Palliative Procedures in the Treatment of Pancreatic Cancer

During the course of the disease, at certain points, many patients with experience symptoms of jaundice, pain, nausea, and digestive difficulties, which can be treated or ‘palliated’ using one of several approaches designed to reduce suffering and increase the quality of life for patients with pancreatic cancer.

Palliation of Jaundice

Malignant tumors in the head of the pancreas often obstruct the bile duct producing jaundice, which is a yellowing of the skin and eyes that often causes itching.  Even if the tumor cannot be surgically removed, the obstruction of the bile duct can be relieved by a variety of methods to resolve the jaundice.  The mainstay of bile duct decompression is endoscopic placement of a stent.  Plastic stents typically will stay open for about 6 to 8 weeks before needing to be changed.  These are often used when the patient is expected to go to surgery to remove the tumor within a couple of weeks of the endoscopy.  Patients that require a longer period of stenting, typically will have a metal stent placed which will stay open for a year or more.

If endoscopic attempts at relieving biliary obstruction fail, the patient may have an external drain placed through the abdominal wall into the bile duct directly through the liver (percutaneous transhepatic cholangiocatheter or PTC).  This is less desirable because the patient’s bile will collect in a bag that is external.

Finally, the bile duct can be bypassed surgically by sewing the small intestine into the bile duct above the level of the obstruction.  This is needed less frequently as non-operative approaches have become more feasible and durable.

Palliation of gastric outlet obstruction

A malignant tumor within the head of the pancreas can obstruct the outlet of the stomach into the first portion of the small intestine.  When this occurs, the patient is not able to eat and will have persistent vomiting.  Sometimes this type of obstruction can be opened up with an endoscopic stent, but many patients will need a surgical procedure called a gastrojejunostomy in which the small intestine is sewn into the stomach creating a bypass of the obstruction and allowing the patient to eat again.