Supportive care (controlling symptoms) for pancreatic cancer
For many people with pancreatic cancer, the main aim of treatment is to control symptoms.
Treating symptoms is known as supportive care. Chemotherapy, radiotherapy and surgery can all be used to control symptoms. You may also be offered additional treatments or procedures to relieve any symptoms you have.
We have more information available about the methods of treating different symptoms of cancer.
If the cancer is blocking your bile duct or your duodenum this can be treated with a tube called a stent or, rarely, with surgery to bypass the blockage.
A stent is a flexible plastic or metal tube that can be put into a duct or the section of bowel that’s blocked by cancer. The stent holds the duct or bowel open, allowing fluid to pass through it.
Sometimes a stent needs to be replaced if it becomes blocked or if an infection occurs. If a plastic stent has been in place for a long time it may need to be replaced with a new one.
Stents to relieve a blockage in the duodenum are usually put in using an endoscopy.
You’re given an injection to help you to relax (a sedative) and some local anaesthetic is sprayed on to the back of your throat.
The doctor passes a thin flexible tube (endoscope) down your throat, into your stomach and then into your duodenum.
An expandable, flexible tube is then put down the endoscope and into the duodenum to hold it open.
Bile duct stents are most commonly put in using an ERCP but can also be put in during a procedure called a percutaneous transhepatic cholangiogram (PTC).
PTC (percutaneous transhepatic cholangiogram)
If a stent can’t be passed into the bile duct during an ERCP, a PTC may be carried out. This involves taking an x-ray of your bile duct.
You will be asked not to eat or drink for a few hours before a PTC. The procedure is carried out in the x-ray department by a doctor called a radiologist. Once you are lying down, you are given a sedative so that you feel relaxed and drowsy.
The doctor injects some local anaesthetic into the skin to numb it, then inserts a long, thin, flexible needle through the skin into the liver. The doctor looks at x-ray images on a screen to help them guide the needle to the bile duct and inject a dye.
Some people feel warm all over when the dye is injected. This is normal and the feeling wears off quickly.
The dye flows through the ducts, showing the area that is blocked. The doctor passes a fine guide wire along the needle into the blockage in the bile duct. A stent is then passed along this wire. The stent holds open the bile duct where it has narrowed, allowing fluid to flow through it again. You may feel some pushing when the wire and stent are being put in. If this is uncomfortable or painful, let the doctor know so that you can be given painkillers.
To help prevent infection you will be given antibiotics before and after the procedure. You will probably need to stay in hospital for a few days.
Pain caused by pancreatic cancer can usually be well controlled.
If you are in pain, it’s important to let your nurse or doctors know as soon as possible so that you can be given appropriate treatment. Doctors and nurses who specialise in controlling pain and other cancer symptoms are called palliative care specialists. They are based in hospitals, hospices, palliative care units and pain clinics, and work with you, your GP, district nurses and other health professionals to make sure that your pain is controlled.
Giving your doctor or nurse as much information as you can about your pain will help them to assess it and plan treatments.
You may want to tell them:
how your pain rates on a scale of 0 (no pain) to 10 (worst pain)
what words best describe your pain – for example, is it dull, sharp, shooting or aching?
what makes the pain better or worse
how your pain affects everyday activities.
There are many painkilling drugs available to treat different types and levels of pain. They come in different forms including tablets, liquid medicines and skin patches. Painkillers can also be given by injection or infusion into a vein.
Cancer treatments such as chemotherapy or radiotherapy can also be used to relieve pain. They work by shrinking the cancer.
If your pain can’t be well controlled with painkillers, your doctor may suggest you have a procedure called a nerve block. This stops pain messages from getting to the brain by blocking the nerves themselves. It’s usually done by injecting an anaesthetic such as alcohol into the nerve. Sometimes the nerve can be cut rather than injected. This needs a general anaesthetic and is more likely to be done when a person is having other surgery, such as bypass surgery.
There are different names for nerve blocks depending on which nerves need to be treated. If you have persistent pain in your abdomen and back, this may be due to the tumour pressing on a network of nerves at the back of your abdomen called the coeliac plexus. This type of pain can usually be treated very effectively with a coeliac plexus nerve block.
There are different ways of doing a nerve block. Your doctor may inject into the nerve through your back. Pictures from a CT scan help guide the doctor to the right place. Your skin is numbed with a local anaesthetic injection. The doctor then puts a long, fine needle through your back and into the nerve, which is then injected with alcohol.
Nerve blocks can also be carried out using endoscopic ultrasound (EUS). The doctor passes an ultrasound probe down the endoscope to produce a picture of the inside of your body on a monitor. When the doctor sees the coeliac plexus on the monitor, they pass a needle down the endoscope to inject alcohol into the nerves to deaden them.
After a nerve block, your blood pressure may be low for a day or two. This may make you feel a bit light-headed and dizzy, particularly when you stand up.
Loss of appetite and weight loss
Pancreatic cancer can cause problems with eating and digestion. If the pancreas isn’t working properly you may not be able to digest fat. Your doctor may prescribe tablets containing pancreatic enzymes to help with this.
Try to maintain your weight by adding extra calories where you can. For example, you can add high-protein powders to your food or you can supplement meals with nutritious, high-calorie drinks. These are available from most chemists and can be prescribed by your GP. If you find it difficult to eat a lot at one time, perhaps because you feel full quickly, try eating several smaller meals and snacks during the day rather than three large meals.
If your appetite isn’t good, medicines such as steroids may help to improve it. You can also ask to be referred to a dietitian at your hospital. Dietitians are experts in assessing the nutritional needs of people who are ill. They can advise you on which foods are best for you and also whether any food supplements would help. If you are at home, your GP can arrange this for you.
We have more information available about building-up your diet in our section on eating well.
Many people with pancreatic cancer feel tired and have less energy to do the things they normally do. This may be due to your illness or may be a side effect of treatment.
Your body will tell you when you need to rest. When you do feel like doing things, try to pace yourself. Keeping a fatigue diary [PDF] can help you record your energy levels and plan activities for when you’re feeling stronger.
Physical activity can be helpful for some people. One study found that after surgery to remove pancreatic cancer people who took regular walks, doing a little bit more each week, had more energy and felt less tired.
Some causes of tiredness can be treated. For example, anaemia (low number of red blood cells) can be treated with a blood transfusion. Your doctor can take a blood sample from you to find out if you have anaemia.
Coping with pain is tiring and affects the quality of your sleep. If pain is causing or contributing to your fatigue, then effective treatment for this will help you feel better and may improve your energy levels.
If sleep problems are causing or contributing to your fatigue then improving these will help you feel better. You can read about ways of getting a better night-time rest in our section about fatigue.
Fatigue is a common symptom of depression. If you think you’re depressed, talk to your doctor or nurse. You and your doctor will be able to work out if what you’re feeling is depression or fatigue. Talking about your feelings with a professional counsellor can often help depression, and antidepressants may help you feel better.
In many cancers, the balance of chemicals that control blood clotting is changed.
This increases the risk of a blood clot developing in a blood vessel. Chemotherapy and surgery can increase the risk of blood clots developing. But for most people the benefits of treatment greatly outweigh the risks.
If a blood clot develops it is most often in the veins deep in the legs. This is called
a deep vein thrombosis or DVT. The first sign of a DVT is usually swelling in the leg, sometimes with pain or tenderness in the calf, or numbness or tingling in the foot.
The leg may also be warmer and a different colour from usual, often red, purple
Less commonly, a blood clot can develop in the lungs. This is called a pulmonary embolus (PE). It can occur when a piece breaks off from a clot in the leg and travels in the bloodstream to the lungs. This can cause pain in your chest or back that gets worse when you breathe deeply, breathlessness or coughing up blood.
A blood clot in the lungs is a serious condition and can be life threatening. So, if you suspect you might have a clot in your leg or lungs, it’s important to see a doctor straight away so that you can have treatment. Blood clots are treated with drugs that thin the blood (anti-coagulants).
drink plenty of water
take short walks regularly
keep your blood flowing by taking deep breaths and exercising the muscles in your legs every so often if you can't get up to walk around for a few hours.
Sitting in one position during a long journey (three hours or more) on a plane, train, car or bus is also a common cause of blood clots. If you are planning to go on a long journey, speak to your doctor about whether there are any particular precautions you should take.
Ask your cancer specialist for advice if you are worried about your risk of blood clots. They can talk through your own personal risk factors and things that may be done to reduce your risk.
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Some people find that complementary therapies can reduce symptoms and help them to feel better. It’s important to discuss your planned therapy either with your specialist or GP to check if there are any reasons why you shouldn’t go ahead. Many doctors are now comfortable with medical and complementary therapies being used together.
Many hospitals and hospices offer complementary therapies. Treatments may include acupuncture, massage, aromatherapy and relaxation techniques.
Therapies such as gentle massage can be carried out by your relatives or carers, and this can help them to support you.