Healthcare Professionals

Palliation

Palliation in metastasised pancreatic cancer aims at the following:

• Prevent progression of the cancer
• Control Pain
• Relieve obstructive jaundice
• Relieve duodenal obstruction

The two approaches used in palliative therapy are non operative palliation and operative palliation. Operative methods are associated with a high rate of morbidity and mortality.

• Chemotherapy and radiotherapy are used to prevent progression of the cancer and to manage symptoms.
• Pain management consists of analgesic drug treatment based on the WHO analgesic ladder, in addition to it external beam radiation with or without chemotherapy, anesthetic block of celiac plexus, and procedures that relive biliary obstruction are helpful. The therapy has to be individualised as per the patient's need.
• Tumors of the head lead to biliary obstruction causing jaundice. Clearing the obstruction provides relief from the symptoms and improves quality of life in patients. Surgical bypass (cholecystojejunostomy, choledochojejunostomy, or hepaticojejunostomy) and biliary stenting are the techniques used to relive obstruction. The choice of technique is based on the patients overall health status, in general expandable metal stents are preferred in patients with metastatic cancer.
• Duodenal obstruction or gastric outlet obstruction may occur in patients due to tumors, gastrojejunostomy is usually performed to relive such an obstruction. The procedure can be performed from a side- to- side or end to side fashion. Though the surgery is not complex, morbidity and mortality is high as the patients are already in a compromised health status.

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