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ampulla of Vater adenocarcinoma
Etiology:
- risk factors
a) familial adenomatous polyposis
b) Lynch syndrome (HNPCC)
Pathology:
- tumors may arise from bile duct, pancreatic duct or duodenum
Clinical manifestations:
- painless jaundice
- gastric outlet obstruction (duodenal obstruction)
Laboratory:
- no specific markers
- serum CA 19-9 may be elevated
- serum carcinoembryonic antigen may be elevated
Special laboratory:
- ERCP & endoscopic ultrasound
a) tissue sampling
b) decompression of obstruction via placing a stent
- upper gastrointestinal endoscopy & colonoscopy for surveillance of hereditary polyposis syndrome (familial adenomatous polyposis, Lynch syndrome)
Radiology:
- computed tomography
- magnetic resonance imaging
Management:
- surgical excision (pancreaticoduodenectomy) if no evidence of advanced disease
Related
ampulla of Vater (hepatopancreatic, bilaropancreatic ampulla)
General
small intestinal cancer
adenocarcinoma
References
- Medical Knowledge Self Assessment Program (MKSAP) 15, 16, 17, 18.
American College of Physicians, Philadelphia 2009, 2012, 2015, 2018.
- Heinrich S, Clavien PA.
Ampullary cancer.
Curr Opin Gastroenterol. 2010 May;26(3):280-5
PMID: 20168227
- Askew J, Connor S
Review of the investigation and surgical management of
resectable ampullary adenocarcinoma.
HPB (Oxford). 2013 Nov;15(11):829-38
PMID: 23458317