Ampullary Cancer: An Overview

Abstract

OVERVIEW Ampullary cancers are rare, accounting for only 0.2% of gastrointestinal cancers and approximately 7% of all periampullary cancers.1 They arise from the ampullary complex, distal to the confluence of the common bile and pancreatic duct (Fig. 1). In contrast to other periampullary malignancies, true ampullary cancers present earlier in their disease course with symptoms that result from biliary obstruction. It is often difficult to distinguish primary ampullary cancers from other periampullary cancers preoperatively. In early stages, ampullary cancers are surgically treated, similar to pancreatic cancers, and typically with a pancreatico-duodenoectomy (or Whipple procedure). Because of their earlier presentation, resection rates for all patients are much higher than other periampullary carcinomas. Moreover, their prognosis tends to be better than those with other periampullary- and pancreatic-originating cancers. In patients with true ampullary cancer, there is very limited data to guide physicians on the choice of therapy, largely because of the rarity of the disease and the paucity of related research. Herein, we provide an overview of the biology, histology, current therapeutic strategies, and potential future therapies for carcinomas arising from the ampulla of Vater.

Advances in Molecular Pathology and Treatment of Periampullary Cancers

“…Response rates vary from 10% to 40%. 56 In a study of 905 resected PAC, overall survival for ampullary cancers was similar to duodenal cancers but significantly different to extrahepatic biliary cancers. In this study, fluoropyrimidinebased chemotherapy was associated with a significant improvement in time to progression compared with gemcitabine-based chemotherapy in metastatic ampullary cancer, suggesting that fluoropyrymidine-based chemotherapy may be a more appropriate front-line approach in these cancers.…”

Safety signal detection and evaluation in clinical development programs: A case study of tofacitinib

“…The panel of medical oncologists recommended excluding 2 of the first 10 reported cases from PDAC classification. Specifically, the carcinoma of the ampulla of Vater in a psoriasis patient was excluded on the basis of differences in biology from PDAC . The case reported in the psoriatic arthritis program was excluded as PDAC classification by the oncologists due to absence of abnormalities on a computed tomography scan of the pancreas.…”

Surgical Treatment of Ampullary Adenocarcinoma – Single Center Experience and a Review of Literature

“…Moreover, approaches are different in the US and in Europe. Adjuvant oncologic ther apy should be considered if risk factors occur (positive lymph nodes, positive resection margins, unfavorable grading, perineural, angio or lymphovascular invasion) [3,12]. With regard to TNM staging, tumor grade, angio or lymphagio invasion, resection margins, performance status and experiences of the oncologic center, adjuvant chemother apy or chemoradiother apy must be always considered [31].…”

“…Curative surgery is pos sible in ap proximately 80% of cases at the time of dia gnosis of ampul lary cancer compared to pancrea tic adenocarcinoma where the resectability rate is around 20% [3,12]. The re sectability in the case of PD procedure depends on exclusion of the metastatic dissemination and spread ing to sur round ing organs and arteries (superior mesenteric artery, coeliac trunk) [10].…”