Palliative Management of Pancreatic Cancer

Reference work entry

Abstract

The results of anticancer therapy are suboptimal for pancreatic cancer and palliation of symptoms is an important goal. Pain, depression, cachexia, ascites, jaundice, thrombosis, and gastroparesis occur commonly in pancreatic cancer patients. Painless jaundice, often associated with cancer of the pancreatic head, can be surgically treated in resectable cases or managed with a biliary stent in patients with locally advanced or metastatic disease. Pain control is optimally achieved with the use of oral analgesics; however, a neurolytic celiac plexus block can be considered when oral opioids are ineffective. Depression is associated with poor symptom control, diminished social support, and advancing illness and should be treated. Symptoms of intractable nausea, early satiety, and weight loss, in the absence of mechanical gastric outlet obstruction, suggest gastroparesis. Prokinetic agents are beneficial for some patients, but in extreme cases, gastrostomy or jejunostomy is required. Cachexia is difficult to treat and requires nutritional support, orexigenic agents, diabetic control, and enzyme supplementation. Malignant ascites can be investigated with ascitic-serum albumin gradient; a high gradient in the absence of positive cytology suggests portal vein thrombosis. Constipation is common problem and can be treated with stool softeners, osmotic agents, and peripherally acting opioid receptor antagonists.

Keywords

Pancreatic cancer Palliative care Cancer pain Anorexia-Cachexia syndrome Gastroparesis Jaundice Depression Ascites 

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© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Symptom Control and Palliative MedicineUniversity of Texas MD Anderson Cancer CenterHoustonUSA
  2. 2.Gastrointestinal Medical OncologyUniversity of Texas MD Anderson Cancer CenterHoustonUSA

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