Alternatives in the management of pancreatic cancer

Pancreatic carcinoma is one of the most lethal malignancies seen in humans. If cure is to be effected, radical surgery for small lesions confined to the gland must be undertaken, but the cost in morbidity and mortality is high. An otherwise fit elderly patient should not be denied the small chance of cure because of age alone, but such a patient must be frankly appraised of the significant risks and limitations of resectional therapy. The Whipple procedure remains the standard operation for lesions of the head of the gland, but pre-existing severe diabetes and technical factors may dictate that a total pancreatectomy be performed. Patients with unresectable cancers who develop biliary or enteric obstruction should be bypassed internally if otherwise healthy. If frail or infirm from other organ failure, patients may be offered relief by a percutaneous decompression with minimal risk. Pain must be dealt with in all patients with celiac blocks or liberal use of analgesics. Adjuvant forms of therapy are experimental, costly in time and money, not without serious side effects, and should be advised cautiously in elderly patients.