Managing symptoms of pancreatic cancer

For many people with pancreatic cancer, the main aim of treatment is to control symptoms.

Chemotherapy and radiotherapy can sometimes help shrink the cancer for a time. This can help to control symptoms. You can also have other treatments that will help you feel better and have the best quality of life possible. This is called supportive care.

Your GP or cancer specialist will refer you to a palliative care team for supportive care. This is a team of doctors and nurses who will make sure that your symptoms are controlled. They will work with you, your GP, and other health professionals.

They are experts in helping control symptoms such as:

• pain
• tiredness
• changes in bowel function (poo)
• loss of appetite
• weight loss
• any other problems caused by pancreatic cancer.

Palliative care teams are based in hospitals, hospices, palliative care units and pain clinics.

We have further information about controlling the symptoms of cancer and coping with advanced cancer.

If cancer blocks the bile duct, you may develop jaundice. This happens because bile cannot drain away and builds up in the body. This can cause yellowing of the skin and the whites of the eyes. It can also cause itchy skin.

Your doctors may suggest they place a tube called a stent in the bile duct. Or they may suggest you have an operation to bypass the blockage.

Stents

Bile duct stents are most commonly put in using endoscopic retrograde cholangio-pancreatography (an ERCP).

You should not eat or drink anything for 6 hours before the procedure. You have an injection to make you feel relaxed and sleepy. The doctor passes a thin, flexible tube with a camera on the end (called an endoscope) into your mouth. The tube moves down into your stomach and into the duodenum, which is the first part of your small bowel. Doctors then place the stent into the opening of the bile duct. The stent keeps the bile duct open and allows bile to drain.

Stents can be made of plastic or metal. If a plastic stent has been in place for a long time, it may need replacing. Metal stents do not usually need replacing. Sometimes a stent needs replacing if it becomes blocked or if you get an infection.

PTC (percutaneous transhepatic cholangiogram)

If doctors cannot pass a stent into the bile duct during an ERCP, they may do a PTC instead.

Bypass surgery for a blocked bile duct

If a stent is unsuccessful, or if it is not possible, you might be able to have surgery to relieve the blockage. You need to be fit enough to cope with surgery and the anaesthetic.

The surgeon makes a cut in the bile duct, or sometimes the gall bladder, just above the blockage. They will then reconnect it to the small bowel. This bypasses the blocked part of the bile duct. It allows the bile to flow from the liver into the bowel and stops the jaundice. In some hospitals, it is possible to do this procedure during a laparoscopy (keyhole surgery).

Many people with pancreatic cancer feel tired (fatigued). You may have less energy to do the things you normally do. The cancer itself may be causing this. Or it may be because of other symptoms, such as pain.

If you feel tired, it is important to get enough rest. You need to save your energy for the things that matter to you and that you enjoy. Try not to feel guilty if you need to ask for help with any daily activities or tasks. Letting other people do these can help you have energy for the things you really want to do. Friends and family may want to help and may be pleased if you ask them.

Just do as much as you feel like doing. You will not do any harm to yourself by doing too much. But you may need to rest and relax a bit more the next day. Tiredness and weakness sometimes make it harder to concentrate or fully take part in what is happening around you. If you have important things to do, save some energy so you feel less tired and more able to do them.

There is evidence that physical activity, like gentle strengthening exercises and walking, can help reduce fatigue. Being active may help boost your appetite and give you more energy. It can also improve your general well-being. It is important to try to do some exercise, even if you do not feel like it. It is best to try to balance being active, exercising and getting plenty of rest.

You may be able to have treatment for some causes of tiredness. For example, if you have anaemia (low number of red blood cells) you may have a blood transfusion. Your doctor can take a blood sample to find out if you have anaemia.

Many people find they cannot sleep because of worry or anxiety. It can help to write down your concerns or to talk to someone about them. You may not be able to do anything about them immediately. But if you note them down, you can work through them the following day. Simple breathing and relaxation exercises may also be very useful in reducing anxiety and stress.

Sometimes pain can stop you from sleeping. Talk to your doctor or pain specialist about painkillers that can last through the night. Some medicines, such as steroids, can affect your sleep. Ask your doctor or nurse if you can take them earlier in the day. They may suggest you take them before 2pm.

We have more information about improving your sleep. 

If your pancreas is not working properly, you may not be able to digest fats and proteins.

Digestive enzymes help your body to break down and absorb fats and protein. If you do not have enough of them, you may have diarrhoea. Your stools (poo) may float, smell bad and be difficult to flush. This is called steatorrhoea. You will also find it difficult to put on weight because you cannot absorb nutrients from your food.

You can replace the digestive enzymes by swallowing capsules. You will usually take these capsules with every meal and snack. Your nurse or a dietitian will explain how to take the capsules. You will need to take them for the rest of your life.

Commonly used pancreatic enzyme replacement therapy drugs are:

• Creon®
• Nutrizym®
• Pancrease®
• Pancrex®.

Most replacement enzymes are made from pork. Vegetarian enzymes are not available.

The most commonly used supplement is a tablet called Creon, which is a pork-based enzyme replacement. There is no alternative that is not pork-based. It has been approved for use by Jewish patients by the Chief Rabbi. Previous rulings by Islamic scholars suggest that Muslims may use pork-based medicines if there is no alternative. If you have concerns about this, speak to your religious leader.

If the cancer has spread in the abdomen (tummy area), fluid can sometimes collect between the two layers of the peritoneum. The peritoneum is a layer of tissue (membrane) that lines the tummy. Your tummy may become swollen and distended (bloated). This is called ascites and can be uncomfortable and painful. You may also have less of an appetite and feel breathless. The breathlessness happens when the swelling stops your lungs fully expanding as you breathe.

Your doctors may treat ascites by inserting a small tube into your tummy. This drains off the fluid. You usually have this treatment in hospital with a local anaesthetic. Your doctors can repeat this procedure when necessary. If needed, you can have a permanent drain.

Your doctors may give you water tablets (diuretics). These try to stop (or slow down) the build-up of fluid.

Cancer can increase your risk of developing a blood clot (thrombosis). Some treatments may increase this risk further. A blood clot may cause symptoms such as:

• throbbing pain, redness or swelling in a leg or arm
• suddenly feeling breathless or coughing
• sharp chest pain, which may be worse when you cough or take a deep breath.

Blood clots can be very serious. It is important to tell your doctor straight away if you have any of these symptoms. Drugs that thin the blood can successfully treat blood clots. Your doctor or nurse can give you more information about blood clots.

To help lower your risk of blood clots:

• drink plenty of water
• go for regular short walks
• take deep breaths to keep your blood flowing
• exercise the muscles in your legs regularly, even when you are not walking around.

Ask your cancer specialist for advice if you are worried about your risk of blood clots. They can talk to you about things that can reduce your risk.