How Aggressive is Ampullary Cancer

Ampullary Cancer-How aggressive is it?

Ampullary Cancer   |   Causes & Risk Factors   |   Symptoms   |   Aggressiveness   |   Stages   |   Diagnosis   |   Treatment   |   Complications   |   Survival Rates   |   Conclusion   |

Ampullary cancer, an uncommon variant of cancer, targets the ampulla of Vater within the digestive system.

As per research conducted in 2014, it represents a mere 0.2% of all gastrointestinal cancers.

Despite its rarity, the prognosis for ampullary cancer is often more optimistic when compared to other, similar types of cancers, like pancreatic cancer.

What is Ampullary Cancer?

It is a rare type of cancer that starts in the ampulla of Vater, a small opening in your small intestine where the pancreatic and bile ducts release their secretions.

Because it’s situated at this junction where these two vital digestive juices enter the intestines, ampullary cancer can affect the normal functioning of the liver, pancreas, and small intestine.

Causes And Risk Factors

The exact causes and risk factors of ampullary cancer are not fully understood. Medical professionals suggest that the majority of ampullary cancers occur spontaneously and are not typically associated with lifestyle choices, genetic predispositions, or other identifiable risks.

However, it is generally understood that cancer initiates when cells undergo mutations or alterations in their DNA. This leads to abnormal cell growth and multiplication, forming a mass or tumor.

There are specific factors that can elevate the likelihood of developing ampullary cancer. These risk factors encompass:

  1. Advanced age, particularly being over 70 years old.
  2. Being of the male gender.
  3. Possessing inherited conditions known to heighten the risk of cancer, such as Lynch syndrome or familial adenomatous polyposis (FAP).


Individuals suffering from ampullary cancer frequently exhibit jaundice, which is characterized by a yellowing of the eyes and skin. This symptom occurs due to the tumor obstructing the bile duct, thereby preventing bile from flowing into the intestines and causing it to enter the bloodstream instead.

Additional signs of this cancer may include:

  1. Unexpected weight loss
  2. Decreased appetite
  3. Nausea and episodes of vomiting
  4. Pain in the abdomen
  5. Back discomfort
  6. Skin that is itchy
  7. Feverish temperatures
  8. Diarrhea episodes
  9. Anemia, or a deficiency in red blood cells
  10. Pancreatitis, or inflammation of the pancreas
  11. Stools that are clay-colored
  12. Bleeding from the rectum

How Aggressive is Ampullary Cancer?

The term ‘aggressiveness’ in cancer refers to how quickly a cancer grows and spreads. In terms of ampullary cancer, the aggressiveness varies depending on certain factors. Here are some elements to consider:

  1. Stage of the Cancer: Like most cancers, the earlier ampullary cancer is detected, the less aggressive it typically is. Early-stage ampullary cancer can often be removed surgically, and it has a relatively high five-year survival rate compared to more advanced stages. On the other hand, later stages are usually more aggressive, spreading to other parts of the body, which makes treatment more challenging.
  2. Histological Subtype: Ampullary cancers are classified based on their cell types. Some subtypes grow and spread faster than others. For instance, adenocarcinomas (originating from glandular cells) are the most common type and can be quite aggressive. Other types such as neuroendocrine tumors may have different growth patterns.
  3. Individual Health Factors: Certain individual factors can also influence the aggressiveness of ampullary cancer. These include the patient’s age, overall health, and immune system status. People with stronger immune systems may fight cancer more effectively than those with weaker immune systems.

Stages of Ampullary Cancer

Stages of Ampullary Cancer

When it metastasizes or spreads, often extends to organs like the liver, lymph nodes, lungs, peritoneum (the lining of the abdomen), and other parts of the body. To gain a clearer understanding of this metastatic process, it’s beneficial to examine the stages of ampullary cancer:

Stage 1: At this initial stage, the cancer is restricted to the inner layer of the small intestine and has not spread to adjacent areas.

Stage 2: In this stage, the tumor has extended to the middle layer of the small intestine. It may also have infiltrated the sphincter of Oddi, which is a muscular ring surrounding the ampulla of Vater.

Stage 3: At this point, the cancer has invaded the outer wall of the small intestine.

Stage 4: This is the most severe stage, where the cancer has metastasized to other regions of the body. This may encompass lymph nodes or organs such as the liver or pancreas.


Ampullary cancer often first manifests through jaundice, a symptom characterized by the yellowing of the skin. This observable sign typically prompts healthcare professionals to commence diagnostic testing for the disease.

The following are common tests employed to diagnose ampullary cancer:

  1. Blood or urine tests: These are carried out to identify markers that might indicate the presence of cancer.
  2. Imaging tests: These tests, including CT (computed tomography) scans, ultrasounds, and MRI (magnetic resonance imaging), are utilized to search for potential tumors.
  3. Upper endoscopy: This procedure uses a diminutive camera to inspect the interior of your body for signs of cancer.
  4. ERCP (endoscopic retrograde cholangiopancreatography): This specialized procedure can provide insights to your healthcare provider regarding potential blockage of your bile duct.
  5. Biopsy: This process involves the extraction of a small cell sample that can be analyzed for the presence of cancer.


Ampullary Cancer | Treatment |

Treatment for ampullary cancer can vary and often depends on the specific factors like the location, size, and stage of the cancer, as well as the overall health and recuperative ability of the patient.

Here are the common treatment options for ampullary cancer:

  1. Endoscopic Surgery: In cases where ampullary cancer is detected in its early stages, it can sometimes be removed via endoscopic surgery. During this procedure, the surgeon eliminates the cancerous cells utilizing tools inserted through an endoscope, which is a small tube typically used in minimally invasive procedures.
  2. Whipple Procedure: Also known as a pancreaticoduodenectomy, this surgical method involves the removal of the gallbladder, a segment of your bile duct, a part of your small intestine, and the head of your pancreas.
  3. Chemotherapy: This approach employs drugs designed to eradicate cancer cells. Chemotherapy is frequently utilized post-surgery to exterminate any lingering cancer cells, but it can also be used to retard the growth of the tumor.
  4. Combined Chemotherapy and Radiation Therapy: Often, chemotherapy is combined with radiation therapy when treating ampullary cancer. Radiation therapy uses potent energy beams to target and destroy cancer cells. This combination could be employed prior to surgery to reduce the size of the tumor, or post-surgery to eliminate remaining cancer cells.
  5. Symptom-Management Treatments: In scenarios where other treatments aren’t effective, your healthcare provider may suggest the insertion of a stent (a small wire mesh tube) into your bile duct. This helps alleviate jaundice and other associated symptoms.

Possible Complications Following Ampullary Cancer Treatments

Like all medical procedures, ampullary cancer treatments can lead to potential complications. The nature and severity of these complications can differ among individuals, depending largely on the specific treatment employed.

Individuals who undergo surgery for ampullary cancer may experience the following complications:

  1. Wound Infection: Surgical incisions may become infected, requiring additional treatment.
  2. Blood Clots: These can pose serious risks if they travel to the lungs, heart, or brain.
  3. Delayed Gastric Emptying: This can result in nausea, vomiting, and a feeling of fullness.
  4. Pancreatic Anastomotic Leak: A condition wherein pancreatic fluid leaks due to disruptions in the pancreatic ducts.

Those who receive chemotherapy or radiation therapy for ampullary cancer may encounter a range of side effects. These could include

  • Fatigue
  • Hair loss
  • Nausea
  • Diarrhea
  • Constipation
  • Infertility
  • Symptoms resembling the flu

If you’ve recently completed treatment for ampullary cancer, it is crucial to attend all scheduled follow-up appointments.

These visits enable your healthcare provider to track your health and promptly address any arising complications, preventing them from becoming severe.

Survival Rates

Ampullary cancer is regarded as a life-threatening condition, and survival rates tend to decline as the disease progresses through its stages.

That said, the five-year survival rate for individuals who have undergone the Whipple procedure varies between 20% to 61%.

This suggests that up to 61 out of every 100 people who have had the Whipple operation for ampullary cancer may still be living after five years.

It’s crucial to understand that these survival rates are mere estimates. They cannot predict your personal response to treatment or precisely how long you might live.

For more detailed information concerning survival rates linked with ampullary cancer, it’s advisable to consult with your healthcare provider.


Ampullary cancer, like other forms of cancer, can be aggressive, especially in its later stages or depending on the histological subtype.

However, with early detection and prompt treatment, the prognosis can be relatively favorable compared to other gastrointestinal cancers.

Always remember the importance of regular check-ups and addressing unusual health symptoms promptly with your doctor. This enables the possibility of early detection not only for ampullary cancer but for any potential health issues.

Take Care of Yourself!


Reviewed By : Dr. Aviral Vatsa

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