In situations where the cancer has spread and cannot be completely removed by surgery, a priority is to alleviate, or palliate, symptoms such as jaundice, pain, nausea, and digestive difficulties. Palliative surgical and endoscopic techniques are meant to improve quality of life and make the patient more comfortable.
If the tumor is situated so that it blocks the common bile duct, pancreatic duct, or duodenum, it can cause jaundice and pain. In some cases, a stent can be placed endoscopically to relieve the blockage. A stent is a small tube made of either plastic or metal that is inserted into the blocked area to open the duct and restore flow. A plastic stent is considered a short term solution and is often placed when a patient may have a pancreatic operation in the future. A metal stent is a more permanent device.
In situations where a blockage cannot be opened with a stent, a surgeon can perform a bypass procedure to restore normal flow. If the tumor is blocking the bile duct, a biliary bypass can reroute the flow of bile around the tumor to relieve pain and jaundice. If the tumor is blocking the duodenum, a gastrojejunostomy or gastric bypass can be performed to enable food to pass from the stomach around the tumor and through the rest of the digestive system.
A tumor pressing on the nerves in the abdominal cavity can cause severe pain, especially in the more advanced stages of pancreatic cancer. In many cases, pain management with morphine or similar medications can provide significant relief. In situations when medication does not adequately control pain, the nerves responsible for sending the pain signals can be cut or injected with nerve blocks to alleviate symptoms.