Advanced pancreatic cancer can sometimes press on the bile duct and cause a blockage, which prevents bile from passing into the small bowel and it builds up in the bloodstream.
This causes symptoms of jaundice:
- yellowing of the skin and whites of the eyes
- itchy skin
- reduced appetite, poor digestion and weight loss
- dark urine and pale stools.
If cancer blocks the upper part of the small intestine (duodenum), food can’t pass into the bowel and builds up in your stomach, causing nausea and vomiting. An operation to bypass the blockage can help. Inserting a stent may also help relieve the blockage and symptoms of jaundice.
Debulking, removing as much of the tumour as possible, may be an option for relieving symptoms of pancreatic NETs.
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Double bypass surgery
A double bypass surgery may relieve symptoms such as jaundice.
This surgery is often carried out when the surgeon has planned to remove the tumour, but is unable to because the cancer has spread (metastasised) or has involved one or more of the major blood vessels in the region.
During a double bypass surgery, the surgeon connects a piece of your bowel to the bile duct or gall bladder to redirect the bile around the blockage. At the same time, the surgeon also connects a part of your bowel to the stomach, to bypass the duodenum. This will allow your stomach to empty properly.
The surgery usually requires a hospital stay of 7–10 days.
Inserting a stent
If the cancer cannot be removed, and is pressing on the bile duct or duodenum, a stent may be inserted.
A stent holds the bile duct or duodenum open, allowing the bile or food to flow into the bowel again.
Types of stents
Plastic stents – These are sometimes used to temporarily relieve symptoms before surgery, then removed as part of the operation.
They are generally short term and can be replaced when they become blocked, usually after a few months.
Metal stents – These are used when the tumour cannot be surgically removed. They usually remain open from several months to over a year. If the metal stent becomes blocked, another stent will be placed inside the blocked stent to open it up.
How the stent is inserted
The stent is inserted during a procedure known as an endoscopic retrograde cholangiopancreatography (ERCP).
An ERCP involves passing an endoscope into the bile duct via your mouth, stomach and duodenum. X-rays are used to position the stent across the blockage to keep the bile duct or duodenum open. You will be sedated for the procedure.
You can have an ERCP as an outpatient or you may stay in hospital for 1–2 days.
Relief of symptoms
- Jaundice symptoms usually disappears over 2–3 weeks
- Itchy skin improves in 3–4 days
- Appetite loss should improve and you may gain some weight.
Debulking pancreatic NETs
Debulking is used for pancreatic NETs only. If the whole tumour can’t be removed, the surgeon may still try to remove as much of it as possible. This surgery, called debulking, is not always possible and will depend on the position and size of the tumour.
Debulking may relieve some of your symptoms and, for functioning pancreatic NETs, reduce your hormone levels. If your hormone levels can be regulated, you will feel better and experience fewer side effects.