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Ampullary Carcinoma Clinical Presentation

  • Author: Vivek K Mehta, MD; Chief Editor: N Joseph Espat, MD, MS, FACS  more...
 
Updated: Sep 15, 2015
 

History

See the list below:

  • Patients with carcinoma of the ampulla of Vater often complain of anorexia, nausea, vomiting, jaundice, pruritus, or weight loss.
  • Many patients complain of abdominal pain.
  • Diarrhea, a common but not universal symptom, might be associated with an absence of lipase within the gut because of pancreatic duct obstruction.
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Physical

See the list below:

  • Physical examination sometimes discloses a Courvoisier gallbladder (ie, a distended, palpable gallbladder in a patient with jaundice).
  • Fever can be present, particularly when the biliary tract has been explored previously (eg, after common duct exploration for stones).
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Contributor Information and Disclosures
Author

Vivek K Mehta, MD Radiation Oncologist, Director, Center for Advanced Targeted Radiotherapies, Department of Radiation Oncology, Swedish Cancer Institute

Vivek K Mehta, MD is a member of the following medical societies: American Society for Radiation Oncology, Phi Beta Kappa, Sigma Xi

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Benjamin Movsas, MD 

Benjamin Movsas, MD is a member of the following medical societies: American College of Radiology, American Radium Society, American Society for Radiation Oncology

Disclosure: Nothing to disclose.

Chief Editor

N Joseph Espat, MD, MS, FACS Harold J Wanebo Professor of Surgery, Assistant Dean of Clinical Affairs, Boston University School of Medicine; Chairman, Department of Surgery, Director, Adele R Decof Cancer Center, Roger Williams Medical Center

N Joseph Espat, MD, MS, FACS is a member of the following medical societies: Alpha Omega Alpha, American Association for Cancer Research, American College of Surgeons, American Medical Association, American Society for Parenteral and Enteral Nutrition, American Society of Clinical Oncology, Americas Hepato-Pancreato-Biliary Association, Association for Academic Surgery, Central Surgical Association, Chicago Medical Society, International Hepato-Pancreato-Biliary Association, Pancreas Club, Sigma Xi, Society for Leukocyte Biology, Society for Surgery of the Alimentary Tract, Society of American Gastrointestinal and Endoscopic Surgeons, Society of Surgical Oncology, Society of University Surgeons, Southeastern Surgical Congress, Southern Medical Association, Surgical Infection Society

Disclosure: Nothing to disclose.

Additional Contributors

Clarence Sarkodee Adoo, MD, FACP Consulting Staff, Department of Bone Marrow Transplantation, City of Hope Samaritan BMT Program

Clarence Sarkodee Adoo, MD, FACP is a member of the following medical societies: American College of Physicians-American Society of Internal Medicine, American Society of Hematology, American Society of Clinical Oncology

Disclosure: Nothing to disclose.

Acknowledgements

Coauthor(s): George Fisher, MD, PhD, Associate Professor, Department of Internal Medicine, Division of Medical Oncology, Stanford University School of Medicine

References
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Table 1. Staging of Ampullary Cancers by the TNM System
StageTNM
Stage 0TisN0M0
Stage IT1N0M0
Stage IIT2-3N0M0
Stage IIIT1-3N1M0
Stage IVT4N0-1M0
T1-4N0-1M1
Table 2. Results of Pancreaticoduodenal Resection for Carcinoma of the Ampulla of Vater
InstitutionYearPatients, #Resected, #Mortality Rate, %5-Year Survival Rate, %
Cleveland Clinic[9] 1950-19845959837
Leicester Royal Infirmary, United Kingdom[10] 1972-198452241356
University of Alabama[11] 1953-198824241361
Mayo Clinic[12] 1965-19891041045.734
Montebelluna Hospital, Italy[13] 1971-19903631356
Veterans Affairs hospitals[14] 1971-1993123641420
Academic Medical Center, Amsterdam[15] 1984-19926762650
Hanover Hospital, Germany[16] 1971-19938785938
Johns Hopkins[17] 1969-1996120106438
Memorial Sloan-Kettering[18] 1983-1995123101544
Catholic University, Italy[19] 1981-20029464964
Table 3. Summary of 5-Year Survival After Resection for Lymph Node Negative and Positive Carcinoma of the Ampulla of Vater
InstitutionNode-Negative, % (#)Node-Positive, % (#)P Value
University of Alabama at Birmingham[11] 78 (19)50 (5)Not significant
Mayo Clinic, Minnesota[12] 43 (53)16 (50).001
Montebelluna Hospital, Italy[13] 64 (22)0 (9).36
Academic Medical Center, Amsterdam[15] 59 (32)41 (35).05
Niigata University, Japan[20] 81 (17)41 (18)< .01
Johns Hopkins, Baltimore[17] 43 (53)31 (50).05
Kanazawa University Hospital, Japan[21] 74 (21)31 (15)< .05
Memorial Sloan- Kettering, New York[18] 55 (55)30 (46).04
Loyola University, Chicago[28] 78 (27)25 (24)< 0.05
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