Managing symptoms of pancreatic cancer

Pancreatic cancer can cause symptoms like jaundice, loss of appetite and weight loss. Palliative care experts can help control the symptoms with treatment.

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 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 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 treat it quickly. Your medical team will work with you to find the best way to manage the 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. You can also have painkillers by injection or into a vein (infusion). Your doctors and nurses will help you find the drugs that work best for you.

Nerve block

If painkilling drugs are not controlling the pain, or you have having side effects, your doctor or pain specialist may talk to you about having a nerve block. Nerves that cause you to feel the pain are injected with local anaesthetic and a steroid drug.

Before the treatment, you may be given some sedation to make you feel sleepy. During the treatment, you lie on your front and the doctor injects the drugs into the nerves through your back. They use an x-ray or ultrasound scan to guide them. Afterwards, your back may be sore for a few hours or days.

Sometimes an injection can be given through an endoscope during an endoscopic ultrasound. The injection is given into the nerves from inside the body using the endoscope.

Cancer treatments

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

Other treatments

The team looking after you may talk to you about other possible ways of helping with your pain. These may include:

  • relaxation techniques
  • breathing exercises
  • massage
  • distraction techniques.


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.


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).

Blockage in the bowel

Sometimes, the cancer blocks the first part of your 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 (nausea) and be sick (vomit).


An expandable, flexible tube called a stent can often be used to 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 and feel sleepy. 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.

Bypass surgery

If a stent is not suitable, 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 connects part of your small bowel just below the duodenum, directly to your stomach. This lets food pass from the stomach into your bowel. In some hospitals, it is possible to do this procedure during a laparoscopy (keyhole surgery). This operation may happen at the same time as an operation to relieve a blocked bile duct.

Tiredness (fatigue)

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.


Tiredness can also be a sign of depression. If you think you are depressed, talk to your doctor or nurse. Talking about our feelings with a professional counsellor can often help with depression. Antidepressant medication may also help you feel better.

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. 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

Loss of appetite and weight loss

Pancreatic cancer can cause problems with eating and digestion.

You may have diarrhoea. This means you are not absorbing nutrients from food properly and you may lose weight.

Try to maintain your weight by adding extra calories where you can. If your food has more calories, it will give you more energy. 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 3 large meals.

If your appetite is not good, medicines such as steroids or an appetite stimulant may help improve it. You may be referred to a dietitian at your hospital. Dietitians are experts in knowing what nutrition people need when they are ill. 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.

Enzyme replacement

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.

Feeling sick (nausea)

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 you steroids. 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.


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.


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

You may find moisturising lotions helpful. Your doctor can also prescribe or suggest medicines that may help relieve itching while you wait for treatment such as a stent. 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. 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.

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

    European Society for Medical Oncology, Cancer of the pancreas: ESMO clinical Practice Guidelines. Volume 26, Supplement 5, V56-V68, 1 September 2015. Available from: (accessed May 2021).

    National Institute for Health and Care Excellence. Pancreatic cancer in adults: diagnosis and management. NICE guideline (NG85). Published 7 February 2018. Available at: (accessed May 2021).

  • 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.

Date reviewed

Reviewed: 05 January 2022
Next review: 05 January 2025
Trusted Information Creator - Patient Information Forum
Trusted Information Creator - Patient Information Forum

Our cancer information meets the PIF TICK quality mark.

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