Periampullary cancer is a

cancer Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body. These contrast with benign tumors, which do not spread. Possible signs and symptoms include a lump, abnormal b ...

that forms near the ampulla of Vater, an enlargement of the ducts from the

liver The liver is a major Organ (anatomy), organ only found in vertebrates which performs many essential biological functions such as detoxification of the organism, and the Protein biosynthesis, synthesis of proteins and biochemicals necessary for ...

and

pancreas The pancreas is an organ of the digestive system and endocrine system of vertebrates. In humans, it is located in the abdomen behind the stomach and functions as a gland. The pancreas is a mixed or heterocrine gland, i.e. it has both an end ...

where they join and enter the

small intestine The small intestine or small bowel is an organ in the gastrointestinal tract where most of the absorption of nutrients from food takes place. It lies between the stomach and large intestine, and receives bile and pancreatic juice through the p ...

. Quoted material is in the

public domain The public domain (PD) consists of all the creative work A creative work is a manifestation of creative effort including fine artwork (sculpture, paintings, drawing, sketching, performance art), dance, writing (literature), filmmaking, ...

. 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 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 abnormal heme meta ...

which may have 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 * Jaundice (yellowing of skin, eyes and urine with pale stools) * Itching * Abdominal pain * Weight loss and loss of appetite * Recurrent vomiting * Black stools * Anaemia

Treatment

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, your 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 called stent is placed in the bile duct which is blocked by tumour and opens it up from inside. If the tumour is advanced, then he may also give you neoadjuvant treatment (chemotherapy or chemoradiotherapy) to decrease the size of the tumour and then resect it to increase your 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.

Surgery

The operation 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.

Notes

Digestive system neoplasia {{oncology-stub