Papillary carcinoma

Definition

Papillary carcinoma is a relatively rare, malignant tumor of the papilla. The papilla (papilla duodeni major or papilla Vateri) is the opening of the common bile duct (Ductus choledochus) and pancreatic duct (Ductus pancreaticus) into the duodenum. The tumor causes narrowing of the papilla and the resulting digestive disorders.

Causes

Papillary carcinomas are extremely rare tumor diseases that occur predominantly in young patients between the ages of 20 and 30. They are adenocarcinomas, i.e. malignant tumors that originate from the glandular tissue of the gastrointestinal tract. In the case of papillary carcinoma, cell changes cause the glandular tissue in the area of the papilla Vateri to multiply.

Cell changes are caused by mutations that lead to uncontrolled cell growth, cell death and the inability to differentiate into a certain tissue type. A distinction is made between benign (papilla adenoma) and malignant growths (papilla carcinoma). In the course of the disease, a benign papillary adenoma often develops into a malignant papillary carcinoma.

It is therefore advisable to have benign growths completely removed by surgery in order to keep the risk of degeneration low. One risk factor for the development of papillary tumors is familial adenomatous polyposis (FAP). This is a congenital disease in which a genetic mutation leads to the formation of numerous polyps (mucous membrane protrusions) in the colon. Smoking, the use of oral contraceptives (“contraceptive pill”) and parasitic infections affecting the liver (e.g. liver gel infections) are further risk factors. In addition, as with many other types of cancer, genetic predisposition, environmental influences and lifestyle probably play an important role.

Diagnosis

In most cases, papillary carcinoma is diagnosed by the accompanying symptoms, such as jaundice (icterus) or pancreatitis (acute pancreatitis). The doctor performs an ultrasound examination of the abdomen, where the backlog of bile and the dilated bile ducts are noticeable. The duodenum, the bile ducts and the pancreatic duct can also be visualized from the inside by endoscopic retrograde cholangiopancreaticography (ERCP).

The final diagnosis of a papillary carcinoma is made after taking a tissue sample (biopsy) with subsequent fine tissue examination by a pathologist. Under the microscope, typical changes in cell morphology and disturbances in tissue architecture are visible, which indicate a malignant tumor. The tumor markers are determined in a blood test.

Elevated values of the markers CA19-9 and CEA indicate a malignant tumor of the papilla, but are not sufficient for diagnosis alone and therefore have no diagnostic significance. The elevation of these tumor markers may also have other, harmless causes. For a clear diagnosis of papillary carcinoma, an imaging procedure (ERCP, MRT, CT) and a biopsy must be performed.

Papillary carcinomas often remain symptom-free for a long time and can grow unnoticed. Only when the tumor has reached a certain size does the papilla become mechanically displaced in the area of the duodenum and symptoms appear. Frequent complaints are disturbances of the bile flow and an inflammation of the pancreas.

Accompanying symptoms of a papilla tumor are pain in the upper abdomen and colicky cramps. Patients complain of a feeling of pressure and abdominal pain. Due to the narrowing of the bile ducts (obstructive cholestasis) caused by the tumor, jaundice (posthepatic jaundice) may develop.

An icterus can be easily diagnosed by the typical symptoms, such as yellowing of the skin and sclerae (the white part of the eyes). The tumor prevents the bile from entering the intestines and patients suffer from indigestion, diarrhea and colorless stool. As a result, they lose weight and lose their appetite.

Other unspecific symptoms may include sudden fever, fatigue and a pronounced feeling of weakness.During a blood test, the doctor may detect anemia and high levels of inflammation, which are usually caused by inflammation of the pancreas (acute pancreatitis). This topic might also be of interest to you: Pain in the bileForming the papillary carcinoma metastases (daughter tumors), the prognosis is significantly worse. The tumor then attacks the surrounding lymph nodes, especially along the arterial vessels. The tumor cells can spread through the lymph vessels and form metastases.