Ampullary Carcinoma

Diagnosis

Physicians at Mayo Clinic combine the latest diagnostic techniques and their extensive experience to diagnose ampullary carcinoma. The team of specialists establishes the type of cells involved and the stage of the cancer to develop the best treatment for each patient.

Medical History

A first step toward diagnosing ampullary carcinoma is an in-depth interview with the patient. The physician records details about the patient's symptoms and when they first appeared.

Physical Examination

The next step is a physical examination. The physician will feel the patient's abdomen for lumps, swelling, and areas where the patient reports pain. The doctor may also order a blood test and ask for a stool sample to test for the presence of blood.

Imaging Studies

To diagnose ampullary carcinoma, Mayo Clinic specialists use various high-resolution imaging studies.

• X-rays generate a two-dimensional view of the chest and abdomen to help physicians locate abnormalities in the abdomen or in other parts of the body where the cancer may have spread.
• Barium X-rays. Before having this X-ray, patients drink a liquid containing a radiopaque substance. With barium coating the intestines, an X-ray image can show abnormal structures in the duodenum. Patients cannot have food or beverages for a specified time before the test.
• Percutaneous transhepatic cholangiography (PTC) is used to identify obstructions that may be tumors. A thin needle is inserted into the liver to deliver dye to the bile ducts. A specialist uses a fluoroscope (specialized X-ray machine) to track the dye's movement toward the pancreas.
• Endoscopic retrograde cholangiopancreatography (ERCP) produces X-ray images of the ducts that lead to the pancreas. Physicians pass a thin flexible tube (endoscope) down the throat, through the stomach, and into the upper small intestine. They inject dye into the pancreas and take X-rays of the ducts.
• Ultrasound uses high-frequency sound waves to create images of the abdomen that can identify a tumor. A technician places a wandlike device (transducer) on the surface of the abdomen and monitors the image on the screen.
• Endoscopic ultrasound (EUS) involves the use of an endoscope (flexible tube) to pass an ultrasound probe into the gastrointestinal tract. A computer can translate the sound waves sent around the duodenum into images that identify tumors. Physicians may use endoscopic ultrasound before surgery to assess the depth of the tumor invasion and to determine whether the tumor has spread to the liver.
• Computed tomography (CT) scans generate two-dimensional images of the abdomen that may reveal whether cancer has invaded other tissues or organs. New technology available at Mayo Clinic allows three-dimensional reconstruction of the CT images.
• Magnetic resonance imaging (MRI) uses magnetic fields and radio waves to create two- and three-dimensional views to identify small abnormalities in the soft tissue of the abdomen.
• Positron emission tomography (PET) involves the use of radioactive materials to identify metabolically active tissues, such as cancer, in the ampulla of Vater and other organs.

Endoscopy

Endoscopy enables specialists to examine the inside of the duodenum. A physician gives the patient a mild sedative, then passes a thin tube down the throat and through the stomach. A light in the tube helps the doctor see any abnormal areas. If necessary, a small sample of cells (biopsy) can be taken for microscopic examination by a pathologist. During endoscopy, physicians can sometimes drain blocked bile ducts.

Biopsy

Before planning or recommending treatment, physicians at Mayo Clinic may want to examine tissue from the tumor in a laboratory. They often use a procedure called fine-needle aspiration to gather a small sample of cells from the ampulla of Vater. Experienced pathologists examine the tissue under a microscope.

Symptoms of ampullary carcinoma may include:

• Jaundice (yellowing of skin and eyes)
• Itchy skin
• Light-colored feces
• Dark-colored urine
• Abdominal pain or cramping
• Gastrointestinal hemorrhage