Surgery and stents to relieve symptoms of pancreatic cancer

Surgery to relieve symptoms

Relieving jaundice

A blockage in your bile duct causes jaundice. The symptoms of this are:

• sickness (nausea)

• weakness and lack of energy

• itchy skin

• digestive discomfort and wind

• yellowing of your skin and the whites of your eyes

• loss of appetite

• darkened urine

• pale coloured stools (poo)

You might have an operation to allow bile to drain by bypassing your blocked bile duct if you can't have a stent or it hasn't worked. This is called bypass surgery.

Your surgeon cuts the bile duct above the blockage and reconnects it to your small bowel. This operation is called a choledochojejunostomy.

This is nearly always successful in relieving jaundice. It is abdominal surgery, so can take quite a bit of getting over. But it can make a difference to your quality of life.

Relieving a blocked bowel

If your small bowel (duodenum) becomes partly or completely blocked by the cancer it can make you very sick. Any food or drink you swallow can't pass through to the bowel in the normal way. It collects in your stomach and you need to vomit it back up again. This type of vomiting can be quite forceful, but you feel relief afterwards for a while.

Other symptoms of a blocked bowel might include:

• pain in the upper part of your tummy (abdomen)

• feeling full quickly or you are unable to eat a full meal

• bloating of your abdomen

• weight loss

In some cases it may be possible to operate to bypass the blockage. The surgeon attaches the part of your small bowel that is below the duodenum directly to your stomach. This allows digested food to pass through to the bowel.

This operation will not cure your cancer but may help you to live a fuller life for longer. You will need to talk to your surgeon about what the surgery could achieve for you and about how your recovery will be.

Stents to relieve symptoms

A stent is a small tube that are put in to clear a blockage in your body. They are made of flexible plastic or metal. They aim to relieve symptoms that a blockage causes.

Treating a blocked bile duct

Putting a stent into the bile duct aims to clear the blockage. This means that bile can flow again into the bowel. 

Having a stent put in is generally a simple procedure. You usually have this done during a type of endoscopy called an ERCP (endoscopic retrograde cholangio pancreatography). In some cases, your doctor may put a stent in through your skin, using a long needle.

For both procedures, you don't eat or drink for about 6 hours before you have the stent put in. This is to make sure that your stomach and the top part of your bowel are empty. You have a drug that makes you sleepy and relaxes you before the procedure. This is called a sedative.

Treating a blocked bowel

A stent might help to keep the duodenum open. This should give you relief from being sick, and so you might feel like eating again.

Your doctor may put a stent into the bile duct at the same time as the duodenum.

Having the stent put in

Most stents go into the top of the small bowel (duodenum) using endoscopy.

Before the procedure

You stop eating and drinking 6 hours before the procedure. This is to make sure your stomach and duodenum are empty. You'll have some sedation to help you relax.  

During the procedure 

Your doctor puts a thin tube with a camera (an endoscope) into your mouth and passes it down your food pipe (oesophagus), through the stomach and into the duodenum. They can see the images from the camera on a TV screen.

They pass a very thin guide wire down the endoscope into the blockage. 

They then remove the endoscope and use the thin wire to guide the stent into the blockage. The stent gradually expands and opens up the blockage. 

Afterwards 

When the sedation wears off you can start drinking and eating. You might feel a little drowsy for up to 24 hours. It takes a couple of days for the stent to fully open, so the amount you can eat will gradually increase. You usually start with a soft moist diet, to avoid blocking the stent.

You may have a little pain after the procedure but you can have painkillers. 

There might be a little bleeding, but this usually stops by itself. 

The stent may slip out of position, but this is rare. If this happens, or the stent becomes blocked, you may have another stent put in.

There is a small risk of a tear or hole (perforation) in the stomach or duodenum. You need to stay in hospital if this happens, and you may need surgery.

Other treatments

Medicines called somatostatin or octreotide might help relieve symptoms. They work by reducing the amount of fluid that builds up in your stomach and digestive system. This helps to stop you being sick and can relieve bloating.

Find out about controlling symptoms of pancreatic cancer