Fast Five Quiz: Test Your Knowledge of Metastatic Pancreatic Cancer Pathophysiology, Diagnosis, and Treatment

Michael J. Pishvaian, MD, PhD

Disclosures

September 26, 2018

Biliary obstruction from pancreatic cancer is usually best palliated by the endoscopic placement of plastic or metal stents. Plastic biliary stents have an estimated lifespan of 3-4 months. While metal stents are similarly placed via endoscopy and provide a longer duration of patency, they are more expensive. Other options for the relief of obstructive jaundice include surgical biliary decompression via choledochojejunostomy (anastomosis of the common bile duct to the jejunum) or cholecystojejunostomy (anastomosis of the gallbladder to the jejunum).

Obstructive jaundice may warrant biliary stenting if the patient has pruritus, right upper quadrant pain, or cholangitis. Occasionally, anorexia of a patient will improve biliary obstruction relief. Relief of obstructive jaundice is also important in nonsymptomatic patients to allow them to safely receive several chemotherapies used in the treatment of pancreatic cancer, which cannot otherwise be used in patients with significant hepatic dysfunction (nanoparticle albumin-bound [nab]-paclitaxel, gemcitabine, and irinotecan).

The European Society for Medical Oncology (ESMO) recommends endoscopic placement over percutaneous insertion of biliary stents because of relative safety. The National Comprehensive Cancer Network (NCCN) guidelines suggest using endoscopically placed metal stents for biliary obstruction.

To learn more about the treatment of jaundice in metastatic pancreatic cancer, read here.

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