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• #1 Ampullary carcinoma: Treatment and prognosis – UpToDate

  https://www.uptodate.com/contents/ampullary-carcinoma-treatment-and-prognosis

  Ampullary carcinoma: Treatment and prognosis […] The only potentially curative treatment for ampullary carcinoma is surgical resection. Complete tumor resection with negative margins (R0 resection) is a prerequisite for cure. […] Resectability rates are higher, and five-year survival rates are approximately 30 to 50 percent in patients with limited lymph node involvement. […] An aggressive approach to diagnosis and treatment of periampullary tumors is needed to ensure that patients with these comparatively favorable cancers are treated optimally. […] ADJUVANT THERAPY […] Benefit from adjuvant therapy […] Chemoradiotherapy […] Chemotherapy alone […] CHEMOTHERAPY FOR ADVANCED DISEASE […] Choice of therapy […] Importance of somatic and germline genomic testing.

• #2 Ampullary carcinoma: Treatment and prognosis – UpToDate

  https://www.uptodate.com/contents/ampullary-carcinoma-treatment-and-prognosis/print

  Ampullary carcinomas are defined as those that arise within the ampullary complex, distal to the confluence of the distal common bile duct and the pancreatic duct. […] This topic review will cover the treatment and prognosis of ampullary carcinomas. […] The only potentially curative treatment for ampullary carcinoma is surgical resection. Complete tumor resection with negative margins (R0 resection) is a prerequisite for cure. […] True ampullary cancers have a better prognosis than periampullary malignancies of pancreatic or bile duct origin. Resectability rates are higher, and five-year survival rates are approximately 30 to 50 percent in patients with limited lymph node involvement.

• #3 Ampullary Carcinoma Treatment & Management: Surgical Care, Adjuvant Therapy, Treatment of Unresectable Disease

  https://emedicine.medscape.com/article/276413-treatment

  The standard surgical approach is pancreaticoduodenal resection (Whipple procedure). The procedure involves en bloc resection of the following: The gastric antrum and duodenum, a segment of the first portion of the jejunum, gallbladder, and distal common bile duct, the head and often the neck of the pancreas, adjacent regional lymph nodes. […] In a review of 450 cases of surgical resection of ampullary adenoma or adenocarcinoma at Johns Hopkins, Winter et al found that 96.7% of the patients had undergone pancreaticoduodenectomy rather than local excision. These researchers concluded that pancreaticoduodenectomy should be the preferred approach for most ampullary neoplasms that require surgical resection, given that nearly 30% of the Johns Hopkins patients with T1 disease had lymph node metastases.

• #4 Ampullary cancer // Middlesex Health

  https://middlesexhealth.org/learning-center/diseases-and-conditions/ampullary-cancer

  Ampullary cancer treatment often involves surgery to remove the cancer. Treatment also may include radiation therapy and chemotherapy to kill cancer cells. […] Ampullary cancer treatment often starts with surgery to remove the cancer. Other treatments may include chemotherapy and radiation. These other treatments can be done before or after surgery. The best treatment for your ampullary cancer depends on several factors. These include the size of the cancer, your overall health and your preferences. […] Surgery options may include: Surgery to remove the cancer and nearby structures. The Whipple procedure, also known as a pancreaticoduodenectomy, involves removing the cancer by removing the head of the pancreas. The surgeon also removes a portion of the small intestine, gallbladder and part of the bile duct. The Whipple procedure can be done using a large incision in the abdomen. It also can be done using several small incisions.

• #5 Ampullary carcinoma: Treatment and prognosis – UpToDate

  https://www.uptodate.com/contents/ampullary-carcinoma-treatment-and-prognosis

  Ampullary carcinoma: Treatment and prognosis […] The only potentially curative treatment for ampullary carcinoma is surgical resection. Complete tumor resection with negative margins (R0 resection) is a prerequisite for cure. […] Resectability rates are higher, and five-year survival rates are approximately 30 to 50 percent in patients with limited lymph node involvement. […] An aggressive approach to diagnosis and treatment of periampullary tumors is needed to ensure that patients with these comparatively favorable cancers are treated optimally. […] ADJUVANT THERAPY […] Benefit from adjuvant therapy […] Chemoradiotherapy […] Chemotherapy alone […] CHEMOTHERAPY FOR ADVANCED DISEASE […] Choice of therapy […] Importance of somatic and germline genomic testing.

• #6 Ampullary Carcinoma Treatment & Management: Surgical Care, Adjuvant Therapy, Treatment of Unresectable Disease

  https://emedicine.medscape.com/article/276413-treatment

  The standard surgical approach is pancreaticoduodenal resection (Whipple procedure). The procedure involves en bloc resection of the following: The gastric antrum and duodenum, a segment of the first portion of the jejunum, gallbladder, and distal common bile duct, the head and often the neck of the pancreas, adjacent regional lymph nodes. […] In a review of 450 cases of surgical resection of ampullary adenoma or adenocarcinoma at Johns Hopkins, Winter et al found that 96.7% of the patients had undergone pancreaticoduodenectomy rather than local excision. These researchers concluded that pancreaticoduodenectomy should be the preferred approach for most ampullary neoplasms that require surgical resection, given that nearly 30% of the Johns Hopkins patients with T1 disease had lymph node metastases.

• #7 Ampullary Carcinoma Treatment & Management: Surgical Care, Adjuvant Therapy, Treatment of Unresectable Disease

  https://emedicine.medscape.com/article/276413-treatment

  Local resection has generally been reserved for poor operative candidates (eg, elderly patients, those with other comorbid conditions) with favorable tumors (generally 2 cm, polypoid). […] Palliative surgery is reserved for patients who have unresectable tumors but who are good candidates for surgery. The goal is to alleviate biliary obstruction, duodenal obstruction, or pain. […] Because local and systemic failures remain problematic, physicians continue to be interested in offering adjuvant therapy. […] A systematic review and meta-analysis of 27 studies involving 3,538 patients concluded that adjuvant therapy was significantly associated with decreased mortality risk, especially for chemoradiotherapy. […] For patients with unresectable ampllary carcinoma, endoscopic stenting to achieve biliary decompression is an appropriate palliative procedure. […] Given the paucity of effective standard treatment options, encourage patients to enroll in clinical trials.

• #8 Ampullary cancer: 9 things to know about this rare gastrointestinal cancer | MD Anderson Cancer Center

  https://www.mdanderson.org/cancerwise/ampullary-cancer-9-insights-on-this-rare-gastrointestinal-cancer.h00-159542112.html

  A surgery called the Whipple procedure is the most common treatment for ampullary cancer. The surgeon removes the tumor in the ampulla of Vater, as well as several adjoining areas where cancer may have spread. These include the head of the pancreas, part of the small intestine, the gallbladder, nearby lymph nodes, and, in some cases, the lower half of the stomach. […] Some patients undergo chemotherapy and radiation therapy after surgery to kill any remaining cancer cells. […] Patients who are not healthy enough to undergo a Whipple procedure may be treated with chemotherapy, radiation therapy, or laser surgery that uses special light beams instead of a scalpel to cut tissue.

• #9 Ampullary cancer – Augusta HealthSearchClose SearchSearch IconSearch IconClose Search IconMobile Menu IconMobile Menu Close IconInstagramFacebookTwitterYoutube

  https://www.augustahealth.com/disease/ampullary-cancer/

  Ampullary cancer treatment often involves extensive surgery to remove the cancer and a large margin of healthy tissue. […] Ampullary cancer treatment options may include: […] Surgery to remove the pancreas and small intestine. The Whipple procedure (pancreaticoduodenectomy) involves removing the head of your pancreas as well as a portion of your small intestine (duodenum), your gallbladder and part of your bile duct. […] Minimally invasive surgery. For very small ampullary cancers and precancerous tumors, it may be possible to remove the cancer with tools passed through an endoscope (endoscopic surgery). This may be an option in certain situations. […] Combined chemotherapy and radiation. Chemotherapy uses drugs to kill cancer cells. Radiation therapy uses beams of energy, such as X-rays and protons, to kill cancer cells. Used together, these treatments may be more effective for ampullary cancers.

• #10 Ampullary Carcinoma Treatment & Management: Surgical Care, Adjuvant Therapy, Treatment of Unresectable Disease

  https://emedicine.medscape.com/article/276413-treatment

  Results after radical resection of ampullary of Vater carcinoma have been improving. During recent decades, 5-year survival rates have ranged from 20-61%, averaging higher than 35%. The reported mortality rates from this operation are decreasing. […] In a review of more than 1100 patients published in a surgical series, Howe et al reported that the overall rate of resectability was 82%. […] A review of cases from Veterans Affairs hospitals across the United States by el-Ghazzawy et al revealed that only 63% of presenting patients undergo surgery for cure. At disease presentation, 30-50% have involved lymph nodes. […] In general, for ampullary carcinoma, pancreaticoduodenectomy remains the gold standard and should be offered as long as the patient is able to tolerate the operation. […] However, because of the mortality and morbidity associated with pancreaticoduodenectomy, surgeons have studied local excision of cancers of the ampulla of Vater to avoid major resection.

• #11 Ampullary Carcinoma Treatment & Management: Surgical Care, Adjuvant Therapy, Treatment of Unresectable Disease

  https://emedicine.medscape.com/article/276413-treatment

  Results after radical resection of ampullary of Vater carcinoma have been improving. During recent decades, 5-year survival rates have ranged from 20-61%, averaging higher than 35%. The reported mortality rates from this operation are decreasing. […] In a review of more than 1100 patients published in a surgical series, Howe et al reported that the overall rate of resectability was 82%. […] A review of cases from Veterans Affairs hospitals across the United States by el-Ghazzawy et al revealed that only 63% of presenting patients undergo surgery for cure. At disease presentation, 30-50% have involved lymph nodes. […] In general, for ampullary carcinoma, pancreaticoduodenectomy remains the gold standard and should be offered as long as the patient is able to tolerate the operation. […] However, because of the mortality and morbidity associated with pancreaticoduodenectomy, surgeons have studied local excision of cancers of the ampulla of Vater to avoid major resection.

• #12 Ampullary cancer: symptoms, stages, treatment and survival rate | Dr. Nikhil Agrawal | Delhi, India

  https://www.drnikhilagrawal.com/ampullary-cancer

  The 5-year survival rate of ampulla of Vater cancer after radical surgery ranges from 35.0% to 62.7%. […] If the tumour is locally advanced, then we may give you neoadjuvant treatment (chemotherapy or chemoradiotherapy) to decrease the size of the tumour and then resect it to increase your chances of survival. […] Advanced disease (unresectable and metastatic) is treated with systemic therapy (chemotherapy, targeted therapy and immunotherapy). After FNAC/biopsy and stenting (if jaundiced) chemotherapy is given. Chemotherapy uses drugs to destroy cancer cells.

• #13 Updates in Management of Ampullary Carcinomas

  https://www.primescholars.com/articles/updates-in-management-of-ampullary-carcinomas-97508.html

  Ampullary carcinomas are rare malignancies representing less than 1% of all gastrointestinal cancers. […] The standard treatment for ampullary carcinoma has been complete surgical resection via pancreaticoduodenectomy. […] Evidence suggests that pancreaticoduodenectomy has significantly improved survival rates in ampullary carcinomas with 5-year survival rates up to 39%. […] A recent prospective trial in 2010 analyzed survival of 450 patients with ampullary tumors who underwent pancreaticoduodenectomy and found that the 5-year survival rate was 45%. […] There has been a lack of specific therapeutic protocols for adjuvant treatment of ampullary cancer. […] Although only supported by retrospective or small randomized studies, data indicate that adjuvant chemoradiation has improved survival outcomes.

• #14 Ampullary Carcinoma Treatment & Management: Surgical Care, Adjuvant Therapy, Treatment of Unresectable Disease

  https://emedicine.medscape.com/article/276413-treatment

  Local resection has generally been reserved for poor operative candidates (eg, elderly patients, those with other comorbid conditions) with favorable tumors (generally 2 cm, polypoid). […] Palliative surgery is reserved for patients who have unresectable tumors but who are good candidates for surgery. The goal is to alleviate biliary obstruction, duodenal obstruction, or pain. […] Because local and systemic failures remain problematic, physicians continue to be interested in offering adjuvant therapy. […] A systematic review and meta-analysis of 27 studies involving 3,538 patients concluded that adjuvant therapy was significantly associated with decreased mortality risk, especially for chemoradiotherapy. […] For patients with unresectable ampllary carcinoma, endoscopic stenting to achieve biliary decompression is an appropriate palliative procedure. […] Given the paucity of effective standard treatment options, encourage patients to enroll in clinical trials.

• #15 Adjuvant Treatment for Ampullary Cancer

  https://www.primescholars.com/articles/adjuvant-treatment-for-ampullary-cancer-97811.html

  Ampullary cancer is an uncommon tumor and tends to have a better prognosis than pancreatic cancer. However, one half of patients will die from recurrent disease suggesting the need for effective adjuvant therapy. Currently, there is lack of randomized trials to guide the use of adjuvant therapy in ampullary cancer. […] The only randomized phase III trials that included substantial number of periampullary cancer failed to show benefit of adjuvant chemoradiotherapy. […] There is much less data on the benefit of adjuvant chemotherapy for ampullary cancer. […] Prior to the 2011 ASCO Annual Meeting there was no level I evidence supporting benefit from adjuvant treatment in ampullary cancer. […] Overall the trial did not meet its endpoint as adjuvant chemotherapy did not significantly improve survival in resected ampullary cancer.

• #16 Ampullary Adenocarcinoma, Version 1.2023, NCCN Clinical Practice Guidelines in Oncology in: Journal of the National Comprehensive Cancer Network Volume 21 Issue 7 (2023)

  https://jnccn.org/abstract/journals/jnccn/21/7/article-p753.xml

  The first line of treatment of localized ampullary adenocarcinoma usually involves surgery, primarily pancreatoduodenectomy. […] All resected ampullary cancers can receive postoperative adjuvant treatment. The initiation of adjuvant systemic therapy is recommended within 12 weeks of surgery if the patient is medically fit. […] The NCCN recommendations for each disease stage are as follows: (1) stage I disease, systemic therapy or observation; (2) stage II disease, systemic therapy with or without chemoradiation or observation; and (3) stage III disease, systemic therapy with or without chemoradiation. […] Adjuvant therapy is frequently used after curative resection in ampullary cancer, most often in the form of chemotherapy. […] The NCCN-recommended adjuvant therapy options for pancreatobiliary/mixed type ampullary cancer are gemcitabine (category 1), 5-FU + leucovorin (category 1), gemcitabine + capecitabine, gemcitabine + cisplatin, FOLFOX/CapeOx, capecitabine, and mFOLFIRINOX.

• #17 Ampullary Adenocarcinoma, Version 1.2023, NCCN Clinical Practice Guidelines in Oncology in: Journal of the National Comprehensive Cancer Network Volume 21 Issue 7 (2023)

  https://jnccn.org/abstract/journals/jnccn/21/7/article-p753.xml

  The first line of treatment of localized ampullary adenocarcinoma usually involves surgery, primarily pancreatoduodenectomy. […] All resected ampullary cancers can receive postoperative adjuvant treatment. The initiation of adjuvant systemic therapy is recommended within 12 weeks of surgery if the patient is medically fit. […] The NCCN recommendations for each disease stage are as follows: (1) stage I disease, systemic therapy or observation; (2) stage II disease, systemic therapy with or without chemoradiation or observation; and (3) stage III disease, systemic therapy with or without chemoradiation. […] Adjuvant therapy is frequently used after curative resection in ampullary cancer, most often in the form of chemotherapy. […] The NCCN-recommended adjuvant therapy options for pancreatobiliary/mixed type ampullary cancer are gemcitabine (category 1), 5-FU + leucovorin (category 1), gemcitabine + capecitabine, gemcitabine + cisplatin, FOLFOX/CapeOx, capecitabine, and mFOLFIRINOX.

• #18 Ampullary Adenocarcinoma, Version 1.2023, NCCN Clinical Practice Guidelines in Oncology in: Journal of the National Comprehensive Cancer Network Volume 21 Issue 7 (2023)

  https://jnccn.org/abstract/journals/jnccn/21/7/article-p753.xml

  The recommendations for 5-FU + leucovorin and gemcitabine are based on results of the ESPAC-3 trial. […] The recommendation for gemcitabine + capecitabine is based on extrapolation of data from ESPAC-4. […] The recommendation for gemcitabine + cisplatin is extrapolated from data from a phase II randomized trial that enrolled 410 patients with advanced biliary tract cancer. […] The recommendation for CapeOx is extrapolated from data from a phase II trial that enrolled a total of 31 patients with advanced small bowel and ampullary cancers. […] The recommendation for capecitabine is based on extrapolation of data from BILCAP, a phase III randomized trial that enrolled 447 patients with biliary tract cancer. […] The recommendation for mFOLFIRINOX is based on extrapolation of data from the PRODIGE 24/CCTG PA.6 phase III randomized trial in resected pancreatic cancer.

• #19 The future of adjuvant therapy in ampullary cancer: should we offer it to our patients? – Tella – Hepatobiliary Surgery and Nutrition

  https://hbsn.amegroups.org/article/view/31979/html

  Several retrospective studies of similar or larger sample size have yielded controversial results to-date. […] None of these studies, including the latest multi-institutional analysis by Ecker et al., included information on the duration and tolerance of therapy. […] In the subgroup analysis of ampullary cancer patients in ESPAC-3 trial, OS benefit was observed only in gemcitabine arm and not in 5-fluorouracil arm. […] The question that arises is whether we should offer or advocate post-surgical adjuvant therapy to our patients with ampullary carcinoma? […] In fact, prospective randomized clinical trials that evaluated the role of adjuvant therapy in ampullary cancer showed contrast results. […] However, no benefit was reported in 5-fluorouracil arm. […] The controversy about the benefits of adjuvant therapy in ampullary cancer should be discussed with the patient and their goals of care are to be taken into consideration to deliver highest quality care to our patients. […] A better understanding on molecular pathogenesis and genetic aberrations implicated in ampullary cancer will hopefully open doors for precision oncology, especially in the adjuvant setting.

• #20 Ampullary Adenocarcinoma, Version 1.2023, NCCN Clinical Practice Guidelines in Oncology in: Journal of the National Comprehensive Cancer Network Volume 21 Issue 7 (2023)

  https://jnccn.org/abstract/journals/jnccn/21/7/article-p753.xml

  The recommendations for 5-FU + leucovorin and gemcitabine are based on results of the ESPAC-3 trial. […] The recommendation for gemcitabine + capecitabine is based on extrapolation of data from ESPAC-4. […] The recommendation for gemcitabine + cisplatin is extrapolated from data from a phase II randomized trial that enrolled 410 patients with advanced biliary tract cancer. […] The recommendation for CapeOx is extrapolated from data from a phase II trial that enrolled a total of 31 patients with advanced small bowel and ampullary cancers. […] The recommendation for capecitabine is based on extrapolation of data from BILCAP, a phase III randomized trial that enrolled 447 patients with biliary tract cancer. […] The recommendation for mFOLFIRINOX is based on extrapolation of data from the PRODIGE 24/CCTG PA.6 phase III randomized trial in resected pancreatic cancer.

• #21 Ampullary Adenocarcinoma, Version 1.2023, NCCN Clinical Practice Guidelines in Oncology in: Journal of the National Comprehensive Cancer Network Volume 21 Issue 7 (2023)

  https://jnccn.org/abstract/journals/jnccn/21/7/article-p753.xml

  The NCCN recommendations for chemoradiation in ampullary cancer are similar to those in the NCCN Guidelines for Pancreatic Adenocarcinoma, NCCN Guidelines for Biliary Tract Cancers for pancreatobiliary ampullary cancers, and NCCN Guidelines for Small Bowel Adenocarcinoma for intestinal type ampullary cancers. […] For pancreatobiliary/mixed type ampullary cancer, the recommendations for FOLFIRINOX/mFOLFIRINOX, gemcitabine + cisplatin, and gemcitabine + albumin-bound paclitaxel are derived from the NCCN Guidelines for Pancreatic Adenocarcinoma and NCCN Guidelines for Biliary Tract Cancers. […] For intestinal type ampullary cancer, all recommendations are derived from the NCCN Guidelines for Colon Cancer. […] For patients diagnosed with metastatic ampullary adenocarcinomas, those with good performance status can receive systemic therapy.

• #22 Evaluation of adjuvant chemoradiation therapy for ampullary adenocarcinoma: the Johns Hopkins Hospital – Mayo Clinic collaborative study | Radiation Oncology | Full Text

  https://ro-journal.biomedcentral.com/articles/10.1186/1748-717X-6-126

  The role of adjuvant chemoradiation therapy for ampullary carcinoma is unknown. Previous literature suggests that certain populations with high risk factors for recurrence may benefit from adjuvant chemoradiation. […] Patients who received adjuvant chemoradiation (n = 66) vs. surgery alone (n = 120) showed a higher rate of T3/T4 stage disease (57.6% vs. 30.8%, P 0.001), lymph node involvement (72.7% vs. 30.0%, P 0.001), and close or positive margins (4.6% vs. 0.0%, P = 0.019). […] When compared with surgery alone, use of adjuvant chemoradiation improved survival among node positive patients (mOS 32.1 vs. 15.7 mos, 5 yr OS: 27.5% vs. 5.9%; RR = 0.47, P = 0.004). […] Node-positive patients with resected ampullary adenocarcinoma may benefit from 5-FU based adjuvant chemoradiation. Since a significant proportion of patients develop metastatic disease, there is a need for more effective systemic treatment.

• #23 Ampullary Carcinoma Treatment & Management: Surgical Care, Adjuvant Therapy, Treatment of Unresectable Disease

  https://emedicine.medscape.com/article/276413-treatment

  Local resection has generally been reserved for poor operative candidates (eg, elderly patients, those with other comorbid conditions) with favorable tumors (generally 2 cm, polypoid). […] Palliative surgery is reserved for patients who have unresectable tumors but who are good candidates for surgery. The goal is to alleviate biliary obstruction, duodenal obstruction, or pain. […] Because local and systemic failures remain problematic, physicians continue to be interested in offering adjuvant therapy. […] A systematic review and meta-analysis of 27 studies involving 3,538 patients concluded that adjuvant therapy was significantly associated with decreased mortality risk, especially for chemoradiotherapy. […] For patients with unresectable ampllary carcinoma, endoscopic stenting to achieve biliary decompression is an appropriate palliative procedure. […] Given the paucity of effective standard treatment options, encourage patients to enroll in clinical trials.

• #24 Ampullary cancer: symptoms, stages, treatment and survival rate | Dr. Nikhil Agrawal | Delhi, India

  https://www.drnikhilagrawal.com/ampullary-cancer

  The 5-year survival rate of ampulla of Vater cancer after radical surgery ranges from 35.0% to 62.7%. […] If the tumour is locally advanced, then we may give you neoadjuvant treatment (chemotherapy or chemoradiotherapy) to decrease the size of the tumour and then resect it to increase your chances of survival. […] Advanced disease (unresectable and metastatic) is treated with systemic therapy (chemotherapy, targeted therapy and immunotherapy). After FNAC/biopsy and stenting (if jaundiced) chemotherapy is given. Chemotherapy uses drugs to destroy cancer cells.

• #25 Dr. Roach: Ampullary cancer treatment can include chemo prior to surgery

  https://www.detroitnews.com/story/life/advice/2023/11/06/dr-roach-ampullary-cancer-treatment-can-include-chemo-prior-to-surgery/71437850007/

  Dr. Roach: Ampullary cancer treatment can include chemo prior to surgery […] However, giving chemotherapy before surgery (neoadjuvant chemotherapy) has increasingly been used in people with ampullary cancer. […] I can confirm that giving chemotherapy prior to surgery is being used in regards to ampullary cancer.

• #26 Ampullary cancer // Middlesex Health

  https://middlesexhealth.org/learning-center/diseases-and-conditions/ampullary-cancer

  Other treatments may be used, including: Combined chemotherapy and radiation. Chemotherapy treats cancer with strong medicines. Radiation therapy treats cancer with powerful energy beams. The energy can come from X-rays, protons or other sources. Used together, these treatments may be more effective for ampullary cancers. Combined chemotherapy and radiation may be used before surgery, to make it more likely that a cancer can be removed completely during an operation. The combined treatment also can be used after surgery to kill any cancer cells that might remain. […] Targeted therapy uses medicines that attack specific chemicals in the cancer cells. By blocking these chemicals, targeted treatments can cause cancer cells to die. Targeted therapy is used to treat ampullary cancer that spreads to other parts of the body or comes back after treatment. It’s only used in certain situations.

• #27 Ampullary Carcinoma Treatment & Management: Surgical Care, Adjuvant Therapy, Treatment of Unresectable Disease

  https://emedicine.medscape.com/article/276413-treatment

  Local resection has generally been reserved for poor operative candidates (eg, elderly patients, those with other comorbid conditions) with favorable tumors (generally 2 cm, polypoid). […] Palliative surgery is reserved for patients who have unresectable tumors but who are good candidates for surgery. The goal is to alleviate biliary obstruction, duodenal obstruction, or pain. […] Because local and systemic failures remain problematic, physicians continue to be interested in offering adjuvant therapy. […] A systematic review and meta-analysis of 27 studies involving 3,538 patients concluded that adjuvant therapy was significantly associated with decreased mortality risk, especially for chemoradiotherapy. […] For patients with unresectable ampllary carcinoma, endoscopic stenting to achieve biliary decompression is an appropriate palliative procedure. […] Given the paucity of effective standard treatment options, encourage patients to enroll in clinical trials.

• #28 Ampullary Carcinoma Treatment & Management: Surgical Care, Adjuvant Therapy, Treatment of Unresectable Disease

  https://emedicine.medscape.com/article/276413-treatment

  Local resection has generally been reserved for poor operative candidates (eg, elderly patients, those with other comorbid conditions) with favorable tumors (generally 2 cm, polypoid). […] Palliative surgery is reserved for patients who have unresectable tumors but who are good candidates for surgery. The goal is to alleviate biliary obstruction, duodenal obstruction, or pain. […] Because local and systemic failures remain problematic, physicians continue to be interested in offering adjuvant therapy. […] A systematic review and meta-analysis of 27 studies involving 3,538 patients concluded that adjuvant therapy was significantly associated with decreased mortality risk, especially for chemoradiotherapy. […] For patients with unresectable ampllary carcinoma, endoscopic stenting to achieve biliary decompression is an appropriate palliative procedure. […] Given the paucity of effective standard treatment options, encourage patients to enroll in clinical trials.

• #29 Therapeutic options for ampullary carcinomas. A review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6747019/

  Chemotherapy does a pivotal job in the treatment of Ampullary Carcinoma, especially in patients who present with distant metastasis/ recurrence or unresectable locally advanced disease. […] In conclusion, chemoradiotherapy plays a crucial role in early Ampullary Carcinoma after surgical resection, especially in node-positive disease. In contrast, few studies have shown no meaningful benefit of chemoradiation irrespective of node status and tumor stage. Nevertheless, chemoradiation should be considered in patients with poor prognostic factors given the high risk of recurrence and local failure with surgery alone.

• #30 Ampullary Adenocarcinoma, Version 1.2023, NCCN Clinical Practice Guidelines in Oncology in: Journal of the National Comprehensive Cancer Network Volume 21 Issue 7 (2023)

  https://jnccn.org/abstract/journals/jnccn/21/7/article-p753.xml

  The NCCN recommendations for chemoradiation in ampullary cancer are similar to those in the NCCN Guidelines for Pancreatic Adenocarcinoma, NCCN Guidelines for Biliary Tract Cancers for pancreatobiliary ampullary cancers, and NCCN Guidelines for Small Bowel Adenocarcinoma for intestinal type ampullary cancers. […] For pancreatobiliary/mixed type ampullary cancer, the recommendations for FOLFIRINOX/mFOLFIRINOX, gemcitabine + cisplatin, and gemcitabine + albumin-bound paclitaxel are derived from the NCCN Guidelines for Pancreatic Adenocarcinoma and NCCN Guidelines for Biliary Tract Cancers. […] For intestinal type ampullary cancer, all recommendations are derived from the NCCN Guidelines for Colon Cancer. […] For patients diagnosed with metastatic ampullary adenocarcinomas, those with good performance status can receive systemic therapy.

• #31 Ampullary Adenocarcinoma, Version 1.2023, NCCN Clinical Practice Guidelines in Oncology in: Journal of the National Comprehensive Cancer Network Volume 21 Issue 7 (2023)

  https://jnccn.org/abstract/journals/jnccn/21/7/article-p753.xml

  The NCCN recommendations for chemoradiation in ampullary cancer are similar to those in the NCCN Guidelines for Pancreatic Adenocarcinoma, NCCN Guidelines for Biliary Tract Cancers for pancreatobiliary ampullary cancers, and NCCN Guidelines for Small Bowel Adenocarcinoma for intestinal type ampullary cancers. […] For pancreatobiliary/mixed type ampullary cancer, the recommendations for FOLFIRINOX/mFOLFIRINOX, gemcitabine + cisplatin, and gemcitabine + albumin-bound paclitaxel are derived from the NCCN Guidelines for Pancreatic Adenocarcinoma and NCCN Guidelines for Biliary Tract Cancers. […] For intestinal type ampullary cancer, all recommendations are derived from the NCCN Guidelines for Colon Cancer. […] For patients diagnosed with metastatic ampullary adenocarcinomas, those with good performance status can receive systemic therapy.

• #32 Ampullary Cancer: Risk Factors, Treatments, and Prognosis

  https://www.healthline.com/health/cancer/ampullary-cancer

  Sometimes, ampullary cancer has spread to other organs or its location is unresectable, meaning a surgeon cant remove it. When this happens, a doctor may prescribe chemotherapy medications to keep the cancer from spreading further. Ideally, this will also reduce symptoms. […] A doctor may prescribe a combination of chemotherapy medications, such as an antimetabolite, like fluoropyrimidine or gemcitabine, with a platinum compound, like cisplatin or oxaliplatin. These medications attack cancer cells in different ways to keep the cancer from spreading. […] An estimated 45 percent of people treated with surgery for ampullary cancer experience a recurrence of their cancer. If a person has a tumor at stage T2 or higher, a doctor will usually recommend chemotherapy to prevent cancer recurrence.

• #33 Ampullary cancer // Middlesex Health

  https://middlesexhealth.org/learning-center/diseases-and-conditions/ampullary-cancer

  Other treatments may be used, including: Combined chemotherapy and radiation. Chemotherapy treats cancer with strong medicines. Radiation therapy treats cancer with powerful energy beams. The energy can come from X-rays, protons or other sources. Used together, these treatments may be more effective for ampullary cancers. Combined chemotherapy and radiation may be used before surgery, to make it more likely that a cancer can be removed completely during an operation. The combined treatment also can be used after surgery to kill any cancer cells that might remain. […] Targeted therapy uses medicines that attack specific chemicals in the cancer cells. By blocking these chemicals, targeted treatments can cause cancer cells to die. Targeted therapy is used to treat ampullary cancer that spreads to other parts of the body or comes back after treatment. It’s only used in certain situations.

• #34 Ampullary cancer – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/ampullary-cancer/diagnosis-treatment/drc-20446378

  Chemotherapy alone. Chemotherapy is sometimes used after surgery to kill cancer cells that might remain. In people with advanced ampullary cancer, chemotherapy may be used alone to slow the growth of the cancer. […] Targeted therapy. Targeted therapy uses medicines that attack specific chemicals in the cancer cells. By blocking these chemicals, targeted treatments can cause cancer cells to die. Targeted therapy is used to treat ampullary cancer that spreads to other parts of the body or comes back after treatment. It’s only used in certain situations. […] Immunotherapy. Immunotherapy is a treatment with medicine that helps the immune system kill cancer cells. The immune system fights off diseases by attacking germs and other cells that shouldn’t be in the body. Cancer cells survive by hiding from the immune system. Immunotherapy helps the immune system cells find and kill the cancer cells. It may be an option for treating ampullary cancer that spreads to other parts of the body or comes back after treatment. Immunotherapy is only used in certain situations.

• #35 Ampullary Adenocarcinoma, Version 1.2023, NCCN Clinical Practice Guidelines in Oncology in: Journal of the National Comprehensive Cancer Network Volume 21 Issue 7 (2023)

  https://jnccn.org/abstract/journals/jnccn/21/7/article-p753.xml

  The second line of treatment includes palliative and best supportive care or clinical trial enrollment. […] The recommendation for selpercatinib is supported by data from a phase I/II basket trial in RET fusion-positive solid tumors. […] The recommendation for pembrolizumab is supported by data from the phase II KEYNOTE-518 study. […] The recommendation for nivolumab + ipilimumab is based on data in the metastatic colorectal cancer setting. […] The recommendations for larotrectinib and entrectinib are supported by data from 2 phase III basket trials. […] Based on the recent FDA approvals, dabrafenib + trametinib can be used as a treatment option for BRAF V600E-mutated ampullary adenocarcinomas with good or poor PS.

• #36 Ampullary cancer // Middlesex Health

  https://middlesexhealth.org/learning-center/diseases-and-conditions/ampullary-cancer

  Immunotherapy is a treatment with medicine that helps the immune system kill cancer cells. The immune system fights off diseases by attacking germs and other cells that shouldn’t be in the body. Cancer cells survive by hiding from the immune system. Immunotherapy helps the immune system cells find and kill the cancer cells. It may be an option for treating ampullary cancer that spreads to other parts of the body or comes back after treatment. Immunotherapy is only used in certain situations. […] Palliative care is a special type of healthcare that helps you feel better when you have a serious illness. If you have cancer, palliative care can help relieve pain and other symptoms. A healthcare team that may include doctors, nurses and other specially trained health professionals provides palliative care. The care team’s goal is to improve quality of life for you and your family.

• #37 Ampullary cancer – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/ampullary-cancer/diagnosis-treatment/drc-20446378

  Chemotherapy alone. Chemotherapy is sometimes used after surgery to kill cancer cells that might remain. In people with advanced ampullary cancer, chemotherapy may be used alone to slow the growth of the cancer. […] Targeted therapy. Targeted therapy uses medicines that attack specific chemicals in the cancer cells. By blocking these chemicals, targeted treatments can cause cancer cells to die. Targeted therapy is used to treat ampullary cancer that spreads to other parts of the body or comes back after treatment. It’s only used in certain situations. […] Immunotherapy. Immunotherapy is a treatment with medicine that helps the immune system kill cancer cells. The immune system fights off diseases by attacking germs and other cells that shouldn’t be in the body. Cancer cells survive by hiding from the immune system. Immunotherapy helps the immune system cells find and kill the cancer cells. It may be an option for treating ampullary cancer that spreads to other parts of the body or comes back after treatment. Immunotherapy is only used in certain situations.

• #38 Ampullary Adenocarcinoma, Version 1.2023, NCCN Clinical Practice Guidelines in Oncology in: Journal of the National Comprehensive Cancer Network Volume 21 Issue 7 (2023)

  https://jnccn.org/abstract/journals/jnccn/21/7/article-p753.xml

  The second line of treatment includes palliative and best supportive care or clinical trial enrollment. […] The recommendation for selpercatinib is supported by data from a phase I/II basket trial in RET fusion-positive solid tumors. […] The recommendation for pembrolizumab is supported by data from the phase II KEYNOTE-518 study. […] The recommendation for nivolumab + ipilimumab is based on data in the metastatic colorectal cancer setting. […] The recommendations for larotrectinib and entrectinib are supported by data from 2 phase III basket trials. […] Based on the recent FDA approvals, dabrafenib + trametinib can be used as a treatment option for BRAF V600E-mutated ampullary adenocarcinomas with good or poor PS.

• #39 Progression of Metastatic, PD-L1–Positive, Ampullary Carcinoma with a Treatment Holiday from Off-Label Use of Pembrolizumab Therapy

  https://jhoponline.com/issue-archive/2020-issues/august-2020-vol-10-no-4/18303-progression-of-metastatic-pd-l1-positive-ampullary-carcinoma-with-a-treatment-holiday-from-off-label-use-of-pembrolizumab-therapy

  Ampullary carcinoma, a rare type of tumor that arises from the ampulla of Vater, represents only 0.2% of all gastrointestinal (GI) tract neoplasms to date. […] The use of pembrolizumab in the setting of ampullary carcinoma has not been explicitly studied. […] We present a case of using off-label pembrolizumab therapy that produced a durable response in a 75-year-old woman with microsatellite-stable, metastatic ampullary carcinoma and 35% PD-L1 expression. […] The off-label use of pembrolizumab for third-line treatment resulted in a durable response in a patient with microsatellite-stable, metastatic ampullary carcinoma and 35% PD-L1 expression. […] Pembrolizumab has not been approved by the FDA for use in the setting of microsatellite-stable cholangiocarcinoma or ampullary carcinoma, but several studies have provided examples of PD-L1 expression in the setting of ampullary carcinoma.

• #40 The Diagnosis and Treatment of Ampullary Carcinoma

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10714289/

  Ampullary carcinoma has an incidence of 0.5 to 0.9 per 100 000 persons and a poor prognosis, with a 5-year survival rate of 41% to 45% for locally confined and 4% to 7% for metastatic disease. […] The treatment of choice for ampullary carcinoma is radical oncological resection of the head of the pancreas with systematic lymphadenectomy. Five-year overall survival is between 10% and 75% depending on the stage. […] No definitive recommendation for adjuvant therapy can be given. Palliative therapy can be oriented to the published treatment strategies for cancer of the colon, pancreas, and bile duct. […] The current state of the evidence on the treatment of ampullary carcinoma is poor. Therapeutic decisions should be discussed in an interdisciplinary tumor board and should, in our opinion, take the histological subtype into account.

• #41 NCCN Establishes Standards of Care in Ampullary Adenocarcinoma

  https://www.onclive.com/view/nccn-establishes-standards-of-care-in-ampullary-adenocarcinoma

  Physicians determine treatment for ampullary adenocarcinomas depending on whether the tumor histology is pancreatobiliary, intestinal, or mixed. […] The current standard of care for localized ampullary cancer is pancreaticoduodenectomy, also known as the Whipple procedure, in which a surgeon removes the head of the pancreas, part of the duodenum, the common bile duct, and the gallbladder. […] Neoadjuvant therapy is an option for patients with localized pancreatic cancer because those tumors are more commonly closed to the celiac arterial axis, but the guidelines say that there is limited evidence supporting such treatment for ampullary cancers and most such patients proceed straight to surgery. […] After surgical resection, we consider administering adjuvant therapy to reduce the odds of recurrence based, again, on the histology, Chiorean said.

• #42 Chemotherapy selection regimens based on pathological type | OTT

  https://www.dovepress.com/remission-from-the-5-fu-based-chemotherapy-to-gemcitabine-based-chemot-peer-reviewed-fulltext-article-OTT

  According to existing literature reports, surgery is still the only reliable curative treatment, which is often followed by subtype-based personalized adjuvant chemoradiotherapy regimen decision-making with the basic principle that patients with the IN type tend to use fluorouracil-based treatment options and patients with the PB subtype tend to be treated with gemcitabine-based options.

• #43 Ampullary Adenocarcinoma, Version 1.2023, NCCN Clinical Practice Guidelines in Oncology in: Journal of the National Comprehensive Cancer Network Volume 21 Issue 7 (2023)

  https://jnccn.org/abstract/journals/jnccn/21/7/article-p753.xml

  The NCCN recommendations for chemoradiation in ampullary cancer are similar to those in the NCCN Guidelines for Pancreatic Adenocarcinoma, NCCN Guidelines for Biliary Tract Cancers for pancreatobiliary ampullary cancers, and NCCN Guidelines for Small Bowel Adenocarcinoma for intestinal type ampullary cancers. […] For pancreatobiliary/mixed type ampullary cancer, the recommendations for FOLFIRINOX/mFOLFIRINOX, gemcitabine + cisplatin, and gemcitabine + albumin-bound paclitaxel are derived from the NCCN Guidelines for Pancreatic Adenocarcinoma and NCCN Guidelines for Biliary Tract Cancers. […] For intestinal type ampullary cancer, all recommendations are derived from the NCCN Guidelines for Colon Cancer. […] For patients diagnosed with metastatic ampullary adenocarcinomas, those with good performance status can receive systemic therapy.

• #44 NCCN Establishes Standards of Care in Ampullary Adenocarcinoma

  https://www.onclive.com/view/nccn-establishes-standards-of-care-in-ampullary-adenocarcinoma

  The guidelines suggest FOLFIRINOX or modified FOLFIRINOX with or without subsequent chemoradiation, or gemcitabine-based regimens with cisplatin, capecitabine, or nab-paclitaxel (Abraxane), all with or without subsequent chemoradiation for those with pancreatobiliary or mixed disease. […] In the adjuvant setting, the guidelines specifically cite the phase 3 ESPAC-3 trial (NCT00058201), which included patients with ampullary cancers, to support the use of postoperative gemcitabine or 5-fluorouracil (5-FU). […] The choice of second-line therapy depends on both disease subtype and the regimen used in up front. […] For instance, guideline recommendations suggest 5-FU plus leucovorin and liposomal irinotecan, FOLFIRI, FOLFOX, modified FOLFIRINOX, oxaliplatin plus 5-FU and leucovorin, capecitabine/oxaliplatin, capecitabine alone, or 5-FU plus leucovorin for patients with pancreatobiliary/mixed disease who received gemcitabine-based therapy in first line. […] Similar to other solid tumor indications, the guidelines recommend genetic testing for hereditary cancer genes, as well as tumor genomic and molecular profiling, the latter for patients with advanced disease.

• #45 Ampullary cancer – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/ampullary-cancer/diagnosis-treatment/drc-20446378

  Palliative care is a special type of healthcare that helps you feel better when you have a serious illness. If you have cancer, palliative care can help relieve pain and other symptoms. A healthcare team that may include doctors, nurses and other specially trained health professionals provides palliative care. The care team’s goal is to improve quality of life for you and your family.

• #46 Ampullary cancer – Augusta HealthSearchClose SearchSearch IconSearch IconClose Search IconMobile Menu IconMobile Menu Close IconInstagramFacebookTwitterYoutube

  https://www.augustahealth.com/disease/ampullary-cancer/

  Combined chemotherapy and radiation may be used before surgery, to make it more likely that a cancer can be removed completely during an operation. The combined treatment can also be used after surgery to kill any cancer cells that might remain. […] Chemotherapy alone. Chemotherapy is sometimes used after surgery to kill cancer cells that might remain. In people with advanced ampullary cancer, chemotherapy may be used alone to slow the growth of the cancer. […] Treatment to reduce pain and discomfort. If other treatments aren’t possible or aren’t helping, your doctor may recommend treatments that focus on making you feel more comfortable. This can include surgery to place a small wire mesh tube (stent) in your bile ducts to drain fluid that causes your skin and eyes to yellow.

• #47 Get Ampullary Cancer Treatment | Cleveland Clinic

  https://my.clevelandclinic.org/services/ampullary-cancer-treatment

  We may recommend chemotherapy or radiation therapy after surgery. These therapies reduce the risk of cancer returning. Or you may receive chemotherapy if cancer has spread widely or you’re not healthy enough for surgery. Your care team may suggest both treatments as part of your plan. […] Sometimes we place a stent (small mesh tube) to drain a blocked bile duct. Biliary drainage as a palliative therapy can reduce jaundice and relieve other symptoms. […] At Cleveland Clinic, we’ll help you make informed, confident decisions about your treatment plan and offer guidance and support every step along the way.

• #48 Ampullary Cancer

  https://library.sarahbush.org/library/diseasesconditions/pediatric/EarNoseThroat/134,37

  Your treatment choices depend on the type of ampullary cancer you have, test results, if the cancer can be removed with surgery, and the size and stage of the cancer. The goal of treatment may be to cure you, control the cancer, or to help ease problems caused by the cancer. Talk with your healthcare team about your treatment choices, the goals of treatment, and what the risks and side effects may be. […] The main treatment for ampullary cancer is surgery to remove the tumor. The Whipple procedure (also called a pancreaticoduodenectomy) is used. This is a major surgery where your surgeon removes the tumor in the affected part of the ampulla of Vater. Nearby tissues are often removed as well. These include the head of the pancreas, the lower half of the stomach, the duodenum, gallbladder, and lymph nodes. […] Some healthcare providers may also advise other treatments after surgery, such as chemotherapy or radiation therapy.

• #49 Ampullary Carcinoma: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/276413-overview

  Surgical resection with pancreaticoduodenectomy (the Whipple procedure) remains the gold standard for treatment, although local excision is an option for patients who may be unable to tolerate this. […] Several palliative options exist for patients with unresectable or metastatic disease. […] The standard surgical approach to the treatment of ampullary carcinoma is pancreaticoduodenal resection (Whipple procedure). […] The operative mortality rate for pancreaticoduodenectomy was at one time reported to be approximately 20%, but several hospital centers have since reported large series with operative mortality rates in the range of 5%. […] Patients with ampullary tumors have an overall better prognosis than those with pancreatic cancer and studies have demonstrated better survival after surgical resection for ampullary cancer. […] Adjuvant therapy was associated with improved overall survival. […] Patterns of failure after pancreaticoduodenectomy for ampullary carcinoma.

• #50 The Diagnosis and Treatment of Ampullary Carcinoma

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10714289/

  Ampullary carcinoma has an incidence of 0.5 to 0.9 per 100 000 persons and a poor prognosis, with a 5-year survival rate of 41% to 45% for locally confined and 4% to 7% for metastatic disease. […] The treatment of choice for ampullary carcinoma is radical oncological resection of the head of the pancreas with systematic lymphadenectomy. Five-year overall survival is between 10% and 75% depending on the stage. […] No definitive recommendation for adjuvant therapy can be given. Palliative therapy can be oriented to the published treatment strategies for cancer of the colon, pancreas, and bile duct. […] The current state of the evidence on the treatment of ampullary carcinoma is poor. Therapeutic decisions should be discussed in an interdisciplinary tumor board and should, in our opinion, take the histological subtype into account.

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