Il carcinoma dell’ampolla di Vaterrappresenta il 10% circa dei processi neoplastici ostruenti la via biliare principale. Il carcinoma della papilla di Vater cresce lentamente e metastatizza con maggiore lentezza rispetto al carcinoma pancreatico.
Quali sono i sintomi del carcinoma dell’ampolla di Vater?
I sintomi sono molto simili a quelli presenti in caso di carcinoma della testa del pancreas, benchè la perdita di peso e il dolore siano in genere meno marcati.
L’ittero ostruttivoè di tipo ingravescente e compare precocemente; ciò spiega perché questo tipo di neoplasia venga spesso diagnosticata quando è ancora entro limiti della curabilità chirurgica.
Le feci spesso contengono sangue occulto, proveniente dalla neoplasia ulcerata.
Non di rado si associa steatorrea, perché l’ostruzione interessa non solo il coledoco, ma anche il Wirsung, impedendo quindi l’alflusso regolare nel duodeno delle secrezioni pancreatiche.
Come viene diagnosticato il carcinoma dell’ampolla di Vater?
Una radiografia del tubo gastroenterico con pasto bariatico rivela, a livello duodenale una massa intraluminale di aspetto polipoide, e la lesione può essere ben visualizzata (e biopsiata) nel corso di un’esofagogastroduodenoscopia (EGDS) o di un’ecoendoscopia.
Come si cura il carcinoma dell’ampolla di Vater?
La terapia di scelta consiste in una duodeno-cefalo pancreasectomia , analogamente al carcinoma del pancreas. Se la lesione è piccola, circoscritta e non ha invaso il pancreas, e il paziente è troppo defedato per essere sottoposta al complesso intervento di duodeno-cefalo- pancreasectomia, può essere sufficiente l’exeresi della neoplasia per via transluminale.
La sopravvivenza a 5 anni dopo l’intervento di exeresi è del 35%.
Il carcinoma del pancreas rappresenta circa il 2% di tutti i tumori maligni e il 10% circa di quelli dell’ apparato gastroenterico, secondo solo al tumore del colon; la sua incidenza è notevolmente aumentata negli ultimi decenni. L’incidenza è in netto aumento nei paesi occidentali. Il carcinoma del pancreas è un poco più comune nell’uomo che della donna, nei soggetti di colore rispetto alle popolazioni bianche; l’epoca massima di incidenza è nel quinto-settimo decennio di vita.
Sono stati identificati alcuni fattori di rischio che aumentano il pericolo di sviluppo sviluppare un carcinoma pancreatico:
Si stima che il fumo di sigaretta sia responsabile del 30% circa dei casi.
Una dieta ricca di grassi, carne, prosciutto e salumi aumenta il rischio relativo di sviluppare un carcinoma pancreatico.
Il ruolo di caffè e alcool è ancora controverso.
Altri fattori associati sono:
Obesità
Scarsa attività fisica
Età avanzata
Basso livello socio-economico
Razza afroamericana.
I due terzi dei casi sono localizzati nella testa del pancreas, il 15-20% nel corpo ( Continua a leggere)
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