To Your Good Health: Ampullary cancer treatment can include chemo prior to surgery

My husband was diagnosed with ampullary cancer. He has a tumor the size of a marble. We are told this is an aggressive cancer. My concern is that they are giving him chemotherapy before the Whipple surgery. Is this standard practice?

The ampulla of Vater is an opening in the duodenum — the first segment of the small intestine — where the common bile duct releases bile and pancreatic enzymes to aid digestion. A cancer of the ampulla can originate from the pancreas, bile duct or duodenum, and these can all be aggressive cancers.

The standard approach in people with the possibility to be cured is called a pancreaticoduodenectomy, otherwise known as the Whipple procedure. Although this is a complex surgery that used to have a high mortality rate, the risk of death from the procedure in specialized centers is now about 1%.

Most people are familiar with getting chemotherapy after surgery to help remove any cancer cells that remain, a technique called “adjuvant therapy.” However, giving chemotherapy before surgery — “neoadjuvant chemotherapy” — has increasingly been used in people with ampullary cancer. The idea is to shrink the tumor to make it easier for the surgeon to remove completely. Chemotherapy may also kill any cancer cells that have already spread.

The decision of when to use chemotherapy depends on the individual’s situation, so I can’t tell you which would be better in your husband’s case, as I lack both the details of his tumor and the expertise. I can confirm that giving chemotherapy prior to surgery is being used in regards to ampullary cancer.

I am 22. I had an electrocardiogram last year, which indicated an incomplete right bundle branch block and early repolarization of the ventricles. Are these two related to each other? Are they serious to any extent, since I don’t have any symptoms? How can my heart rate be normal if the ventricles repolarize early?

Both early repolarization and an incomplete right bundle branch block are common findings in young people who are getting EKGs, usually as part of a school physical and often as an evaluation for athletes.

Depolarization of the heart muscle is seen on the surface electrocardiogram and corresponds to the contraction of the ventricle, called the QRS waves. The muscle cells must then “repolarize” — that is, restore their electrical potential to get ready for the next contraction.

Early repolarization is a normal variant where the ventricle gets electrically ready for the next beat faster than average. In fact, one way to be sure that the EKG finding really does signify early repolarization is to put the person on a treadmill to raise their heart rate. The early repolarization will then go away, since faster repolarization is appropriate for a quicker heartbeat.

About 15% of young athletes with early repolarization will also have an incomplete right bundle branch block, which represents slowing of the electrical impulses within the ventricles and a widening of the QRS complex.

Fortunately, these findings almost never represent serious disease in people without any symptoms.