Pancreatic cancer is the 4th deadliest cancer that one can be diagnosed with. The only proven cure for pancreatic cancer is complete resection of the pancreas mass found in the early stages of the disease process. Unfortunately, discovery of the mass at the time of presentation of symptoms is late stage. Upon symptomatic presentation, 15-20% of patients are eligible for surgical removal. Even with mass removal, prognosis is dismal with a 5 year survival rate of approximately 25-30% for disease not involving lymph nodes, approximately 10% for disease involving lymph nodes. According to the national cancer data base, the overall total median survival for pancreatic adenocarcinoma is 12.6 months. Palliative procedures have been developed for patients with unresectable or recurrent disease.
Palliative treatment can control obstructive jaundice, pain, pancreatic insufficiency as well as gastric obstruction. For control of obstructive jaundice, an ERCP can be performed with stent placement or a percutaneous drain can be placed. If these procedures fail, surgical options include cholecystojejunostomy or a choledochojejunostomy, which target opening a blocked common bile duct that is unable to be decompressed with stenting.
Duodenal obstruction is a late complication of a pancreatic mass. This is a mechanical obstruction that can lead to gastric outlet obstruction. Palliative treatment for a gastric outlet obstruction includes a gastrojejunostomy with a biliary bypass. This surgery allows for gastric emptying through a created bypass. Another option for gastric outlet obstruction is a stent that is placed enteroscopically.
Pain is difficult problem for patients who suffer pancreatic cancer due to involvement of the celiac plexus. Typically, medication management alone is sufficient, but if pain continues to be uncontrolled, a block can be performed. A block includes medically ablating the nerve fibers that transmit the pain sensation. The procedure can be performed by an endoscopist with ultrasonography.
Lastly, cachexia due to fat malabsorption as a result of obstruction of the main pancreatic duct. Pancreatic enzymes can be administered in these cases. Delayed gastric emptying without mechanical invasion can also occur due to nerve involvement which can result in nausea and vomiting leading to lack of intake of calories. Surgery cannot alleviate these symptoms and medication management is utilized to control the nausea.