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Ampullary cancer

Medically reviewed by Last updated on Dec 5, 2023.


Ampullary cancer is cancer that starts as a growth of cells in the ampulla of Vater. The ampulla of Vater is located where the bile duct and pancreatic duct join and empty into the small intestine. Ampullary (AM-poo-la-ree) cancer is rare.

Ampullary cancer forms near many other parts of the digestive system. This includes the liver, pancreas and small intestine. When ampullary cancer grows, it may affect these other organs.

Ampullary cancer treatment often involves surgery to remove the cancer. Treatment also may include radiation therapy and chemotherapy to kill cancer cells.

Ampulla of Vater

The ampulla of Vater is located where the bile duct and pancreatic duct join and empty into the small intestine.


Signs and symptoms of ampullary cancer may include:

When to see a doctor

Make an appointment with a doctor or other healthcare professional if you have any persistent symptoms that worry you.


It's not clear what causes ampullary cancer.

Ampullary cancer happens when cells in the ampulla of Vater develop changes in their DNA. A cell's DNA holds the instructions that tell a cell what to do. In healthy cells, the DNA gives instructions to grow and multiply at a set rate. The instructions tell the cells to die at a set time. In cancer cells, the changes give different instructions. The changes tell the cancer cells to make many more cells quickly. Cancer cells can keep living when healthy cells would die. This causes too many cells.

The cancer cells might form a mass called a tumor. The tumor can grow to invade and destroy healthy body tissue. In time, cancer cells can break away and spread to other parts of the body. When cancer spreads, it's called metastatic cancer.

Risk factors

Factors that can increase the risk of ampullary cancer include:

There is no way to prevent ampullary cancer.


Tests and procedures used to diagnose ampullary cancer include:

Passing a thin, flexible scope down the throat, called an endoscopy

Endoscopy is a procedure to examine the digestive system. It uses a long, thin tube with a tiny camera, called an endoscope. The endoscope passes down the throat, through the stomach and into the small intestine. It allows the healthcare team to see the ampulla of Vater.

Special tools can pass through the endoscope to collect a sample of tissue for testing.

Endoscopy also can be used to create images. For instance, endoscopic ultrasound may help capture images of ampullary cancer.

Sometimes a dye is injected into the bile duct using endoscopy. This procedure is called endoscopic retrograde cholangiopancreatography. The dye shows up on X-rays. It can help look for blockages in the bile duct or pancreatic duct.

Imaging tests

Imaging tests make pictures of the body. They can show the location and size of ampullary cancer. Imaging tests may help the healthcare team understand more about the cancer and determine whether it has spread beyond the ampulla of Vater.

Imaging tests may include:

Removing a sample of tissue for testing, called biopsy

A biopsy is a procedure to remove a sample of tissue for testing in a lab. The sample is tested in a lab to see if it is cancer. Other special tests give more details about the cancer cells. Healthcare teams use this information to make a treatment plan.

Endoscopic retrograde cholangiopancreatography

Endoscopic retrograde cholangiopancreatography (ERCP) uses a dye to highlight the bile ducts and pancreatic duct on X-ray images. A thin, flexible tube with a camera on the end, called an endoscope, is passed down your throat and into your small intestine. The dye enters the ducts through a small hollow tube, called a catheter, passed through the endoscope. Tiny tools passed through the catheter also can be used to remove gallstones.


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:

Other treatments

Other treatments may be used, including:

Palliative care

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.

Palliative care specialists work with you, your family and your care team. They provide an extra layer of support while you have cancer treatment. You can have palliative care at the same time you're getting strong cancer treatments, such as surgery, chemotherapy or radiation therapy.

The use of palliative care with other treatments can help people with cancer feel better and live longer.

Whipple procedure

The Whipple procedure, also called pancreaticoduodenectomy, is an operation to remove the head of the pancreas. The operation also involves removing the first part of the small intestine, called the duodenum, the gallbladder and the bile duct. The remaining organs are rejoined to allow food to move through the digestive system after surgery.

Coping and support

With time, you'll find what helps you cope with the uncertainty and distress of a cancer diagnosis. Until then, you may find it helps to:

Preparing for an appointment

Make an appointment with a doctor or other healthcare professional if you have any symptoms that worry you.

If your healthcare professional thinks you might have ampullary cancer, you may be referred to a specialist. This might be a doctor who specializes in treating diseases and conditions of the digestive system, called a gastroenterologist. If a cancer diagnosis is made, you also may be referred to a doctor who specializes in treating cancer. This doctor is called an oncologist.

Because appointments can be brief, it's a good idea to be prepared. Here's some information to help you get ready.

What you can do

Your time with your healthcare team is limited, so preparing a list of questions can help you make the most of your time together. List your questions from most important to least important in case time runs out. For ampullary cancer, some basic questions to ask include:

Don't hesitate to ask other questions.

What to expect from your doctor

Be prepared to answer questions, such as:

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