What Is Ampullary Carcinoma?

Periampullary carcinoma (VPC) is a general term for cancers that grow on the ampulla, the duodenal papilla, the lower end of the common bile duct, the opening of the pancreatic duct, and the inner wall of the duodenum. Its common feature is that when the cancer is small, it can cause obstruction of the common bile duct and main pancreatic duct, so the patient's jaundice appears early. The age of onset is mostly 40 to 70 years old, mostly males. The main manifestations are jaundice, epigastric pain, fever, weight loss, hepatomegaly, and gallbladder enlargement.

Basic Information

nickname: Ampulla
English name: periampullarycarcinoma
Visiting department: Oncology

Multiple groups: 40 to 70 year old men
Common symptoms: Jaundice, abdominal pain, chills, fever, gastrointestinal symptoms, enlarged liver and gallbladder

Causes of periampullary cancer

The cause of periampullary cancer is not very clear. It may be related to factors such as diet, drinking, environment, biliary stones, or chronic inflammation. It can also be malignant by benign tumors.

Clinical manifestations of periampullary cancer

Jaundice

The periampullary cancer jaundice appears earlier, progressively worsening, and can also show fluctuating jaundice. Jaundice is obstructive, yellowing of the skin and mucous membrane is more obvious, and it is often accompanied by itching of the skin. Chronic cholestasis can cause biliary cirrhosis and gallbladder enlargement. People with biliary tract infections can have high fever, chills, and even toxic shock.

Abdominal pain

Upper and middle abdominal pain is often the first symptom. Some patients may develop blunt pain under the xiphoid process, and abdominal pain can be radiated to the back, which often worsens after eating, in the evening, at night or after a fat meal.

3. Intermittent chills and fever

It is often caused by tumor rupture, cholestasis and biliary infection. It is characterized by transient high fever with chills, an increase in the total number of white blood cells, and even toxic shock.

4. Gastrointestinal symptoms

Due to intestinal deficiency of bile and pancreatic juice, digestive and absorption disorders are caused mainly by loss of appetite, fullness, indigestion, fatigue, diarrhea or fatty diarrhea, gray stools, and weight loss. Melanosis occurs in the later stage and secondary anemia. Ascites can occur in cancerous peritoneal or portal vein metastases.

5. Enlarged liver and gallbladder

The enlarged liver and gallbladder can often be touched, and the texture of the liver is hard and smooth. Few patients have biliary cirrhosis and splenomegaly due to long-term jaundice.

Periampullary cancer

1. stool and urine test

Fecal occult blood tests continued to be positive in most patients, with mild anemia, urinary bilirubin positive, and urobilinogen negative.

Blood test

Serum bilirubin increased mostly from 256.5 to 342 mol / L, alkaline phosphatase and -glutamyl transpeptidase increased, transaminase increased mildly to moderately, and both CA19-9 and CA125 were increased.

3. Duodenal Drainage Examination

The duodenum can drain hemorrhagic or dark brown fluid, and its occult blood test is positive. Microscopic examination shows a large number of red blood cells. Exfoliated cytology can find cancer cells.

4. Barium meal and duodenal hypotonography

Gallbladder pressure marks can be seen above and outside the duodenum. Thickened common bile duct pressure marks appear at the junction of the first and second segments. The duodenal papilla enlarges and the mucosa presents irregular disorder or filling defect. In patients with pancreatic head cancer, duodenal circle enlargement, duodenal medial wall stiffness, compression, deformation, or partial obstruction can be seen, showing a "" shape, but typical performance is rare.

5. Type B ultrasound

B-ultrasound may show dilatation of the bile ducts inside and outside the liver and enlargement of the gallbladder. However, the diagnosis rate of the periampullary carcinoma itself is low, which is caused by duodenal and gastric gas accumulation and food cover in this area.

6.CT, MRI examination

It is meaningful for the identification of pancreatic head cancer, which is helpful for the diagnosis of this disease, and can show the location and contour of the tumor. Periampullary carcinoma and common bile duct carcinoma appear similarly on the image. Both the common bile duct and the pancreatic duct can be dilated or only the bile duct is expanded. In pancreatic head cancer, the head of the pancreas enlarges with a mass, the pancreatic duct expands, the ring shadow is suddenly interrupted and deformed, and a double ring shadow appears, indicating that both the pancreatic head and the common bile duct are invaded. Soft tissue shadows or abnormal signals are sometimes seen in the dilated common bile duct.

7.ERCP

You can look at the inner wall of the duodenum and the nipples. You can see that the nipples are enlarged, the surface is irregular, nodular, brittle and easy to bleed, and the biopsy can be confirmed by pathology.

8.PTC inspection

ERCP is better than ERCP, because the ampulla nipples are uneven, the lumen is narrow and blocked, and ERCP is often difficult to succeed. PTC can show dilatation of the bile ducts inside and outside the liver, and the common bile ducts have irregular filling defects or occlusions in the shape of a "V", which has localized and differential diagnostic value.

9. Selective abdominal angiography (SCA)

It is useful for the diagnosis of pancreatic head cancer. The location of pancreatic cancer can be determined indirectly from the change of blood vessel location.

10. Nuclide inspection

Can understand the obstruction site. Scanning of the pancreas at ⁷⁵ Se-methionine showed a nuclide defect (cold area) in the pancreatic cancer.

Periampullary Cancer Treatment

Once the disease is diagnosed, pancreatoduodenectomy should be performed, which is currently the most effective treatment. Due to the wide scope of surgery, large trauma, and long-term jaundice, impaired liver and kidney function, poor digestion and absorption, and malnutrition, it is necessary to prepare before surgery, provide necessary nutritional support, and give bile salts, pancreatin and other digestive aid Medicine, given vitamin K, if necessary, preoperative blood transfusion, plasma, albumin to correct anemia and hypoproteinemia. If the cancer has invaded the portal vein, extensive retroperitoneal metastasis, or liver metastasis, internal drainage can be used to reduce jaundice, such as palliative bypass surgery such as gallbladder jejunostomy or common bile duct jejunum or duodenal anastomosis; if it occurs Duodenal stenosis is feasible for gastrojejunostomy.

Chemotherapy is generally not sensitive. 5-FU, mitomycin or cytarabine, vincristine, and other combined drugs are commonly used. Traditional Chinese medicine with anti-cancer or immune function can also be applied.