Virtual Patient Case: Advanced Pancreatic Cancer

Online Course Delivery: All courses are delivered through the General Surgery Learning and Resource Centre (LRC). If you do not already have an account associated with this email, we will contact you to set up your LRC account.

CAGS Members: All levels of CAGS membership have complimentary course access for 2023. Please create an account and enter in your code, no purchase necessary. If you do not have a code, email learn@cags-accg.ca.

Non-Members: Purchase access to the course here. Granting access to this eLearning course in the General Surgery Learning and Resource Centre can take up to 2 business days.

Credit Info: 1.0 Learning Hours — 3.0 Section 3 MOC Credits

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).

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.

Case Authors:

• Mike Moser, Hepatobiliary Surgeon, University of Saskatchewan
• Shahid Ahmed, Medical Oncologist, Saskatchewan Cancer Agency
• Andrea Johnson, Palliative Care Physician, Saskatchewan Health Authority

Virtual Patient Case Developers: Nancy Posel PhD, David Fleiszer 

Case Audience: General Surgeons, General Surgery Residents and Fellows