Periampullary carcinoma includes ampullary carcinoma, distal bile duct carcinoma, and duodenal carcinoma. Its malignancy is lower than that of pancreatic head cancer, and its surgical resection rate and five-year survival rate are significantly higher compared to pancreatic head cancer.
Pathology
The predominant histological type of periampullary carcinoma is adenocarcinoma, followed by papillary carcinoma, mucinous carcinoma, and other subtypes.
Diagnosis
Common clinical symptoms include jaundice, weight loss, and abdominal pain, which can easily be confused with pancreatic head cancer. Diagnostic tests and examination methods are largely similar to those used for pancreatic head cancer.
Ampullary Carcinoma
Jaundice often appears early and is intermittent, which is associated with tumor necrosis and tissue shedding. Occult blood in stool may be present, and fever and abdominal pain may occur when infection is present. Duodenoscopy can reveal a cauliflower-like mass at the duodenal papilla.
Distal Bile Duct Carcinoma
This type is associated with a higher degree of malignancy. Jaundice progressively worsens. Diagnostic methods may include intraductal ultrasound and cytologic biopsy via intraductal brushing.
Duodenal Adenocarcinoma
This form usually occurs near the duodenal papilla and originates from the intestinal mucosal epithelium. Jaundice appears later and progresses more slowly. When tumors ulcerate and bleed, occult blood tests of stool may be positive, and large amounts of bleeding may manifest as tarry stools. Larger tumors may cause duodenal obstruction.
Treatment
Patients who do not have surgical contraindications or metastases may undergo a Whipple procedure. For patients with metastases, unresectable tumors, or those who are unable to tolerate major surgery, palliative surgeries such as biliary-enteric anastomosis or gastrojejunostomy may be performed to relieve biliary or duodenal obstruction.