- 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.
- 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.
- 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.
1.0 Section 3 Learning Hour
3.0 Section 3 Credits
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 StatementThis 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.
- Mike Moser, Hepatobiliary Surgeon, University of Saskatchewan
- Shahid Ahmed, Medical Oncologist, Saskatchewan Cancer Agency
- Andrea Johnson, Palliative Care Physician, Saskatchewan Health Authority
- 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