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Palliative Management of Pancreatic Cancer

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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. 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.

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Authors and Affiliations

  1. Symptom Control and Palliative Medicine, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA

    Rony Dev

  2. Gastrointestinal Medical Oncology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA

    Milind Javle

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  1. Rony Dev
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Correspondence to Rony Dev .

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Editors and Affiliations

  1. Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany

    John P. Neoptolemos

  2. Division of Research Department of Surgery and Genomic Sciences and Precision Medicine Center (GSPMC), Medical College of Wisconsin, Milwaukee, Wisconsin, USA

    Raul Urrutia

  3. Division of Medical Oncology, Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina, USA

    James L. Abbruzzese

  4. Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany

    Markus W. Büchler

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Dev, R., Javle, M. (2018). Palliative Management of Pancreatic Cancer. In: Neoptolemos, J., Urrutia, R., Abbruzzese, J., Büchler, M. (eds) Pancreatic Cancer. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-7193-0_33

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