Ampullary cancer is cancer that starts as a growth of cells in the ampulla of Vater. The ampulla of Vater is located where the bile duct and pancreatic duct join and empty into the small intestine. Ampullary (AM-poo-la-ree) cancer is rare.

Ampullary cancer forms near many other parts of the digestive system. This includes the liver, pancreas and small intestine. When ampullary cancer grows, it may affect these other organs.

Ampullary cancer treatment often involves surgery to remove the cancer. Treatment also may include radiation therapy and chemotherapy to kill cancer cells.

Tests and procedures used to diagnose ampullary cancer include:

Passing a thin, flexible scope down the throat, called an endoscopy

Endoscopy is a procedure to examine the digestive system. It uses a long, thin tube with a tiny camera, called an endoscope. The endoscope passes down the throat, through the stomach and into the small intestine. It allows the healthcare team to see the ampulla of Vater.

Special tools can pass through the endoscope to collect a sample of tissue for testing.

Endoscopy also can be used to create images. For instance, endoscopic ultrasound may help capture images of ampullary cancer.

Sometimes a dye is injected into the bile duct using endoscopy. This procedure is called endoscopic retrograde cholangiopancreatography. The dye shows up on X-rays. It can help look for blockages in the bile duct or pancreatic duct.

Imaging tests

Imaging tests make pictures of the body. They can show the location and size of ampullary cancer. Imaging tests may help the healthcare team understand more about the cancer and determine whether it has spread beyond the ampulla of Vater.

Imaging tests may include:

• Endoscopic ultrasound.
• Endoscopic retrograde cholangiopancreatography.
• Magnetic resonance cholangiopancreatography.
• CT scan.

Removing a sample of tissue for testing, called biopsy

A biopsy is a procedure to remove a sample of tissue for testing in a lab. The sample is tested in a lab to see if it is cancer. Other special tests give more details about the cancer cells. Healthcare teams use this information to make a treatment plan.

Ampullary cancer treatment often starts with surgery to remove the cancer. Other treatments may include chemotherapy and radiation. These other treatments can be done before or after surgery. The best treatment for your ampullary cancer depends on several factors. These include the size of the cancer, your overall health and your preferences.

Surgery

Surgery options may include:

• Surgery to remove the cancer and nearby structures. The Whipple procedure, also known as a pancreaticoduodenectomy, involves removing the cancer by removing the head of the pancreas. The surgeon also removes a portion of the small intestine, gallbladder and part of the bile duct. The Whipple procedure can be done using a large incision in the abdomen. It also can be done using several small incisions.
• Surgery for very small cancers. For very small ampullary cancers and precancerous tumors, it may be possible to remove the cancer with tools passed through an endoscope. This is called an endoscopic surgery.
• Surgery to place a stent. Sometimes the goal of surgery is to make you more comfortable. If you have jaundice, surgery may be used to place a small wire mesh tube, called a stent, in your bile ducts. This tube helps drain the fluid that causes a yellowing of the skin and eyes.

Other treatments

Other treatments may be used, including:

• Combined chemotherapy and radiation. Chemotherapy treats cancer with strong medicines. Radiation therapy treats cancer with powerful energy beams. The energy can come from X-rays, protons or other sources. Used together, these treatments may be more effective for ampullary cancers.

  Combined chemotherapy and radiation may be used before surgery, to make it more likely that a cancer can be removed completely during an operation. The combined treatment also can be used after surgery to kill any cancer cells that might remain.

• Chemotherapy alone. Chemotherapy is sometimes used after surgery to kill cancer cells that might remain. In people with advanced ampullary cancer, chemotherapy may be used alone to slow the growth of the cancer.
• Targeted therapy. Targeted therapy uses medicines that attack specific chemicals in the cancer cells. By blocking these chemicals, targeted treatments can cause cancer cells to die. Targeted therapy is used to treat ampullary cancer that spreads to other parts of the body or comes back after treatment. It's only used in certain situations.
• Immunotherapy. Immunotherapy is a treatment with medicine that helps the immune system kill cancer cells. The immune system fights off diseases by attacking germs and other cells that shouldn't be in the body. Cancer cells survive by hiding from the immune system. Immunotherapy helps the immune system cells find and kill the cancer cells. It may be an option for treating ampullary cancer that spreads to other parts of the body or comes back after treatment. Immunotherapy is only used in certain situations.

Palliative care

Palliative care is a special type of healthcare that helps you feel better when you have a serious illness. If you have cancer, palliative care can help relieve pain and other symptoms. A healthcare team that may include doctors, nurses and other specially trained health professionals provides palliative care. The care team's goal is to improve quality of life for you and your family.

Palliative care specialists work with you, your family and your care team. They provide an extra layer of support while you have cancer treatment. You can have palliative care at the same time you're getting strong cancer treatments, such as surgery, chemotherapy or radiation therapy.

The use of palliative care with other treatments can help people with cancer feel better and live longer.