If pancreatic cancer 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; and dark urine and pale stools.
If the 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. Options for managing obstructions may include:
- stenting – inserting a small tube into the bile duct or duodenum (this is the most common method)
- double bypass surgery – connecting the small bowel to the bile duct or gall bladder 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 artificial opening on the abdomen so waste can be collected in a bag outside the body.
Sometimes a surgeon may have planned to remove a pancreatic tumour during an operation, but discovers the cancer has spread. If the tumour cannot be removed, the surgeon may perform one of the operations listed above to relieve symptoms.
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Inserting a stent
If the cancer cannot be removed and is pressing on the common bile duct or duodenum, a stent may be inserted. A stent is a small tube made of either plastic or metal. It holds the bile duct or duodenum open, allowing the bile or food to flow into the bowel again.
The stent is usually inserted during a procedure known as an ERCP (endoscopic retrograde cholangiopancreatography). In an ERCP, an endoscope is passed into the bile duct via your mouth, stomach and duodenum. With the help of x-rays, the stent is positioned across the blockage to keep the bile duct or duodenum open. You may have the ERCP as an outpatient or stay in hospital for 1–2 days.
Jaundice symptoms usually go away over 2–3 weeks. Your appetite is likely to improve and you may gain some weight.