Pancreatic Cancer

Treating the initial symptoms

People may need treatment for their symptoms even before a diagnosis is made. Symptoms can include pain, weight loss, and itching due to jaundice (see ‘Signs and symptoms of pancreatic cancer’). Doctors may prescribe strong analgesics, such as morphine or a nerve block, for the pain, and medicine to control the itching. They may also ask a dietitian to advise the patient to try to prevent further weight loss.
Jaundice can be caused by a blocked bile duct. To relieve it the doctor may decide to insert a stent to open the bile duct. A stent is a thin plastic or metal tube that is used to support a narrowed part of the bile duct and to prevent it from narrowing again. The decision to insert a stent can be difficult to make. Stents can also be used for a blockage in the small intestine (duodenum).
The doctor may use endoscopic retrograde cholangio pancreatography (ERCP) to place the stent (see ‘Endoscopies and biopsies’). If this is not possible the doctor can use another procedure called percutaneous transhepatic cholangiography (PTC), which involves inserting the stent through the skin of the abdomen in the x-ray department.
Most people we interviewed who had had a stent inserted had had it done during ERCP. Some people found the procedure frightening, uncomfortable or even painful, but others remembered little about it. Some people (or their relative) had had more than one stent inserted. Theadora’s mother, for example, had had five stents inserted during the course of her illness. John’s wife had had a plastic stent replaced by a metal one, with good results.
Sometimes the doctors try to insert a stent during an endoscopy, but some do not succeed, so they insert the stent through the skin of the abdominal wall this is to widen ducts that have become narrowed or blocked. Dye is injected through the skin, and liver, into the bile duct, to show up the blockage, then x-rays are taken (percutaneous transhepatic cholangiography) to help the doctor to see where to put the stent.
Less invasive ways of seeing the bile ducts include transabdominal ultrasound. Richard (Interview 22) thought that his doctor had used ultrasound to help him insert a stent in the right place.
Where possible, major surgery is performed to remove the cancer (see ‘Potentially curative surgery’). If during the operation the surgeon finds that the cancer has spread too far and cannot be removed they may do a smaller operation to bypass the bile duct or duodenum (the first part of the small intestine) to relieve symptoms caused by jaundice or a blockage of the duodenum.

When one man came round from the anaesthetic he was very disappointed to learn that the surgeon had only been able to bypass his bile duct instead of removing the tumour. Another man awoke to discover he had had a bypass operation (gastrojejunostomy) to relieve a block in the small intestine.
Ben started to vomit due to a bowel blockage some time after a failed operation to remove his tumour, so was opened up a second time for a gastrojejunostomy to provide a bypass for the stomach content.  

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Last reviewed September 2018.
Last updated September 2018.


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