Periampullary cancer and cancer in head of pancreas: What is the difference?

The pancreas, a fleshy retroperitoneal organ with mixed exocrine and endocrine function, is not spared of malignant disorders. Malignancies of the pancreas are generally of acinar, ductal or neuroendocrine origin. Majority of these are pancreatic ductal cancer (PDAC) with head of pancreas as the most common site. In the developed world, PDAC is the fourth deadliest malignancy for men and the fifth for women and is predicted to become the second by 2030 [1]. Periampullary cancer is a complex disease of heterogenous origin. This is cancer arising within 2 cm of the papilla of Vater and include pancreatic, ampullary, biliary and duodenal cancers [2]. Duodenal cancer has the highest estimated 5-year survival (49%), followed by ampullary cancer (45%), distal bile duct cancer (27%), and pancreatic cancer (18%) [3]. There is some variance in the clinical presentation of periampullary cancer and cancer in the head of pancreas, but the main distinction lies in their cell biology and histology which affect prognosis and outcome. In all, surgical resection involving a pancreaticoduodenectomy is the main stay for curative treatment.