Editing Pancreatic cancer (section)

== '''Palliation''' ==

* Chemotherapy
** FOLFIRINOX
* Pain
** Coeliac plexus neurolysis - effective, reduces opioid use
** Can be done if cancer is found unresectable at laparotomy
** Indication - uncontrolled pain with non-invasive methods
** Injection of 3mL 0.25% bupivacaine and 10mL ethanol into each coeliac plexus, either via EUS, percutaneously, or at operation
* Biliary obstructive symptoms
** Endoscopic
*** ERCP + stent is preferred method
*** Metal stents more durable, best for those where it will need to stay patent for >6 months
*** Technically possible in >90% of cases
*** PTC sometimes possible where ERCP is not
** Surgical
*** Roux-en-Y hepaticojejunostomy - excellent long-term patency
* Gastric outlet obstruction
** Seen in 20% of patients with locally advanced pancreatic cancer
** Endoscopic stenting is as effective as gastrojejunostomy, with almost immediate improvement in oral intake, but limited long-term patency
** Gastrojejunostomy is preferable for patients with longer expected survival
* Hypersplenism
** Splenectomy may be useful, improving platelet counts, allows resumption of chemotherapy, and likely enhances survival