People may need treatment for their symptoms even before a diagnosis is made. Symptoms can include pain, weight loss, and itching due to jaundice (see ‘Signs and symptoms of pancreatic cancer’
). Doctors may prescribe strong analgesics, such as morphine, for the pain, and medicine to control the itching. They may also ask a dietitian to advise the patient to try to prevent further weight loss.
The jaundice is due to a blocked bile duct. To relieve it the doctor may decide to insert a stent to open the bile duct. The stent is a thin plastic or metal tube that is used to support a narrowed part of the bile duct and to prevent it from narrowing again. The decision to insert a stent can be difficult to make.
The doctor may use endoscopic retrograde cholangio pancreatography (ERCP) to place the stent (see ‘Endoscopies and biopsies’
). If this is not possible the doctor can use another procedure called percutaneous transhepatic cholangiography (PTC), which involves inserting the stent through the skin of the abdomen in the x-ray department.
Most people we interviewed who had had a stent inserted had had it done during ERCP. Some people found the procedure frightening, uncomfortable or even painful, but others remembered little about it. Some people (or their relative) had had more than one stent inserted. Theadora’s mother, for example, had had five stents inserted during the course of her illness. John’s wife had had a plastic stent replaced by a metal one, with good results.
Sometimes the doctors try to insert a stent during an endoscopy, but do not succeed, so they insert the stent through the skin of the abdominal wall. A local anaesthetic is used to numb the area around the puncture site. Then a special dye is injected through the skin, and through the liver, into the bile duct, to show up the blockage, then x-rays are taken (percutaneous transhepatic cholangiography). A hollow needle is inserted into the bile duct, and a thin guide wire inserted into it. The wire is guided to the area of obstruction. The X-ray helps the doctor to see where to put the wire. Once the wire is in place, the doctor feeds the stent, which looks like a tube, along the wire until it is in place inside the bile duct. Then the doctor can pull out the wire.
Less invasive means of imaging the bile ducts include transabdominal ultrasound. Richard (Interview 22) thought that his doctor had used ultrasound to help him insert a stent in the right place.
Where possible, major surgery is performed to remove the cancer (see ‘Potentially Curative Surgery’
). If during the operation the surgeon finds that the cancer has spread too far and cannot be removed they may do a smaller operation to bypass the bile duct or duodenum to relieve symptoms caused by jaundice or a blockage of the duodenum.
When one man came round from the anaesthetic he was very disappointed to learn that the surgeon had only been able to bypass his bile duct instead of removing the tumour. Another man awoke to discover he had had a bypass operation to relieve a block in the small intestine.
Ben started to vomit due to a bowel blockage some time after a failed operation to remove his tumour, so was opened up a second time for a gastrojejunostomy.