Palliative care in a patient with unresectable pancreatic cancer

Rentha Monica, Budi Widodo*

*Gastroenterohepatology Division, Department of Internal Medicine Medical Faculty of Airlangga University-Dr Soetomo
Teaching Hospital Surabaya, Indonesia

ABSTRACT

Background: Pancreatic cancer is the fourth most fatal cancer in the world. Surgical therapy is
the definite treatment, but unfortunately 80% of patients present with locally advanced or
metastatic tumor which cannot be resected. Palliative care is the main treatment in unresectable
pancreatic cancer patients with the aim of achieving the best quality of life for patients and their
families.

Case: We report the case of 58 years old man with main complaint of yellow discoloration
throughout the body with pale stools and dark urine. He also suffered from abdominal and back
pain. Laboratory examination showed elevation of bilirubin and coagulation test abnormalities.
Abdominal CT scan with contrast showed mass at the head of the pancreas which also causing
biliary obstruction. The patient was diagnosed with obstructive jaundice due to pancreatic head
cancer. According to AJCC tumor staging, this tumor is unresectable. Biliary drainage was
facilitated by plastic stent placement using ERCP (Endoscopic Retrogade
Cholangiopancreatography) while pain was managed using combination of paracetamol and
codein. Two weeks after discharge from hospital, patient was examined with decrease in yellow
discoloration of his body, stools and urine back to normal colour, and pain was relieved.

Discussion: The most common symptoms that require palliation in patient with pancreatic cancer
are jaundice, gastric outlet obstruction and pain. Palliative care in this patient was managed by
performing biliary drainage and also focus on adequate pain control. Stent placement by using
ERCP is the first line non invasive treatment of biliary obstruction in pancreatic cancer. Pain is
managed using analgetics according to WHO analgetic stepladder and also can be managed with
neurolytic celiac plexus block.

Conclusion: For patients with unresectable pancreatic cancer, palliative management is the best
approach to patient care. In this case report, the quality of life in patient has improved.

Keywords: pancreatic cancer, unresectable, obstructive jaundice, ERCP, palliative care