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Palliative Management of Pancreatic Cancer

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Book cover Pancreatic Cancer

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Abstract:

The results of anticancer therapy are suboptimal for pancreatic cancer and palliation of symptoms is an important goal at all stages of this disease. Pain, depression, cachexia, ascites, jaundice, thrombosis and gastroparesis occur commonly and present a considerable burden on the patient and the caregivers and require inter-disciplinary management. A comprehensive assessment which includes clinical assessment and the use of quality of life instruments are invaluable as is the establishment of treatment goals early on the course of this disease. Painless jaundice is commonly associated with cancer of the pancreatic head. Its palliation can be achieved surgically in resectable cases and with a biliary stent in patients with locally advanced or metastatic disease. Metallic stents are preferred in unresectable tumors. However, cholangitis, stent occlusion and cholecystitis are complications. Pain control is optimally achieved with the use of oral analgesics; however, tolerance, constipation, sedation are common and require close monitoring. Neurolytic celiac plexus blocks have not been shown to be superior to systemic analgesics and are best utilized for instances wherein oral opioids are ineffective. Poor symptom control, social support and advanced stage are all associated with higher risk of depression, which can be treated in a similar manner as in the non-cancer setting. Unrelenting nausea, early satiety and weight loss, in the absence of mechanical gastric outlet obstruction should alert the providers as to the possibility of gastroparesis, an under-recognized problem in gastrointestinal oncology. Prokinetic agents are beneficial for most of these patients, but in extreme cases, gastrostomy or jejunostomy is required. Cachexia is one of the most challenging aspects of care for pancreatic cancer, and occurs irrespective of the cancer stage. Cachexia 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, which is treatable with anticoagulants. Recent data indicate that peripherally-acting opioid receptor antagonists induce laxation and therefore represent a significant advance in the management of opioid-induced constipation. These and other commonly occurring palliative issues in pancreatic cancer are discussed using the case study format.

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  1. Gastrointestinal Medical Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA

    Milind Javle

  2. General Oncology and Associate Professor, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA

    Michael Fisch

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Javle, M., Fisch, M. (2010). Palliative Management of Pancreatic Cancer. In: Pancreatic Cancer. Springer, New York, NY. https://doi.org/10.1007/978-0-387-77498-5_33

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