CT/MRI do not show cancerous
growth, while it is suspected on clinical features.
It is also used to take a sample from the tumour
by passing a needle called fine needle aspiration
cytology (FNAC) for confirmation of diagnosis if
Treatment
 Thetreatment depends upon the staging of the
cancer and the level of jaundice. Surgery is the
best possible option and can be considered if the
cancer is diagnosed at a stage where it can be
completely removed by surgery. If the jaundice is
very high then ERCP is done to open up the bile
duct blocked by tumor.
Surgery
 Theoperation to surgically remove periampullary
cancer is called Whipple operation, also known as
pancreaticoduodenectomy. In this, head of the
pancreas is removed along with duodenum, bile
duct, gall bladder, part of the stomach, a small
part of the small intestine and adjacent lymph
nodes. To restore gastrointestinal continuity, the
small intestine is then joined to the pancreas
(sometimes pancreas is joined to the stomach),
remaining bile duct and stomach.
Palliative Treatment
 Chemotherapy uses drugs that destroy cancer
cells. For cancers which have spread to distant
organs of the body (metastatic), surgery is not an
option. After FNAC/biopsy and stenting (if
jaundiced) chemotherapy is given.
 Chemotherapy is given till the tumor size is
decreased that resection increases chances of
survival.
 For unresectable tumours, an attempt to made to
downstage them to a stage where they can be
surgically removed. For this, neoadjuvant
treatment is administered and some of these
patients will become operable.
Thank You

Periampullary Cancer1

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Periampullary Cancer

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