Palliative Care in Pancreatic Cancer

Frank J. Brescia, MD, MA, FACP

Disclosures

Cancer Control. 2004;11(1) 

In This Article

Biliary Obstruction

Since 70% to 85% of patients have tumors involving the pancreatic head, the development of jaundice is a common initial presentation. Most patients have a previous history of unsuspecting vague, nonspecific abdominal discomfort that predates the jaundice. Biliary obstruction may occur later in the illness due to growth of an unresected primary tumor, recurrent tumor, enlarged regional nodes, or biliary stent occlusion. Ninety percent of patients will have jaundice at some time in their illness, with associated symptoms of malaise, pruritus, loss of appetite, fever, and abdominal discomfort. The optimal strategy for treatment may not be initially obvious due to the patient's age, life expectancy, and generally poor wellbeing, or the physician's experience and expertise. Biliary bypass surgery has long been utilized for patients with unresectable disease or, in cases where other options are unavailable, for relieving disturbing symptoms and perhaps prolonging patient survival.[27]

Endoscopic placement of Teflon stents, introduced in the 1980s, is now routinely performed with a 90% success rate, with the majority successfully placed during the first procedure. However, plastic endoprostheses require changing at 3 to 6 months because of occlusion and a return of jaundice, fever, and discomfort. It is unclear whether antibiotics or bile salts help stents to remain patent.[28] The placement of a metal stent in a patient with repeated bouts of cholangitis is also controversial. The stent can become blocked by tumor invasion without prolonging survival.[29] However, the relief offered by stent placement may enhance the patient's overall quality of life, even in a population of individuals whose survival is limited.

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