Hi, Thanks for writing in. Pancreatic cancer is one of the most feared diseases and gives no time to the patient for survival. Almost every patient of pancreatic cancer will survive for months or few years at most unless it is detected at early stage and resectable. The main concern right now for your wife is to control the rising bilirubin levels. What has happened is that the tumor in pancreas might be causing block in the biliary channels. This leads to collection oof wbile within the liver and biliary pathway. PTBD is a procedure by which the blocked bile will be drained through the skin and the bilirubin level is controlled. This is a safe and easy technique but might affect patient mobility due to insertion of tubes. There is another way called intrahepatic biliary stent placement. In this the biliary channels are approached with catheters and a stent is put in the area of maximum block. Following the procedure bile is drained through the normal opened passage and this reduces the symptoms.