Skip to main content

Pancreas Adenocarcinoma and Ampullary Cancer

  • Chapter
  • First Online:
Book cover Pancreas and Biliary Disease

Abstract

The incidence of periampullary tumors is increasing. Pancreatic cancer estimated to become the second leading cause of cancer related deaths by 2020. Similar to many other solid organ tumors, the management of pancreatic cancer requires a multidisciplinary team approach and the sequencing of oncologic therapies has significant impact on quality of life, treatment toxicity, and survival. This chapter will review pancreatic cancer staging and provide a framework to guide discussions regarding neoadjuvant versus adjuvant therapy for pancreatic cancer. In addition, the management of tumors of the ampulla Vatar will be contrasted with the management of pancreatic cancer.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin. 2011;61(2):69–90.

    Article  PubMed  Google Scholar 

  2. Pancreatic Adenocarcinoma 2015 [updated Version 2.2015. Available from: http://www.nccn.org/professionals/physician_gls/pdf/pancreatic.pdf.

  3. Sohal DP, Walsh RM, Ramanathan RK, Khorana AA. Pancreatic adenocarcinoma: treating a systemic disease with systemic therapy. J Natl Cancer Inst. 2014;106(3):dju011.

    Article  PubMed  Google Scholar 

  4. Goodman MT, Yamamoto J. Descriptive study of gallbladder, extrahepatic bile duct, and ampullary cancers in the United States, 1997–2002. Cancer Causes Control. 2007;18(4):415–22.

    Article  CAS  PubMed  Google Scholar 

  5. AJCC Cancer Staging Manual. 7th ed. In: Edge S, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A, editors. New York: Springer-Verlag; 2010. p. 648.

    Google Scholar 

  6. McIntyre CA, Winter JM. Diagnostic evaluation and staging of pancreatic ductal adenocarcinoma. Semin Oncol. 2015;42(1):19–27.

    Article  PubMed  Google Scholar 

  7. Canto MI, Harinck F, Hruban RH, Offerhaus GJ, Poley JW, Kamel I, et al. International Cancer of the Pancreas Screening (CAPS) Consortium summit on the management of patients with increased risk for familial pancreatic cancer. Gut. 2013;62(3):339–47.

    Article  PubMed  Google Scholar 

  8. Ferrone CR, Finkelstein DM, Thayer SP, Muzikansky A, Fernandez-delCastillo C, Warshaw AL. Perioperative CA19-9 levels can predict stage and survival in patients with resectable pancreatic adenocarcinoma. J Clin Oncol. 2006;24(18):2897–902.

    Article  CAS  PubMed  Google Scholar 

  9. Barton JG, Bois JP, Sarr MG, Wood CM, Qin R, Thomsen KM, et al. Predictive and prognostic value of CA 19–9 in resected pancreatic adenocarcinoma. J Gastrointest Surg. 2009;13(11):2050–8.

    Article  PubMed  Google Scholar 

  10. Hartwig W, Strobel O, Hinz U, Fritz S, Hackert T, Roth C, et al. CA19-9 in potentially resectable pancreatic cancer: perspective to adjust surgical and perioperative therapy. Ann Surg Oncol. 2013;20(7):2188–96.

    Article  PubMed  Google Scholar 

  11. Tempero MA, Uchida E, Takasaki H, Burnett DA, Steplewski Z, Pour PM. Relationship of carbohydrate antigen 19–9 and Lewis antigens in pancreatic cancer. Cancer Res. 1987;47(20):5501–3.

    CAS  PubMed  Google Scholar 

  12. Mann DV, Edwards R, Ho S, Lau WY, Glazer G. Elevated tumour marker CA19-9: clinical interpretation and influence of obstructive jaundice. Eur J Surg Oncol. 2000;26(5):474–9.

    Article  CAS  PubMed  Google Scholar 

  13. Raman SP, Horton KM, Fishman EK. Multimodality imaging of pancreatic cancer-computed tomography, magnetic resonance imaging, and positron emission tomography. Cancer J. 2012;18(6):511–22.

    Article  PubMed  Google Scholar 

  14. Tran Cao HS, Balachandran A, Wang H, Nogueras-Gonzalez GM, Bailey CE, Lee JE, et al. Radiographic tumor-vein interface as a predictor of intraoperative, pathologic, and oncologic outcomes in resectable and borderline resectable pancreatic cancer. J Gastrointest Surg. 2014;18(2):269–78. discussion 78.

    Article  PubMed  Google Scholar 

  15. Chun YS, Milestone BN, Watson JC, Cohen SJ, Burtness B, Engstrom PF, et al. Defining venous involvement in borderline resectable pancreatic cancer. Ann Surg Oncol. 2010;17(11):2832–8.

    Article  PubMed  Google Scholar 

  16. Tseng JF, Raut CP, Lee JE, Pisters PW, Vauthey JN, Abdalla EK, et al. Pancreaticoduodenectomy with vascular resection: margin status and survival duration. J Gastrointest Surg. 2004;8(8):935–49. discussion 49–50.

    Article  PubMed  Google Scholar 

  17. Nakao A, Takeda S, Inoue S, Nomoto S, Kanazumi N, Sugimoto H, et al. Indications and techniques of extended resection for pancreatic cancer. World J Surg. 2006;30(6):976–82. discussion 83–4.

    Article  PubMed  Google Scholar 

  18. Pancreatic adenocarcinoma. NCCN Clinical Practice Guidelines in Oncology (NCCN guidelines) 2012; http://www.nccn.org/professionals/physician_gls/pdf/pancreatic.pdf.

  19. Katz MH, Pisters PW, Evans DB, Sun CC, Lee JE, Fleming JB, et al. Borderline resectable pancreatic cancer: the importance of this emerging stage of disease. J Am Coll Surg. 2008;206(5):833–46. discussion 46–8.

    Article  PubMed  Google Scholar 

  20. Winter JM, Brennan MF, Tang LH, D’Angelica MI, Dematteo RP, Fong Y, et al. Survival after resection of pancreatic adenocarcinoma: results from a single institution over three decades. Ann Surg Oncol. 2012;19(1):169–75.

    Google Scholar 

  21. Winter JM, Cameron JL, Campbell KA, Arnold MA, Chang DC, Coleman J, et al. 1423 pancreaticoduodenectomies for pancreatic cancer: A single-institution experience. J Gastrointest Surg. 2006;10(9):1199–210. discussion 210–1.

    Article  PubMed  Google Scholar 

  22. Oettle H, Neuhaus P, Hochhaus A, Hartmann JT, Gellert K, Ridwelski K, et al. Adjuvant chemotherapy with gemcitabine and long-term outcomes among patients with resected pancreatic cancer: the CONKO-001 randomized trial. JAMA. 2013;310(14):1473–81.

    Article  CAS  PubMed  Google Scholar 

  23. Klinkenbijl JH, Jeekel J, Sahmoud T, van Pel R, Couvreur ML, Veenhof CH, et al. Adjuvant radiotherapy and 5-fluorouracil after curative resection of cancer of the pancreas and periampullary region: phase III trial of the EORTC gastrointestinal tract cancer cooperative group. Ann Surg. 1999;230(6):776–82. discussion 82–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Evans DB, Farnell MB, Lillemoe KD, Vollmer Jr C, Strasberg SM, Schulick RD. Surgical treatment of resectable and borderline resectable pancreas cancer: expert consensus statement. Ann Surg Oncol. 2009;16(7):1736–44.

    Article  PubMed  Google Scholar 

  25. Tempero MA, Arnoletti JP, Behrman S, Ben-Josef E, Benson 3rd AB, Berlin JD, et al. Pancreatic adenocarcinoma. J Natl Compr Cancer Netw. 2010;8(9):972–1017.

    CAS  Google Scholar 

  26. Swanson RS, Pezzi CM, Mallin K, Loomis AM, Winchester DP. The 90-Day Mortality After Pancreatectomy for Cancer Is Double the 30-Day Mortality: More than 20,000 Resections From the National Cancer Data Base. Annals of surgical oncology. 2014.

    Google Scholar 

  27. Mayo SC, Gilson MM, Herman JM, Cameron JL, Nathan H, Edil BH, et al. Management of patients with pancreatic adenocarcinoma: national trends in patient selection, operative management, and use of adjuvant therapy. J Am Coll Surg. 2012;214(1):33–45.

    Article  PubMed  Google Scholar 

  28. Evans DB, Rich TA, Byrd DR, Cleary KR, Connelly JH, Levin B, et al. Preoperative chemoradiation and pancreaticoduodenectomy for adenocarcinoma of the pancreas. Arch Surg. 1992;127(11):1335–9.

    Article  CAS  PubMed  Google Scholar 

  29. Pilepich MV, Miller HH. Preoperative irradiation in carcinoma of the pancreas. Cancer. 1980;46(9):1945–9.

    Article  CAS  PubMed  Google Scholar 

  30. Takahashi H, Ogawa H, Ohigashi H, Gotoh K, Yamada T, Ohue M, et al. Preoperative chemoradiation reduces the risk of pancreatic fistula after distal pancreatectomy for pancreatic adenocarcinoma. Surgery. 2011;150(3):547–56.

    Article  PubMed  Google Scholar 

  31. Raut CP, Evans DB, Crane CH, Pisters PW, Wolff RA. Neoadjuvant therapy for resectable pancreatic cancer. Surg Oncol Clin N Am. 2004;13(4):639–61. ix.

    Article  PubMed  Google Scholar 

  32. Willett CG, Lewandrowski K, Warshaw AL, Efird J, Compton CC. Resection margins in carcinoma of the head of the pancreas. Implications for radiation therapy. Ann Surg. 1993;217(2):144–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Evans DB, Varadhachary GR, Crane CH, Sun CC, Lee JE, Pisters PW, et al. Preoperative gemcitabine-based chemoradiation for patients with resectable adenocarcinoma of the pancreatic head. J Clin Oncol. 2008;26(21):3496–502.

    Article  CAS  PubMed  Google Scholar 

  34. Varadhachary GR, Wolff RA, Crane CH, Sun CC, Lee JE, Pisters PW, et al. Preoperative gemcitabine and cisplatin followed by gemcitabine-based chemoradiation for resectable adenocarcinoma of the pancreatic head. J Clin Oncol. 2008;26(21):3487–95.

    Article  CAS  PubMed  Google Scholar 

  35. Bjork J, Akerbrant H, Iselius L, Bergman A, Engwall Y, Wahlstrom J, et al. Periampullary adenomas and adenocarcinomas in familial adenomatous polyposis: cumulative risks and APC gene mutations. Gastroenterology. 2001;121(5):1127–35.

    Article  CAS  PubMed  Google Scholar 

  36. Showalter TN, Zhan T, Anne PR, Chervoneva I, Mitchell EP, Yeo CJ, et al. The influence of prognostic factors and adjuvant chemoradiation on survival after pancreaticoduodenectomy for ampullary carcinoma. J Gastrointest Surg. 2011;15(8):1411–6.

    Article  PubMed  Google Scholar 

  37. Hornick JR, Johnston FM, Simon PO, Younkin M, Chamberlin M, Mitchem JB, et al. A single-institution review of 157 patients presenting with benign and malignant tumors of the ampulla of Vater: management and outcomes. Surgery. 2011;150(2):169–76.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Raman SP, Fishman EK. Abnormalities of the distal common bile duct and ampulla: diagnostic approach and differential diagnosis using multiplanar reformations and 3D imaging. AJR Am J Roentgenol. 2014;203(1):17–28.

    Article  PubMed  Google Scholar 

  39. Panzeri F, Crippa S, Castelli P, Aleotti F, Pucci A, Partelli S, et al. Management of ampullary neoplasms: a tailored approach between endoscopy and surgery. World J Gastroenterol. 2015;21(26):7970–87.

    PubMed  PubMed Central  Google Scholar 

  40. Tran TC, Vitale GC. Ampullary tumors: endoscopic versus operative management. Surg Innov. 2004;11(4):255–63.

    Article  PubMed  Google Scholar 

  41. Sessa F, Furlan D, Zampatti C, Carnevali I, Franzi F, Capella C. Prognostic factors for ampullary adenocarcinomas: tumor stage, tumor histology, tumor location, immunohistochemistry and microsatellite instability. Virchows Arch. 2007;451(3):649–57.

    Article  CAS  PubMed  Google Scholar 

  42. Amini A, Miura JT, Jayakrishnan TT, Johnston FM, Tsai S, Christians KK, et al. Is local resection adequate for T1 stage ampullary cancer? HPB. 2015;17(1):66–71.

    Article  PubMed  Google Scholar 

  43. Jabbour SK, Mulvihill D. Defining the role of adjuvant therapy: ampullary and duodenal adenocarcinoma. Semin Radiat Oncol. 2014;24(2):85–93.

    Article  PubMed  Google Scholar 

  44. Woo SM, Ryu JK, Lee SH, Yoo JW, Park JK, Kim YT, et al. Recurrence and prognostic factors of ampullary carcinoma after radical resection: comparison with distal extrahepatic cholangiocarcinoma. Ann Surg Oncol. 2007;14(11):3195–201.

    Article  PubMed  Google Scholar 

  45. Neoptolemos JP, Moore MJ, Cox TF, Valle JW, Palmer DH, McDonald AC, et al. Effect of adjuvant chemotherapy with fluorouracil plus folinic acid or gemcitabine vs observation on survival in patients with resected periampullary adenocarcinoma: the ESPAC-3 periampullary cancer randomized trial. JAMA. 2012;308(2):147–56.

    Article  CAS  PubMed  Google Scholar 

  46. Winter JM, Cameron JL, Olino K, Herman JM, de Jong MC, Hruban RH, et al. Clinicopathologic analysis of ampullary neoplasms in 450 patients: implications for surgical strategy and long-term prognosis. J Gastrointest Surg. 2010;14(2):379–87.

    Article  PubMed  Google Scholar 

  47. Hsu HP, Yang TM, Hsieh YH, Shan YS, Lin PW. Predictors for patterns of failure after pancreaticoduodenectomy in ampullary cancer. Ann Surg Oncol. 2007;14(1):50–60.

    Article  PubMed  Google Scholar 

  48. Zhou J, Hsu CC, Winter JM, Pawlik TM, Laheru D, Hughes MA, et al. Adjuvant chemoradiation versus surgery alone for adenocarcinoma of the ampulla of Vater. Radiother Oncol. 2009;92(2):244–8.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Krishnan S, Rana V, Evans DB, Varadhachary G, Das P, Bhatia S, et al. Role of adjuvant chemoradiation therapy in adenocarcinomas of the ampulla of vater. Int J Radiat Oncol Biol Phys. 2008;70(3):735–43.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Susan Tsai M.D., M.H.S. .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Barnes, C., Christians, K.K., Evans, D.B., Tsai, S. (2016). Pancreas Adenocarcinoma and Ampullary Cancer. In: Dua, K., Shaker, R. (eds) Pancreas and Biliary Disease. Springer, Cham. https://doi.org/10.1007/978-3-319-28089-9_6

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-28089-9_6

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-28087-5

  • Online ISBN: 978-3-319-28089-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics