Treatment options for intermediate to advanced pancreatic cancer (1) Surgical palliative surgery: For palliative treatment of pancreatic cancer is important. Because radical surgery cannot be performed in about 88% of patients due to local spread and metastasis of the tumor, when the primary tumor cannot be removed, the surgeon must decide what palliative measures to take to relieve obstruction of the bile duct or duodenum. (1) gallbladder-jejunum loop anastomosis; (2) gallbladder-jejunum Roux-en-Y anastomosis; (3) common bile duct jejunostomy; (4) dual gastrointestinal and biliary-intestinal anastomosis. (2) Radiation therapy: pancreatic cancer is a tumor with low sensitivity to radiotherapy. Because of the deep location of the pancreas, the surrounding gastrointestinal, liver, kidney and spinal cord are less tolerant to radiation, which is unfavorable to radiation therapy for pancreatic cancer. However, in recent years, with the development of intraoperative radiotherapy and treatment planning under CT precise positioning and multifield extracorporeal radiotherapy, radiotherapy has become one of the important means in the treatment of pancreatic cancer. For postoperative and inoperable advanced pancreatic cancer, radiotherapy alone has no significant effect on the survival of patients. Combined radiotherapy and chemotherapy, on the other hand, can effectively relieve symptoms, reduce pain, improve the quality of survival, and prolong survival. In recent years, there are advocates for preoperative radiotherapy and chemotherapy to control the metastasis of tumor. (3) Chemotherapy: Chemotherapy can be administered to pancreatic cancer that cannot be removed surgically or to prevent recurrence after surgery. Chemotherapy for pancreatic cancer is expected to reduce the incidence of cancer recurrence and metastasis after surgery. (1) Single agent chemotherapy: Gemcitabine: It is a difluorodeoxycytidine that, after intracellular activation, causes apoptosis by inhibiting nucleotide reductase and doping into the DNA strand to prevent its continued prolongation. It mainly acts on S-phase cells. The dose is 1000 mg/m2 (body surface area) administered intravenously over 30 min, once/week for 7 weeks with a 1-week break. Preliminary results showed that it could lead to improvement of symptoms and prolongation of survival, which deserves further study. ② Combination chemotherapy: pancreatic cancer is insensitive to chemotherapy and monotherapy is not effective. Combination chemotherapy can reduce the resistance of tumor and improve the efficacy. However, it is still not ideal for prolonging survival. Gemcitabine + platinum oxalate: It is the more commonly used regimen at present. (4) Local ablation therapy: ①High intensity focused ultrasound: High intensity focused ultrasound (HIFU) is to use the physical property that ultrasound can penetrate soft tissues and can be focused, and multiple beams of ultrasound generated by external electroacoustic transducer are coupled into human body and focused on target tissues with the help of aqueous medium, which causes ultrasound through transient high temperature effect (above 50℃), cavitation effect, mechanical effect and other mechanisms. HIFU is less invasive, no radiation damage and no side effects caused by chemotherapy. Recently, HIFU has shown its unique advantages in the treatment of pancreatic cancer, especially in combination with surgery and chemotherapy, showing its broad application prospects. ②Radiofrequency ablation: Radiofrequency ablation (RFA) is the treatment of tumor tissue coagulation and denaturation caused by heat generated by high frequency AC current and tissue friction, which has been widely used in the treatment of liver cancer, lung cancer and other tumors, and has achieved good efficacy, but there is a risk of pancreatic leakage. Microwave ablation: Microwave ablation uses a probe to concentrate microwave energy in one area, which causes the charged particles in tissue cells to oscillate at high speed and generate heat, resulting in a local tissue temperature of 65-100℃, thus killing tumor cells. At present, it has been successfully applied to the treatment of liver, kidney and lung tumors, and has achieved better efficacy. For the treatment of pancreatic tumors microwave ablation is also being applied, but there are also concerns about pancreatic leakage and bleeding. (5) Symptomatic supportive treatment In the middle and late stage of pancreatic cancer, those who have steatorrhea due to pancreatic exocrine insufficiency can take pancreatic enzyme preparation during meals to help digestion. For intractable abdominal pain, analgesics, including opioid analgesics, should be given; if necessary, abdominal plexus injection with 50% to 75% ethanol or sympathectomy should be performed. We found that the use of high-intensity focused ultrasound therapy can significantly improve the symptoms of intractable abdominal pain, enhance one’s anti-tumor immunity, and improve the quality of life with tumor survival.