How to distinguish pancreatic cancer from ampullary cancer

The symptoms of pancreatic cancer, especially pancreatic head cancer and ampullary cancer, are very similar and are easily confused clinically. However, pancreatic cancer and ampullary cancer are very different in biological characteristics and disease prognosis. The effects of surgical treatment also vary greatly. Treatment plans and prognosis are also different. Therefore, they should be carefully distinguished.

The clinical manifestations of the two are similar, but also different:

1. Abdominal pain and discomfort

40% to 70% of pancreatic cancer patients experience abdominal pain as the first symptom, while 30% of ampullary cancer patients also experience this phenomenon.

2. Jaundice

Painless jaundice is the most prominent symptom of pancreatic head cancer, accounting for about 30%. Because pancreatic uncinate cancer is far away from the ampulla, only 15-20% of patients experience jaundice. Jaundice may also occur in the late stage of pancreatic body and tail cancer due to metastasis and compression of the common bile duct or hilar lymph nodes. Jaundice is persistent and progressive. Almost all patients with ampulla cancer have jaundice, and in some patients, jaundice may fluctuate significantly due to ulceration and shedding of the tumor.

3. Gastrointestinal symptoms

Patients with pancreatic cancer experience significant weight loss, which is caused by obstruction of the bile duct and pancreatic duct, while such digestive tract symptoms of ampullary cancer are relatively mild, which may be due to incomplete obstruction of the bile duct and pancreatic duct.

4. Anemia

Ampullary cancer can cause hemorrhagic anemia due to local necrosis and bleeding of the tumor, and sometimes black stools, while pancreatic cancer only causes such symptoms after the tumor invades the duodenum.

5. Inspection

In terms of imaging diagnosis, endoscopic retrograde pancreaticocholangiopancreatography can differentiate pancreatic cancer from ampullary cancer and perform biopsy under direct vision; during percutaneous hepatic biliary drainage, the obstruction site of pancreatic head cancer is higher, in the inner segment of the duodenal wall of the common bile duct, while the obstruction site of ampullary cancer is at the distal end of the bile duct; CT and B-ultrasound examinations will reveal that the pancreatic head of ampullary cancer is not large, and sometimes dilated bile ducts can be seen.