Ampullary cancer adjuvant treatment

My wife, 81, has been diagnosed with pT3b N1 R0 ampullary cancer and underwent a Whipple procedure at the end of October. She has recovered very well from the surgery although her appetite is not back to normal and she has lost a lot of weight..

My question is, is chemotherapy going to be of any benefit? Two oncologists we have consulted point out that two lymph notes out of 14  were invaded and that the margin at one point is less than 1mm, so Xelodex is recommended and possibly radiation.

From the large amount of literature I have read on line, and I am not a doctor, there are conflicting opinions on the efficacy of these treatments. 

Is active surveillance with CT every three months a viable option?

Thank you.

  • Hello Maclean57

    Thanks for getting in touch and welcome to our online community.

    It’s good to hear that your wife has recovered well from surgery, but not so good to hear that she has lost a lot of weight and that her appetite is not back to normal.

    Having part of the pancreas removed during a Whipple’s operation affects how well the pancreas works. Problems with digesting food can be managed with pancreatic enzyme replacement therapy, and some patients may develop diabetes and need medicine to manage this.

    Your wife’s specialist team or dietitian should be able to give advice about this.

    Because it’s so rare, it’s difficult to find data from large scale studies or agreement on the best way to treat patients after surgery for ampullary cancer.

    This review from 2019, discusses various studies which have looked at chemotherapy or chemoradiotherapy in the treatment of ampullary cancer. We would recommend discussing this with your wife’s oncology team. Treatment decisions are usually made by a multidisciplinary team (MDT) and based on several factors, such as grade/stage of the cancer, sub-type and the patient’s general health. It’s fine to ask them why they have recommended specific treatment.

    I’ve not been able to find any research which compares adjuvant therapy (that’s treatment following surgery) with 3 monthly CT scans.

    I hope this is helpful. If you’d like to talk to one of our nurses, please don’t hesitate to get in touch.

    Best wishes,

    Carole (Macmillan Information Nurse Specialist)