Unresectable Pancreatic Cancer:
Improving Patient Quality of Life
Patients with advanced unresectable pancreatic cancer and metastatic cancer often require interventional procedures to palliate symptoms to improve the quality of their lives. The symptoms that often require palliation are:
Relief of Jaundice
- Severe chronic back pain
- Blockage of the intestine
- Buildup of fluid in the abdomen
Patients with cancer of the head of pancreas usually present with jaundice. The jaundice develops because of the blockage of the bile duct. The jaundice is the major reason why many patients adenocarcinoma develop loss of their appetite and weight loss. Jaundice causes itching and severe discomfort.
The relief of jaundice is an important goal for palliation in patients with unresectable or metastatic pancreatic adenocarcinoma. While the jaundice can be relieved by doing a surgical bypass of the bile duct this is usually not recommended in patients with advanced pancreatic cancer because of the long recovery period associated with the surgery.
The treatment of choice for relieving the jaundice in patients with advanced or unresectable pancreatic cancer is insertion of a tube into the bile duct to allow drainage of bile into the intestine by a gastroenterologist. The tubes or stents are available as plastic or metal stents.
The metal stents are preferred in patients with unresectable or metastatic pancreatic cancer since they do not block readily and provide long term relief from the jaundice. Metal stents should not placed in patients with resectable pancreatic cancers since they do damage the bile duct and make any subsequent surgery very difficult. Prior to placement of a metal stent, a patient with pancreas cancer should be evaluated by an experienced surgeon for possible surgical removal of the tumor.
Patients with advanced pancreatic cancer often have severe abdominal and back pain. Relief of the pain is a very important component of palliation. USC provides specialized pain management for patients with advanced pancreatic cancer.
The pain can be treated with many different types of oral morphine-like tablets. In addition to pain medication, blockage of the nerves behind the pancreas is often provides significant relief of pain. This procedure is called a celiac nerve block. The procedure is performed by a insertion of a needle in the celiac nerve to destroy the pain fibers by injected alcohol. A celiac nerve block is performed by a CT guided technique and or by an endoscopic ultrasonography guided technique. This procedure is recommended for patients with severe pain where relief is not provided with pain medications.
Blockage of the Intestine
In a small number of patients with advanced pancreatic cancer, the growth of the tumor may block the duodenum (the first part of the intestine). This leads to difficulty in eating and persistent vomiting. Relief of the blockage by bypassing the cancer invaded area can provide a symptomatic relief. At USC this procedure in now offered with laparoscopic techniques to promote rapid recovery.