Controlling symptoms of pancreatic cancer

Supportive care for 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 known as supportive care.

Your GP or cancer specialist will refer you to a palliative care team. 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 coping with advanced cancer.

Pain

If pancreatic cancer causes you pain, it can usually be well controlled. If you are in pain, it is important to let your nurse or doctors know as soon as possible. This means they can start to treat it straightaway.

There are different types of painkillers. They can be given in different ways such as, tablets, liquids or skin patches. Sometimes they are given by an injection under the skin or into a vein. Always tell your doctor or nurse if you are in pain. They will work with you to find the best way to manage the pain

Other treatments to manage cancer pain could also include:

We have more information about managing pain.

Some people may find that certain complementary therapies help them to cope with pain. For example, relaxation and breathing exercises or massage.

Jaundice

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.

We have more information about treatments for jaundice.

A blockage in the bowel

Sometimes, the cancer blocks the first part of the small bowel (the duodenum). This means food or drink cannot pass from your stomach to your bowel. The food collects in your stomach. This can make you feel sick and be sick.

Bypass surgery

An operation to bypass the blockage can help. The surgeon connects part of your small bowel (just below the duodenum) directly to your stomach. This lets food pass from the stomach into your bowel. This operation may happen at the same time as an operation to relieve a blocked bile duct (see above).

Stents

If surgery is not possible, an expandable, flexible tube called a stent can often treat the blockage. The doctor puts the stent into the section of bowel that the cancer is blocking. The stent holds the bowel open, so it is no longer blocked.

Stents for blockages in the duodenum are usually put in using an endoscopy. You should not eat or drink for about 6 hours before the procedure. You will have an injection to help you to relax. The doctor passes a thin flexible tube (endoscope) down your throat, into your stomach and then into your duodenum. They then put a stent down the endoscope and into the duodenum to hold it open.

Tiredness

Many people with pancreatic cancer feel tired (fatigued). They have less energy to do the things they normally do. The cancer itself may be causing this. Or it may be because of other symptoms, such as pain. Having a low number of red blood cells (anaemia) also causes tiredness. Your doctor can take a blood sample to test you for anaemia.

Make sure you get plenty of rest. Try to save your energy for the things that matter to you. Don't be afraid to ask for help or to accept offers of help. Gentle exercise like regular short walks may help to give you a little more energy.

We have more information about coping with tiredness.

Depression

Tiredness and having a low mood most of the time can also be symptoms of depression. If you think you may be depressed tell your doctor or nurse. They can explain ways of managing it. This can include talking to a professional counsellor and taking antidepressant medicine.

Talking to the people close to you about your feelings can also help.

Difficulty sleeping

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. Simple breathing and relaxation exercises may also be very useful in reducing anxiety and stress.

We have more information about improving your sleep.

Loss of appetite and weight loss

Pancreatic cancer can cause problems with eating and digestion. If your pancreas is not working properly, you may not be able to digest fats and proteins. You may have diarrhoea and your stool (poo) may be pale. This means you are not absorbing nutrients from food properly and you may lose weight. Your doctor may prescribe enzyme replacement tablets to help you to digest food.

They will also give you advice on managing diarrhoea.

Try to maintain your weight by adding extra calories to your food where you can. This will give you more energy.

If your appetite is not good, medicines such as steroids may help improve it. You may be referred to a dietitian at your hospital. They can advise you on the best foods for you and on food supplements that may help. If you are at home, your GP can arrange for you to see a dietitian.

We have more information about coping with eating problems and preventing weight loss.

Feeling sick

The cancer can make you feel sick. Some treatments may also make you feel sick.

Anti-sickness tablets (anti-emetics) can often relieve sickness. There are several different types of anti-emetics available. Your doctor will find the one that suits you best.

Your doctor may prescribe steroids for you to take. These can help relieve sickness and make you feel more energetic. They can also improve your appetite.

We have more information about controlling nausea and vomiting.

Ascites

If the cancer has spread to the liver, fluid can sometimes collect between the two layers of the peritoneum. The peritoneum is a membrane that lines the tummy (abdomen). Your tummy may become swollen and distended (bloated). This is called ascites and can be uncomfortable and painful.

We have more information about ascites.

Itching

Sometimes, when people are jaundiced, bile salts are deposited in the skin. This causes itching. Having frequent showers can wash off the bile salts and provide relief. Try to avoid soaps that dry your skin. They may increase itching.

You may find moisturising lotions helpful. Your doctor can also prescribe medicines to help relieve itching. Treating the cause of the jaundice will help relieve the itching.

Blood clots

Cancer can increase your risk of developing a blood clot (thrombosis). Some treatments may increase this risk further.

We have more information about blood clots.

About our information

References

Below is a sample of the sources used in our pancreatic cancer information. If you would like more information about the sources we use, please contact us at cancerinformationteam@macmillan.org.uk

British Society of Gastroenterology. Guidelines for the management of patients with pancreatic cancer peri-ampullary and ampullary carcinomas. 2005.

European Society for Medial Oncology. Cancer of the pancreas: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology, 2015. 26 (Supplement 5): v56 to v68.

Fernandez-del Castillo. Clinical manifestations, diagnosis, and staging of exocrine pancreatic cancer. UpToDate online. Jan 2018.

Fernandez-del Castillo C, et al. Supportive care of the patient with locally advanced or metastatic exocrine pancreatic cancer. UpToDate online. Feb 2017.

Winter JM, et al. Cancer of the pancreas, DeVita Hellman and Rosenberg’s Cancer: Principles and Practice of Oncology (10th edition). Lippincott Williams and Wilkins. 2016.

Reviewers

This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Chief Medical Editor, Professor Tim Iveson, Consultant Medical Oncologist.

Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.