Symptom: Jaundice

It is common for people with pancreatic cancer to experience jaundice, a yellowing of the skin and eyes caused by the buildup of bilirubin in the blood.  People experiencing jaundice may also have itchiness of the skin, abnormally dark urine and clay-colored stools.

Possible Causes of Jaundice
Like other cells in the body, red blood cells die and break down after a normal life span, typically 110-120 days.  Bilirubin is a breakdown product of hemoglobin, a component of red blood cells.  Bilirubin is then excreted or removed from the body in bile.  Bile is a digestive fluid that flows from the gall bladder through the common bile duct and into the duodenum, part of the small intestine.  Sometimes, pancreatic tumors or inflammation of the pancreas will block the bile duct where it runs through the head of the pancreas.  This obstruction prevents bile from flowing properly and causes the buildup of bilirubin in the blood known as obstructive jaundice.  Jaundice may occur when the bilirubin level in the blood is greater than 2.5 mg/dl.

Obstructive jaundice develops in 70-90% of people with pancreatic cancer and may result in complications, such as the inability to properly absorb nutrients, coagulopathy (a defect in the blood clotting mechanism), pruritus (itching sensation of the skin) and cholangitis (inflammation of the bile duct).

Treatment Options
One strategy for alleviating obstructive jaundice is placement of a biliary stent to keep the bile duct open and to allow for proper flow of bile.  A biliary stent is a small tube made of plastic or metal that is placed in the bile duct at the location of the obstruction.  A stent made of plastic is typically used for temporary or short-term relief of obstructive jaundice.

Plastic Stents
Placement of a plastic stent can relieve jaundice and allow for improved nutrition for an individual who will undergo surgery to remove the pancreatic tumor in the near future.  Plastic stents can become occluded, or blocked, more quickly than metal stents.  However, plastic stents can be removed and replaced if they become blocked.  In general, plastic stents will remain open between a few weeks and a few months.

Metal Stents
An expandable metal stent is typically used for more long-term relief of obstructive jaundice in people whose tumors are not able to be surgically removed.  Metal stents tend to remain open longer than plastic stents.  If a metal stent does become blocked, it will not likely be removed.  Rather, a new stent will be placed inside of the blocked stent to re-open the bile duct.  Metal stents will generally remain open from several months to over a year.

Biliary Stent Placement
Stent placement is performed endoscopically by a gastroenterologist during a procedure called endoscopic retrograde cholangiopancreatography (ERCP).  The patient will be required to fast (no eating or drinking) for six hours prior to the procedure.  In preparation for the procedure, most patients will receive monitored anesthesia.  An endoscope, or lighted tube, is passed down the throat and through the stomach to the area of the bile duct.  When the gastroenterologist locates the area of obstruction, the stent will be placed.

Occasionally, the procedure can be performed in an outpatient setting.  Sometimes, the patient will need to spend one night in the hospital so that the physician can monitor him or her for any complications or reactions.

Possible Complications of Stent Placement
The most common complication during biliary stent placement is inability to place the stent due to the size of the tumor or the shape of the bile duct.  Less common complications include perforation (tearing) of the bile duct and bleeding.

It is possible for an infection to develop around a stent.  Fever or a return of jaundice may indicate infection and require emergency treatment.  Anyone who suspects infection due to blockage of a stent should contact his or her doctor or the emergency room immediately.

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