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Virtual Patient Case: Advanced Pancreatic Cancer

Key Case Concepts
  1. The currently available palliative chemotherapy has been shown to significantly improve survival and quality of life, with a much risk/benefit ratio than was achievable even a decade ago.
  2. Endoscopic self-expanding metallic stents are effective at relieving gastric outlet obstruction, without incurring the risk of an operation or the chance of circulus vomiting as a result of a gastrojejunostomy.
  3. The use of celiac ganglion ablation in a centre with experience in the procedure can facilitate pain management in carefully selected patients, while reducing the need for opioids and their side effects (constipation/ drowsiness / confusion).

Patients with advanced, incurable pancreatic cancer, when managed appropriately and not fatalistically, can survive for a significant period of time and enjoy reasonable to good quality of life.

Learning Hours

1.0 Section 3 Learning Hour

3.0 Section 3 Credits

Learning Objectives

By the end of this case, you should be able to:

  • Describe the role of chemotherapy in the palliation of unresectable or metastatic pancreatic cancer.
  • Compare surgical, endoscopic, and radiologic approaches to the management of biliary obstruction in the patient with advanced pancreatic cancer.
  • Identify gastric outlet obstruction and describe the options available for its management.
  • List options available for the management of pain for patients with advanced pancreatic cancer.
  • Appreciate the importance of active listening and describe a plan for having a serious illness conversation with the patient and his/her family to determine goals of care.
  • Define the appropriate timing for referral to a palliative care team.

Accreditation Statement
This event is an Accredited Self-Assessment Activity (Section 3) as defined by the Maintenance of Certification Program of the Royal College of Physicians and Surgeons of Canada, and approved by Canadian Association of General Surgeons.

Case Authors

  • Mike Moser, Hepatobiliary Surgeon, University of Saskatchewan
  • Shahid Ahmed, Medical Oncologist, Saskatchewan Cancer Agency
  • Andrea Johnson, Palliative Care Physician, Saskatchewan Health Authority
This is the true story of Mr. Frank James (not his real name), a patient I had the privilege of caring for a number of years ago... I will never forget him. - Mike Moser

Case Audience

  • General Surgeons
  • General Surgery Residents and Fellows

Virtual Patient Case Developers

  • David Fleiszer, Surgical Oncologist, McGill University
  • Nancy Posel PhD (Ed), McGill Faculty of Medicine

The user acknowledges that the workshops, handouts, and related course materials contained therein are intended for educational purposes only, and should not be considered to be legal advice or a substitute for legal or clinical consultation. These presentations address issues that are multi-faceted, and the user should not assume that the courses discuss every law, regulation, or ethical code that may be relevant to the subject matter. Legal and ethical standards are subject to change and it is always prudent to check to see whether a particular law, regulation, or ethical standard may have changed.

This course is freely available to CAGS members. Please create an account and enter your code. If you do not have an access code, please contact:
Refunds/Cancellations: CAGS does not offer refunds for On-Demand Library purchases.