Controlling symptoms of advanced pancreatic cancer
Pancreatic cancer is most commonly diagnosed at an advanced stage.This means the cancer is either locally advanced (stage 3) or has spread to another area of the body (metastatic or stage 4). The cancer is not usually able to be completely removed with surgery. So the aim of treatment is to control any symptoms and help you feel as well as possible.
Treatments such as chemotherapy or radiotherapy can sometimes help to shrink the cancer. Other treatments such as stents can treat symptoms such as a blockage in the bile duct or bowel.
Symptoms
The most common symptom is feeling tired and unwell. Other symptoms depend on where the cancer is in the body. They might include:
- feeling or being sick
- unexplained weight loss
- tummy (abdominal) pain
- yellowing of eyes and skin (jaundice)
- a build up of fluid in your abdomen (ascites)
The most common place for pancreatic cancer to spread to is the liver. It can also spread to the lungs, within the abdomen or to nearby lymph nodes. Rarely, it can spread to the bone.
Cancer that has spread to another part of the body is called metastases or secondary cancers.
Tiredness is a common symptom of advanced cancer. It can feel a bit overwhelming and as though you don’t have any energy.
Let your doctor or nurse know if you’re very tired as they might be able to prescribe medicine to help or other treatments. For example, a blood transfusion can give you more energy if you’re tired due to anaemia (low red blood cell levels).
Resting
It’s important to rest a few times throughout the day. Resting regularly can help you feel less tired and more able to cope. You don't have to sleep during these times. Just sitting or lying down will help.
Exercise
Exercising can be hard when you feel very tired. Research has shown that daily light to moderate exercise can give you more energy. Going for a gentle walk is enough. Gentle exercises in bed or standing up can help if you can’t move around easily.
Your hospital 
or community team might be able to help you plan an exercise programme that suits your needs.
Sleeping
You might feel more tired if you have trouble sleeping at night. It can help to change a few things about when and where you sleep.
The cancer might block the bile duct or part of the bowel. This means digestive juices or food can’t pass through. This causes pain, sickness and makes you feel very unwell. You may need to go to the hospital if this happens.
Your doctor might put a tube called a stent into your bile duct or bowel to allow digestive juices or food to pass through.
A few people might have surgery instead of a stent. The aim of surgery is to create a passage to go around the blockage. This is called bypass surgery.
Bypass surgery is a big operation and you have to be well enough to cope with it.
Medicine to relieve a blocked bowel
Your doctor might suggest medicine to help relieve the symptoms of a blocked bowel. These medicines include:
- somatostatin
- octreotide
They work by lessening the amount of fluid that builds up in your stomach and digestive system. This helps to stop you being sick and can relieve bloating.
You might have somatostatin with steroids for advanced pancreatic cancer. The steroids help to reduce swelling that is making the blockage worse.
The medicines might relieve symptoms at first, but the symptoms might come back.
You might not feel like eating and may lose weight. This could be for several reasons including the cancer itself or the treatment you may be having.
The pancreas has several functions including making enzymes. These help digest your food. If the pancreas isn't working properly then you won't be able to absorb food properly. So you may lose weight and won’t get the right amount of nutrients and vitamins your body needs.
You might need to take enzyme supplements to help with this. One of the commonly used ones is called Creon.
Other tips that might help with loss of appetite and weight loss include:
- Eating several small meals and snacks throughout the day can be easier to manage.
- Ask your doctor or dietitian to recommend high calorie drinks to sip if you are worried about losing weight.
- Eat whatever you feel like eating rather than what you think you should eat.
- Eat plenty of calories when you can to make up for times when you don’t feel like eating.
- Drink plenty even if you can't eat.
- Don't fill your stomach with a large amount of liquid before eating.
- Try to eat high calorie foods to keep your weight up.
You might be very worried about having cancer pain. Although pain is common in pancreatic cancer, it can nearly always be kept under control.
Painkillers are also called analgesics or analgesia. There are many different types and strengths of painkillers suitable for different types of pain. They also come in different forms such as:
- tablet and capsules
- liquids
- patches
- injections or as a drip into your bloodstream (intravenous)
The type of painkiller you need will depend on how bad it is. Simple painkillers like paracetamol, are suitable if you have mild pain. If you have moderate pain, you might have weak painkillers such as codeine. This is a morphine based medicine. For ongoing or severe pain, you usually have opioid painkillers.
A doctor or nurse can judge which type of painkiller is best for you. The important thing is that you have the right type of painkiller for your pain and the right dose.
There are other types of medicine to control pain such as anti inflammatory drugs. For example ibuprofen (Nurofen) alongside any of the other painkillers. Anti depressants or anti epileptic drugs help with nerve pain.
Some people may use of pain control alongside painkillers,such as acupuncture or reflexology.
Cancer treatments
Cancer treatment can help to control pain. The cancer in the pancreas might be pressing on a nerve or another organ and causing pain. If treatment can shrink the tumour, pressure on the nerve or organ will ease and you will have less pain.
It can take several weeks before you get the full benefits of the treatments. So you will need to carry on taking your painkillers in the meantime. You may be able to cut down on your painkillers after you have seen the effects of the cancer treatment.
Nerve pain
Many people with pancreatic cancer have nerve pain. This is because the cancer can put pressure on large groups of nerves as it grows. People often describe nerve pain as burning, tingling or shooting pain.
Drugs that might help with this sort of pain include amitriptyline and gabapentin. Amitriptyline is an anti depressant. But it can also help to reduce pain that is difficult to treat with other painkillers.
Gabapentin is an anti convulsant drug. This means that it helps to control fits (seizures), but it can also relieve burning or tingling pain. Doctors may also use other anti convulsant drugs.
Nerve blocks
If you have pain that is very difficult to treat, your doctor may suggest a nerve block. This is a way of killing or deadening a nerve to stop it causing pain.
A nerve block is named after the nerves that it blocks.
The coeliac plexus is a complicated web of nerves at the back of the tummy (abdomen). A coeliac plexus block stops signals that can cause you to feel pain in your upper abdomen.
Other ways to control pain
As well as painkillers, there are other ways to help control pain. These include TENS machines and acupuncture.
There are also many ways that you and your family or friends can help to control your pain.
Side effects of painkillers
Many painkillers have one or two common side effects. Most cause so it helps to start taking regular stool softeners or laxatives.
Morphine type painkillers (opioids) can also cause:
- dizziness
- drowsiness
- feeling or being sick
These side effects usually happen because you are not used to the drug. After a few days they lessen and disappear. Many doctors give an anti sickness drug with opioids for the first week or so.
Your healthcare team will keep a close eye on you to check that the pain relief is working and to help with side effects, if you have any.
You might have a swollen tummy (abdomen) if your cancer has spread to the liver. The swelling is due to a build up of fluid called ascites. It can make your clothes feel tighter. Your tummy might feel bloated. You might also find it difficult to sit comfortably or to move around.
Your doctor might drain off the fluid by putting a small flexible tube into the abdomen. They might use an ultrasound scan to make sure the tube is in the right place. Draining off the fluid helps you to feel more comfortable.
Sometimes the fluid builds up again over a few weeks. If this happens, you might have another tube into your abdomen called an indwelling peritoneal catheter (IPC). This means you can drain the fluid off when you need to at home. So you won’t need to go to hospital each time.
You might pass pale, offensive smelling stools (poo) that float. This is called steatorrhea (fatty poo).
Cancer can cause bowel problems such as diarrhoea or constipation. They can also be caused by cancer treatments or other medicines. For example, painkillers commonly cause constipation.
Talk to your doctor or nurse if you have bowel problems. They can help by giving you medicine. And they can refer you to a dietitian for advice on what to eat or drink.
Palliative care team
Members of the palliative care team are experts at controlling symptoms. They can help you to stay as well as possible for as long as possible. There are palliative care teams in most cancer units. They are also in hospices and many general hospitals. Most palliative care teams have home care services so they can visit you at home.
