Supportive care for pancreatic cancer

For many people with pancreatic cancer, treatment is given to control symptoms (supportive care). Chemotherapy, radiotherapy and surgery can all be used, or you may be offered other treatments to help.

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

They are experts in helping to control symptoms such as pain, tiredness, changes in bowel habits, loss of appetite, weight loss and other problems caused by pancreatic cancer.

Cancer and its treatment can also change how your body looks, works or feels. It is natural to have concerns about this, but it is important to remember that help and support is available. Talk to your doctor or nurse or with a trusted family member or friend. It may also help to share your experience with others in a similar situation through online community groups.

Supportive care (to control symptoms)

For many people with pancreatic cancer, the main aim of treatment is to control symptoms. Chemotherapy, radiotherapy and surgery can all be used to control symptoms. You may also be offered other treatments to help. These will help you feel better and have the best possible quality of life. This is known as supportive care.

You may be referred to a palliative care team by your GP or cancer specialist. This is a team of doctors and nurses who will work with you, your GP, and other health professionals to make sure that your symptoms are controlled. They are based in hospitals, hospices, palliative care units and pain clinics. They are experts in helping control symptoms such as pain, tiredness, changes in bowel habits, loss of appetite, weight loss and other problems caused by pancreatic cancer.


Blockages and stents

If the cancer is blocking your bile duct or your duodenum, this can often be treated with a flexible plastic or metal tube called a stent. The doctor puts the stent into the bile duct or the section of bowel that is blocked by the cancer. The stent holds the duct or bowel open, so it’s no longer blocked.

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 for blockages in the duodenum are usually put in using an endoscopy. You will be asked not to eat or drink for about six hours before the procedure. Your doctor or nurse will give you an injection to help you to relax (a sedative). They will also spray some local anaesthetic 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, the doctor may do a PTC instead. This involves inserting the stent through the skin (percutaneous) and liver (transhepatic) into the top of the bile duct, using a needle and tube.

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, your doctor will give you 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 control

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 it can be treated. Your medical team will work with you to develop the best pain control plan for you.

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 you’ve ever felt)
  • 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 the things you want to do.

We have more information about controlling pain.

Painkilling drugs

There are many painkilling drugs available to treat different types and levels of pain. The drugs come in different forms including tablets, liquids and skin patches. Painkillers can also be given by injection or infusion into a vein. Your doctors and nurses will help you find the drugs that work best for you.

Cancer treatments

Cancer treatments such as chemotherapy or radiotherapy can also be used to relieve pain. They work by shrinking the cancer to reduce any pressure that is causing pain.

Nerve blocks

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. It is usually done by injecting an anaesthetic into the nerve. Sometimes, the nerve can be cut rather than injected. This can be done under sedation using an endoscope or under general anaesthetic during other surgery, such as bypass surgery.

Different nerve blocks can be used depending on which nerves need to be treated. Your doctor will talk to you about these.

Other treatments

Your pain team may talk to you about other possible ways of helping with your pain. These may include relaxation techniques, breathing exercises, massage or distraction techniques.


Managing tiredness

Many people with pancreatic cancer feel tired and have less energy to do the things they normally do. This may be due to the cancer or it 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 diary can help you record your energy levels and plan to do things 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 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 tiredness, then good pain control will help you feel better and may improve your energy levels.

Many people find they can’t sleep because of worry or anxiety. It can help to try to share concerns by writing them down or talking 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 be very useful in reducing anxiety and stress.

Tiredness can also be a sign of depression. If you think you’re depressed, talk to your doctor or nurse. Talking about your feelings with a professional counsellor can often help with depression, and antidepressants may help you feel better.


Digestion and weight loss

Pancreatic cancer can cause problems with eating and digestion. If your pancreas isn’t working properly, you may not be able to digest fats and proteins. You may have diarrhoea and not absorb nutrients from food properly. This can lead to weight loss. If you have diarrhoea, it may help to avoid fatty or high-fibre foods. Try to drink plenty of fluids. Your doctor may prescribe tablets to help with digestion.

Try to maintain your weight by adding extra calories where you can. For example, you can:

  • add high-protein powders to your food
  • supplement meals with nutritious, high-calorie drinks prescribed by your GP
  • 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 may 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 about coping with eating problems and preventing weight loss.

I found I had to eat little and very often at first. From eating three times a day, I had to go to six times.

Mark


Body image

Cancer and its treatment can change how your body looks, works or feels. These changes can happen quickly or over time, and may be temporary or permanent. It is natural to have concerns about this.

You may feel embarrassed or anxious about changes to your body, or concerned that they may affect your relationships. It is normal to have these feelings when coming to terms with body changes.

It is important to remember that help and support is available. Talk to your doctor or nurse or with a trusted family member or friend. It may also help to share your experience with others in a similar situation through online community groups.

We have more information about coping with changes to appearance and body image.


Blood clots

Cancer can increase your risk of developing a blood clot (thrombosis), and some treatments may increase this risk further. A blood clot may cause symptoms such as pain, redness and swelling in a leg, or breathlessness and chest pain.

Blood clots can be very serious so it’s important to tell your doctor straight away if you have any of these symptoms. However, most clots can usually be successfully treated with drugs to thin the blood. Your doctor or nurse can give you more information about blood clots.

To help lower your risk of blood clots:

  • drink plenty of water
  • take short walks regularly
  • keep your blood flowing by taking deep breaths and exercising the muscles in your legs regularly even when you’re 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 may be done to reduce your risk.

Back to Treating

Making treatment decisions

Your doctors may tell you there are different options for your treatment. Having the right information will help you make the right decision for you.

Surgery

Surgery involves removing all or part of the cancer with an operation. It is an important treatment for many cancers.

Chemotherapy

Chemotherapy uses drugs to treat many different types of cancer. It is most commonly given as an injection into a vein or as tablets or capsules.

Radiotherapy

Radiotherapy is the use of high-energy rays, usually x-rays and similar rays (such as electrons) to treat cancer.

Clinical trials

Many people are offered a trial as part of treatment. Find out more to help you decide if a trial is right for you.

Life after cancer treatment

You might be thinking about how to get back to normal following treatment. Find advice, information and support about coping with and after cancer.