Stents to relieve symptoms in pancreatic cancer
This page has information on using stents to relieve symptoms caused by advanced pancreatic cancer. You can find the following information
Stents to relieve symptoms in advanced pancreatic cancer
Pancreatic cancer can sometimes block the bile duct or part of the small bowel (duodenum), which can cause symptoms such as jaundice and sickness. To help relieve these symptoms, your doctor may suggest putting a tube, called a stent, into your bile duct or duodenum to keep the blockage open. This is generally a simple procedure that can be done with either local anaesthetic or sedation.
There are not really very many side effects from having a stent. You may need to take antibiotics for a few days afterwards to prevent infection. Unfortunately, stents can become blocked after a few months. If necessary, your doctor can replace the stent.
If you are unable to have a stent, or the stent does not work for any reason, your doctor may suggest bypass surgery to relieve your symptoms. This is quite a major operation. You may want to talk this over fully with your doctor and nurse, and also with your close family and friends. No one can say how much you will benefit from the operation. But you may make a good recovery and feel better for longer if you have the surgery.
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Pancreatic cancer can sometimes cause pressure on the bile duct and block it. This causes jaundice, which can cause
- Yellowing or darkening of the skin and whites of your eyes
- Feeling sick
- Loss of appetite
- Darkened urine
- Pale coloured stools (poo)
- Lethargy and tiredness
Your doctor is most likely to suggest putting a small flexible plastic or metal tube into the bile duct. This tube is called a stent. The stent allows the bile to flow into the bowel again and reduces the symptoms of jaundice. Having a stent put in is generally a simple procedure. It is often done during an ERCP (endoscopic retrograde cholangio pancreatography).
If the stent does not work for any reason, your specialist may suggest bypass surgery to relieve jaundice. This is quite a major operation.
If your doctor suggests major surgery, you may want to talk this over fully with your doctor and nurse as well as with your close family and friends. No one can say how much you will benefit from the operation. It is likely to be quite a big operation and just when you are feeling very low. But you may make a good recovery and feel better for longer if you do have the surgery. There is more information about this operation in the section on surgery to relieve symptoms of pancreatic cancer.
There are 2 ways of having a stent put in
For either of these procedures, your doctor will ask you not to eat or drink for about 6 hours beforehand so that your stomach and upper bowel are empty. You will have sedation for the procedure to help relax you.
Stenting using endoscopy means that the doctor puts a flexible tube called an endoscope into your mouth and passes it down your throat to your stomach. The endoscope has a light and camera attached, and the doctor can watch the images of the inside of your body on a screen. The doctor passes the endoscope tube all the way down through your stomach to your duodenum until it reaches the opening of your bile duct. Once it is in place, the doctor injects dye into the bile duct and uses an X-ray to watch the flow of the dye to see where the duct is blocked. Once the doctor has found the blockage, they can stretch the duct and put the stent in place.
Putting a stent in through the skin is sometimes called percutaneous transhepatic cholangiography. You have a local anaesthetic to numb the area where the needle is to go in. Dye is used to show up the bile duct and blockage. Then, the doctor puts a needle attached to a wire through the skin and moves it carefully into position inside the bile duct. The X-ray helps the doctor to see where to put the wire. Once the wire is in place, the doctor feeds the stent along the wire until it is in place inside the bile duct. Then the doctor can pull out the wire.
After having the stent procedure, you need to recover from the sedative. Your doctor may want you to stay in hospital overnight so the nurses can keep an eye on you while you recover.
There are not really very many side effects from having a stent put into the bile duct. You may need to take antibiotics for a few days afterwards, to prevent any infection from developing. You are at risk of infection while you have the stent in place because bacteria from the gut can travel up the stent to the gallbladder. If you have signs of infection, such as a high temperature and shivering, at any time while the stent is in place you should contact your doctor straight away. You may need to go into hospital for antibiotic treatment.
A stent should keep the bile duct open and stop bile building up and causing jaundice. You should notice the benefit within a day or two of having your stent put in. Unfortunately, stents can become blocked after a few months. If necessary, your stent can be replaced by the same method as before.
Pancreatic cancer can also sometimes block the top of the small bowel (duodenum). This causes you to feel sick and vomit, as the blockage stops food and drink passing from the stomach into the bowel.
As above, one way of relieving symptoms is to have a metal tube called a stent put in to keep the duodenum open. This should give most people relief from vomiting, and so you may feel like eating again. However you may only manage a soft diet at first. Your doctor may put a stent into the bile duct at the same time as the duodenum.
If you are unable to have a duodenal stent, your doctor may offer you surgery to bypass the blockage. There is information about surgery to bypass a blockage in your digestive system in this section. Instead of surgery, you may have drug treatment to relieve a blockage in your digestive system.
You usually have a stent put into the top part of the small bowel (duodenum) using endoscopy. You will not be allowed to eat or drink for about 6 hours before the procedure. First you have sedation to help relax you. The doctor puts the endoscope into your mouth and passes it down your food pipe, through your stomach and into the duodenum. They put a thin guide wire down the endoscope into the area of the blockage. They then remove the endoscope and pass the stent down the guide wire into position. The doctor then removes the guide wire. The stent begins to gradually expand and opens up the blockage.
Once you have recovered from the sedation your nurse will give you a drink. It takes about 24 hours for the sedation to get out of your system. So you may feel drowsy on and off during this time.
Having a stent put into the duodenum (duodenal stent) is normally a safe procedure. Sometimes it can cause a little bleeding during the procedure, but this normally stops by itself. You may have a bit of pain to begin with. This normally settles within a day or two. Your nurse will give you painkillers to help. The stent may slip out of position, but this is rare. If this happens, or the stent becomes blocked, you may have another stent put in.
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