Periampullary cancer is a

cancer Cancer is a group of diseases involving Cell growth#Disorders, abnormal cell growth with the potential to Invasion (cancer), invade or Metastasis, spread to other parts of the body. These contrast with benign tumors, which do not spread. Po ...

that forms near the

ampulla of Vater The ampulla of Vater, hepatopancreatic ampulla or hepatopancreatic duct is the common duct that is usually formed by a union of the common bile duct and the pancreatic duct within the wall of the duodenum. This common duct usually features a di ...

, an enlargement of the ducts from the

liver The liver is a major metabolic organ (anatomy), organ exclusively found in vertebrates, which performs many essential biological Function (biology), functions such as detoxification of the organism, and the Protein biosynthesis, synthesis of var ...

and

pancreas The pancreas (plural pancreases, or pancreata) is an Organ (anatomy), organ of the Digestion, digestive system and endocrine system of vertebrates. In humans, it is located in the abdominal cavity, abdomen behind the stomach and functions as a ...

where they join and enter the

small intestine The small intestine or small bowel is an organ (anatomy), organ in the human gastrointestinal tract, gastrointestinal tract where most of the #Absorption, absorption of nutrients from food takes place. It lies between the stomach and large intes ...

. Quoted material is in the

public domain The public domain (PD) consists of all the creative work to which no Exclusive exclusive intellectual property rights apply. Those rights may have expired, been forfeited, expressly Waiver, waived, or may be inapplicable. Because no one holds ...

. It consists of: # ampullary tumour from ampulla of Vater # cancer of lower common bile duct # duodenal cancer adjacent to ampulla # carcinoma head of pancreas It presents with painless

jaundice Jaundice, also known as icterus, is a yellowish or, less frequently, greenish pigmentation of the skin and sclera due to high bilirubin levels. Jaundice in adults is typically a sign indicating the presence of underlying diseases involving ...

which may have a waxing and waning nature, because at times the sloughing of the

tumor A neoplasm () is a type of abnormal and excessive growth of tissue. The process that occurs to form or produce a neoplasm is called neoplasia. The growth of a neoplasm is uncoordinated with that of the normal surrounding tissue, and persists ...

tissue relieves the obstruction partially.

Signs and symptoms of periampullary cancer

Signs and symptoms of periampullary cancer include: * Jaundice (yellowing of skin, eyes and urine with pale stools) * Itching * Abdominal pain * Weight loss and loss of appetite * Recurrent vomiting * Black stools * Anemia

Treatment

Source: The treatment depends upon the stage of the disease and degree 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, the surgeon may choose to decrease jaundice before surgery by doing a procedure called endoscopic retrograde cholangiopancreatography (ERCP) and stenting. In this, a plastic or metallic tube (stent) is placed in the bile duct, which is blocked by the tumour, and opens it up from inside. If the tumour is at an advanced stage, the surgeon may instead choose to first administer neoadjuvant treatment (chemotherapy or chemoradiotherapy) to decrease the size of the tumour and then to resect the tumour to increase chances of survival. For unresectable tumours, an attempt may be made to downstage them so that they can be surgically removed. For this, neoadjuvant treatment is administered, after which some tumours will become operable.

Surgery

The operation to surgically remove periampullary cancer is called Whipple operation{{Cite web , title=Whipple Procedure or Pancreaticoduodenectomy {{! Dr.Nikhil Agrawal , url=https://www.drnikhilagrawal.com/pancreas-cancer-surgery-whipple , access-date=2023-01-02 , website=Dr. Nikhil Agrawal or pancreaticoduodenectomy. In this, the 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.

Notes

Digestive system neoplasia

Signs and symptoms of periampullary cancer

Treatment

Surgery

See also

Notes