A 68-Year-Old Man Develops Painless Jaundice. Endoscopic Retrograde Cholangiopancreatography Demonstrates a Large Ampullary Mass. Biopsies Demonstrate Adenocarcinoma. How Should This Patient Be Managed?

• Published in: Curbside Consultation in GI Cancer for the Gastroenterologist pp. 119 - 124
• Main Authors: Thakkar, Shyam J., Pleskow, Douglas
• Format: Book Chapter
• Language: English
• Published: CRC Press 2011
• Edition: 1
• ISBN: 9781556429842; 1556429843
• DOI: 10.1201/9781003523536-26

Ampullary and pancreatic cancers originate in close proximity, but they are distinctly different disorders. The ampulla of Vater is a complex junctional structure uniting the common bile duct and ventral pancreatic duct to the duodenal lumen. It is often referred to as the major papilla and encompasses the sphincter of Oddi, the muscle complex encircling the distal portion of these ducts and a shared common channel. Ampullary cancer originates within this complex structure and, as a result, may have an intestinal or pancreatico-biliary histology depending on the site of origin (papillary or intra-ampullary [Figure 23-1]). 1 Ampullary carcinoma should not be confused with peri-ampullary cancers, which may arise from the distal common bile duct, pancreas, or adjacent duodenal mucosa. In advanced stages, peri-ampullary cancers may have overgrown the ampulla, making their site of origin difficult to determine.