Surgery and stents to relieve symptoms of pancreatic cancer
If you can't have surgery to remove pancreatic cancer, you may still have an operation to help relieve symptoms or prevent problems such as a blocked 
or bowel. This is called bypass surgery.
You usually have a small tube put in to open up the blockage instead of an operation. This is called a stent.
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.
Your doctor puts a flexible tube called an endoscope into your mouth and they pass it down your throat to your stomach. The endoscope has a light and camera on the end. This means your doctor can see pictures of inside your body on a screen.
They pass the tube through your stomach to the first part of your small bowel (duodenum). Your bile duct opens into the duodenum.
Your doctor then injects dye into the bile duct and uses an x-ray to watch the flow of the dye to see where the blockage is. They then put the stent in position to open up the bile duct so that the bile can flow again.
Stents can be put into your bile duct by going through your skin. This is called percutaneous transhepatic cholangiography (PTC).
Your doctor injects a local anaesthetic into your skin above the liver to numb the area. They also give you painkillers. Your doctor puts a long thin needle through the skin and liver, and into the bile ducts. You may feel a twinge when the needle goes into the liver or some discomfort around your right shoulder. They use ultrasound or x-rays to help guide the needle.
Your doctor injects some dye (contrast medium) into the bile ducts. You may have a warm sensation through your body. This is normal. The dye shows up on the x-rays, so your doctor can see where the blockage is. They put a wire down the needle into the bile duct and use it to guide the stent into place.
You need to recover from the sedative. You might need to stay in hospital overnight while you recover.
If the stent was put in because of jaundice, you might need blood tests after you have gone home to check the bilirubin level.
You might need to take antibiotics for a few days afterwards to prevent infection. You are at risk of an infection because bacteria from your gut can travel up the stent to the bile duct.
Contact your doctor straight away if you have any signs of an infection, such as a high temperature and shivering. You may need to go into hospital to have antibiotics through a drip.
If your stent blocks
A stent should keep the bile duct open and stop bile building up and causing jaundice. You should notice the benefit within a day or two of having your stent put in.
Stents can become blocked after a few months. If necessary, your doctor can replace the stent in the same way.
If your stent doesn't work
Your specialist may suggest bypass surgery to relieve jaundice if the stent doesn’t work. This is quite a major operation. You might want to talk this over fully with your doctor and nurse as well as with your close family and friends. No one can say how much you will benefit from the operation. But you may make a good recovery and feel better for longer if you do have the surgery.
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.
