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+971 58 881 0987info@drmahmoudtabbal.comAl Zahra HospitalDubai Sheikh Zayed Rd - Al Barsha 1 - Dubai
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Comprehensive Periampullary Cancer Treatment by Dr. Mahmoud Tabbal - Periampullary Cancer Specialist Dubai

Introduction to Periampullary Cancer

Periampullary cancer is a rare form of cancer that originates in the bile duct, pancreas or small intestine, adjacent to an area of your digestive system called the ampulla of Vater, where your bile and pancreatic ducts join. Because this is close to many other important parts of the digestive system such as the liver and pancreas, when periampullary cancer grows it may affect these organs too. That’s why periampullary cancer treatment with Dr. Mahmoud Tabbal often involves more extensive surgery to remove the cancer and a margin of healthy tissue.The signs and symptoms of periampullary cancer may include jaundice – the yellowing of skin and eyes, clay-colored stool, abdominal pain, nausea and vomiting, and rectal bleeding.

Comprehensive Periampullary Cancer Treatment

To improve outcomes, early consultation and detection with Dr. Mahmoud Tabbal and his team is critical. Due to the lack of early symptoms and the tendency of periampullary cancer to invade adjacent structures, many patients already have advanced disease at the time of their diagnosis. The detection of tumors at an early stage relies on CT and MRI scans, coupled with magnetic resonance cholangiopancreatography (MRCP), and biopsies, or fine-needle aspiration using endoscopic ultrasound. The treatment options include the Whipple procedure, which involves removing the head of your pancreas as well as a portion of your small intestine, your gallbladder and part of your bile duct. This can be done by Dr. Tabbal using an incision in your abdomen, or ideally, as a minimally invasive, endoscopic or robotic surgery.
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Advanced Periampullary Cancer Treatment Options

For small periampullary cancers and precancerous tumors, it may be possible for Dr. Tabbal to remove the cancer mass using the latest robotic endoscopic surgery techniques. Chemotherapy uses drugs to kill cancer cells, while radiation therapy uses beams of energy, such as X-rays and protons to kill cancer cells. Combined chemotherapy and radiation may be used before surgery, to make it more likely that a cancer can be removed completely during the operation. The combined treatment can also be used after surgery to kill any cancer cells that might remain. In people with advanced periampullary cancer, chemotherapy may be used alone to slow the growth of the cancer.

Dr. Mahmoud Tabbal: The Best Periampullary Cancer Specialist in Dubai

Dr Mahmoud Tabbal is a Board-Certified Consultant General Surgeon with more than twenty years’ experience in the USA, Canada, Saudi Arabia, and Jordan. He is currently working as the Chief of the General, Robotic, Bariatric, Paediatric, and Acute Care Surgery Division at Al Zahra Hospital in Dubai. Most recently, he worked as the Head of Hepatobiliary surgery at King Fahad Specialist Hospital in Saudi Arabia. Dr Tabbal is a Fellow of the American College of Surgeons and received his advanced surgical training in the USA and Canada through the American Society of Transplant Surgeons and the American Hepatopancreatobiliary Association. He also holds a Jordanian Board Certificate in General Surgery, an advanced Diploma in Laparoscopic Surgery from France, and an Advanced Robotic Training Certificate from the USA. He conducts a broad range of procedures in General Surgery, Minimally Invasive and Robotic Surgery, Hepatobiliary and Transplant Surgery, Advanced Surgical Oncology, and Cancer Surgeries. He is an active member of many local and international societies and a regular speaker at many leading medical congresses around the world.

Personalized Care and Support

The diagnosis and treatment of cancer can be an isolating experience. Our approach to personalized care for cancer guides the relationship between you as the patient, the professionals in Dr. Mahmoud Tabbal’s team, and the world-class hospital system at Al Zahra Hospital, Dubai, in which you receive your care. Most importantly it means that you retain the ultimate choice and active control over the way that your periampullary cancer care is being planned and delivered, under Dr. Tabbal’s expert guidance. Our personalized approach means always using the latest technology to deliver tailored treatments and tackle situations before they deteriorate.

Why Choose Dr. Mahmoud Tabbal for Periampullary Cancer Treatment in Dubai

Dr. Mahmoud Tabbal’s team at Al Zahra Hospital Dubai offers an extensive range of periampullary cancer related services, from diagnostics to surgical interventions and medical treatments. His extensive team of specialized and sub-specialised oncologists are equipped with the latest advances in treatment and offer world-class oncological care to make sure you get the best chance at living a long, happy, and fulfilling life. They bring the best periampullary cancer, and critical non-cancer care to patients from across the Middle East, Africa, India, Europe and beyond. Whether you need a major intervention or simply a second opinion, Dr Tabbal and his expert team are always ready to welcome you to Dubai with open arms.

FAQs about Periampullary Cancer

Periampullary cancer is a rare type of cancer that forms in an area of the head of the pancreas, the distal common bile duct and the first part of the small intestine, close to the ampulla of Vater. Ampullary cancers form inside the ampulla of Vater itself – an enlargement of the ducts from the liver and pancreas where they join and enter the small intestine.

As these types of tumour grow, they may affect the surrounding organs, such as the liver, pancreas and small intestine. Some periampullary cancers may spread (metastasise) to the liver, lymph nodes, lungs, peritoneum (abdominal lining) and other organs.

Signs and symptoms of periampullary cancer may include:

  • Yellowing of the skin and white of eyes (jaundice)
  • Clay-coloured stools
  • Abdominal pain
  • Fever
  • Bleeding from the rectum
  • Nausea
  • Vomiting
  • Unintended weight loss

Jaundice occurs when a tumour blocks the bile duct, leading to a build-up of bile fluid. Signs of jaundice often lead to these cancers being detected earlier than most pancreatic cancers, which can improve prognosis.

These symptoms may also be caused by other medical problems. Consult your doctor if you have persistent signs or symptoms that worry you.

The cause of periampullary cancer is not clear and research is ongoing.

Some factors which appear to increase the risk of periampullary cancer have been identified, including:

  • Being over the age of 70 years
  • Men are slightly more affected by periampullary cancer than women
  • Family history of rare genetic syndromes that can increase cancer risk

A combination of diagnostic tests may be required, such as:

  • Imaging tests, such MRI, CT scan or ultrasound
  • Blood or urine tests to check for cancer markers
  • Endoscopy – passing a thin, flexible tube with a tiny camera (endoscope) down the oesophagus, through the stomach into the small intestine
  • Biopsy – collecting a small tissue sample to be analysed in the laboratory – can be done during endoscopy
  • Endoscopic Ultrasound (EUS) – using an endoscope and ultrasound device to make images of the pancreas, bile ducts and small intestine

Endoscopic retrograde cholangiopancreatography (ERCP) –  using an endoscopic ultrasound device and dye injected into the pancreatic duct and /or bile duct, to look for blockages

Surgical procedures

Surgical removal, along with a large margin of healthy tissue, is often the most successful treatment for periampullary cancer. Minimally invasive (keyhole) surgery, using an endoscope is an option in some cases.

The Whipple procedure is commonly used. This involves removing the head of the pancreas, the first part of the small intestine (duodenum), the gallbladder, part of the bile duct and nearby lymph nodes. The remaining parts of the pancreas, stomach and intestines are reconnected.

When surgical removal is not possible, a small wire mesh tube (stent) can be placed in the bile ducts to drain fluid that causes jaundice.

Chemotherapy and radiation therapy 

Chemotherapy drugs (either injected or taken by mouth) may be used for inoperable cancers, to help kill cancer cells, relieve symptoms and prolong survival. It may also be used to kill any cancer cells remaining after surgery.

Chemoradiation – a combination of chemotherapy and radiotherapy (using high-energy beams to destroy cancer cells) may be used before surgery to help shrink a tumour, or after surgery to reduce the risk of cancer recurring.

Palliative care 

For advanced periampullary cancer that is not amenable to surgery, chemotherapy orradiotherapy, treatment may focus on symptom relief and improving quality of life.Palliative care may also be provided to complement other treatments.

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