Palliative management of pancreatic cancer

The results of anticancer therapy are suboptimal for pancreatic cancer andpalliation of symptoms is an important goal. Pain, depression, cachexia, ascites, jaundice, thrombosis, and gastroparesis occur commonly in pancreatic cancerpatients. Painless jaundice, often associated with cancer of the pancreatic head, can be surgically treated in resectable cases or managed with a biliary stent inpatients with locally advanced or metastatic disease. Pain control is optimallyachieved with the use of oral analgesics; however, a neurolytic celiac plexusblock can be considered when oral opioids are ineffective. Depression is associatedwith poor symptom control, diminished social support, and advancing illnessand should be treated. Symptoms of intractable nausea, early satiety, and weightloss, in the absence of mechanical gastric outlet obstruction, suggestgastroparesis. Prokinetic agents are beneficial for some patients, but in extremecases, gastrostomy or jejunostomy is required. Cachexia is difficult to treat andrequires nutritional support, orexigenic agents, diabetic control, and enzymesupplementation. Malignant ascites can be investigated with ascitic-serum albumingradient; a high gradient in the absence of positive cytology suggests portalvein thrombosis. Constipation is common problem and can be treated with stoolsofteners, osmotic agents, and peripherally acting opioid receptor antagonists.