Surgery to relieve symptoms of pancreatic cancer

How surgery can help relieve symptoms

If the tumour is pressing on the common bile duct, it can cause a blockage and prevent bile from passing into the bowel.

Bile builds up in the blood, causing symptoms of jaundice, such as:

• yellowing of the skin and whites of the eyes
• itchy skin
• reduced appetite, poor digestion and weight loss
• dark urine
• pale stools. 

If cancer blocks the duodenum (first part of the small bowel), food cannot pass into the bowel and builds up in your stomach, causing nausea and vomiting.

Blockages of the common bile duct or duodenum are known as obstructions.

Surgical treatments

Surgical options for managing blockages may include:

• stenting – inserting a small tube into the bile duct or duodenum (this is the most common method, see Inserting a stent)
• bypass surgery – connecting the small bowel to the bile duct or gallbladder to redirect the bile around the blockage, and connecting a part of the bowel to the stomach to bypass the duodenum so the stomach can empty properly
• gastroenterostomy – connecting the stomach to the jejunum (middle section of the small bowel)
• venting gastrostomy – connecting the stomach to an opening in the abdomen so waste can be collected in a small bag outside the body.

Sometimes the surgeon may have planned to remove a pancreatic tumour but discovers during the surgery that the cancer has spread. If the tumour cannot be removed, the surgeon may perform one of the operations listed above to relieve symptoms.

Inserting a stent

If the cancer cannot be removed and is pressing on the common bile duct or duodenum, you may need a stent. A stent is a small tube made of either plastic or metal. It holds the bile duct or duodenum open, letting the bile or food flow into the bowel again.

A bile duct stent is also known as a biliary stent. It is usually inserted using an endoscope passed through the mouth, stomach and duodenum until it reaches the bile duct. You may have this procedure as an outpatient or stay in hospital for 1–2 days. Sometimes the stent needs to be inserted directly through the skin and liver into the bile duct. This is called a PTC (percutaneous transhepatic cholangiogram).

A duodenum stent is also known as a duodenal stent. It is usually inserted via the mouth using an endoscope.

Symptoms caused by the blockage usually go away over 2–3 weeks. Your appetite is likely to improve and you may gain some weight.