Duodenal and ampullary masses begin as pre-malignant polyps that over time can develop into a malignancy. The duodenum is the first portion of the small intestine after the stomach. The ampulla is a structure in the second portion of the duodenum where the bile and pancreatic ducts empty into the intestine. Some individuals can develop polyps and tumors of the duodenum or ampulla. In the early stages, growth in this area does not produce symptoms. In more advanced stages ampullary masses can cause obstructive jaundice or pancreatitis. Duodenal masses can bleed or cause an obstruction in later stages. The work-up modality of choice in an upper endoscopy or ERCP for duodenal masses and ampullary masses, respectively. If the mass is small it can be completely removed endoscopically with a snare. If large and endoscopically unresectable, a biopsy will be performed.
If the biopsy returns as an adenoma (polyp) without features of developing carcinoma, the mass can be removed surgically with a limited resection of the mass (tranduodenal polypectomy/ampullectomy). If a duodenal or ampullary mass biopsy returns as carcinoma (cancer), a Whipple procedure is necessary to remove the entire tumor with the surrounding lymph nodes.
Duodenal and ampullary cancer is rare. Successful treatment requires a multidisciplinary team of professionals with experience. Thus, the treatment strategy will be developed through collaboration with the gastrointestinal tumor board. This is a group of surgeons, oncologists, radiation oncologists, and interventional radiologists who discuss complex GI cancer cases on a weekly basis to determine the best treatment plan. Typically, duodenal and ampullary carcinomas are treated with surgery followed by chemotherapy.