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Wednesday, May 14, 2008

Other treatments for pancreatic cancer

Your doctor may suggest certain treatments or procedures to relieve any uncomfortable symptoms caused by the cancer. Our section on controlling the symptoms of cancer, gives information about the methods of treating different symptoms.

Treating jaundice

If the tumour blocks the bile duct, causing jaundice, and it is not possible to remove the tumour, procedures may be performed which relieve the blockage and allow bile to flow into the small bowel again. The jaundice will then clear up. There are three ways of doing this. These are ERCP, PTC (percutaneous transhepatic cholangiography) and bypass surgery.

ERCP and PTC

In ERCP and PTC, a lining tube called a stent is pushed down the inside of the blocked bile duct to hold it open. The ERCP method is often used when ERCP is first carried out as an investigation.

You will be asked not to eat or drink anything for six hours before the procedure, so that the stomach and duodenum are empty. You will be given a sedative by injection, and the endoscope will be passed through your mouth.

A dye will be used, as before. X-rays are taken, and by looking at the x-ray picture the doctor will be able to see the narrowing in the bile duct. The narrowing can be stretched and a tube pushed in through the endoscope, allowing the bile to drain.

The tube may need to be replaced later if the jaundice comes back or if an infection occurs.

The PTC method is similar to ERCP in that a dye is used to show up the blockage on x-ray. Instead of the tube being inserted through an endoscope, a needle is inserted through the skin just below your rib cage and a fine guide wire passed through the liver and into the blockage in the bile duct. The tube is then passed along this wire.

As with ERCP, you will be asked not to eat or drink for at least six hours beforehand, and you will then be given a sedative. You will also have a local anaesthetic so you should not feel pain as the needle or wire is passed through your skin, although moving the wire into the correct position in the bile duct can be painful. To help prevent any infection you will be given antibiotics before and after the procedure. It is likely that you will stay in hospital for a few days afterwards.

Sometimes, if the tube cannot be passed into the bile duct from the duodenum during ERCP, a combination of ERCP and PTC is carried out.

Bypass surgery

Surgery is sometimes recommended to deal with a blockage of the bile duct. This involves joining the gall bladder or the bile duct to the small bowel (see pancreas diagram). This bypasses the blocked part of the bile duct and allows the bile to flow from the liver into the bowel. This operation is called a cholecystoenterostomy. In some hospitals, it is possible to do this procedure during laparoscopy.

Nerve block (coeliac plexus)

If the pain caused by cancer of the pancreas cannot be properly controlled with painkilling drugs, your doctor may suggest that you have a nerve block. A nerve block stops pain messages from getting to the brain by blocking the nerves themselves. There are different ways in which this can be done – injecting an anaesthetic such as alcohol into the nerve, or, occasionally, cutting the nerve. In people with cancer of the pancreas, persistent pain in the abdomen and back can be caused by the tumour pressing on the coeliac plexus (a complicated web of nerves at the back of the abdomen). A coeliac plexus nerve block is usually a very effective way of treating this type of pancreatic pain.

Before the procedure you will be given a sedative, usually by injection into a vein in your arm (intravenously), to help you relax. The nerve block may be carried out with a CT scan to help the doctor to put the needle into the right place. You will be given an injection of local anaesthetic to numb the skin beforehand. A long, fine needle is inserted through your back and into the nerve, which is then injected with alcohol.

Afterwards, for a day or two, your blood pressure may be low, making you feel light-headed and dizzy, particularly when you stand up. Sometimes the nerve can be cut rather than injected, but for this you will need a general anaesthetic. For this reason, a block involving cutting the nerve is usually carried out when a person is having other surgery, such as bypass surgery.

Via: http://www.cancerbackup.org.uk

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