Supportive care for pancreatic cancer

For many people with pancreatic cancer, the main aim of treatment is to control symptoms (supportive care). Chemotherapy, radiotherapy and surgery can all be used, or your doctor may offer you 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. They will make sure that your symptoms are controlled.

They are experts in helping to control symptoms such as pain, tiredness, loss of appetite, weight loss, feeling sick and problems sleeping.

Your doctors and nurses can also help with other problems that sometimes happen with advanced pancreatic cancer. These problems include jaundice, a blockage in the bowel and swelling in the tummy area (ascites).

Controlling symptoms

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 controlling the symptoms of cancer and 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 treat it promptly. 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.

Cancer treatments

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

  • a nerve block
  • relaxation techniques
  • breathing exercises
  • massage
  • distraction techniques.

Myself and the pain specialist worked out the medicines that I should have. Once you’ve balanced the number of pills and the correct amounts, it seems to work extremely well.

Sabrina


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.

Stents

Bile duct stents are most commonly put in using endoscopic retrograde cholangiopancreatography (an ERCP).

You should not eat or drink anything for 6 hours before the procedure. You will have an injection to make you feel relaxed. The doctor will pass 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 will keep the bile duct open and allow 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. During a PTC, doctors insert the stent through the skin (percutaneous) and liver (transhepatic) using a needle and tube. They then place the stent into the top of the bile duct.

Doctors will ask you not to eat or drink for a few hours before a PTC. You will have the procedure in the x-ray department. A doctor called a radiologist will do the procedure. Once you are lying down, you will have a sedative to make you feel relaxed and drowsy.

The doctor injects a local anaesthetic into the skin to numb it. Then they insert a long, thin, flexible needle through the skin and into the liver. The doctor looks at x-ray images on a screen to help them guide the needle to the bile duct. Once it is in the bile duct, they inject a dye.

When doctors inject the dye, some people feel warm all over. This is normal and the feeling does not last long.

The dye flows through the ducts and allows doctors to see the blocked area. The doctor passes a fine guide wire along the needle into the blockage in the bile duct. A stent then passes along this wire. The stent holds the bile duct open where the blockage has narrowed it. This allows bile to flow through it again. You may feel some pushing when doctors put the wire and stent in. If this is uncomfortable or painful, let the doctor know. They can give you painkillers.

To help prevent infection, you will take antibiotics before and after the procedure. You will probably need to stay in hospital overnight.

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.

The surgeon will make a cut in the bile duct (or occasionally 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).

The stent provided great relief after over a week of being very uncomfortable with the jaundice. The jaundice starts to fade over maybe 48 hours. I was able to be up and about, and get a break from the hospital and feeling unwell. So yes, I would say a stent is a marvellous thing.

Steve


A 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).

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.

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 (fatigue)

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.

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. Often, friends and relatives want to help and are 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. So 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 from you 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 your feelings with a professional counsellor can often help with depression. Antidepressant medication may also help you feel better.

Coping with fatigue

Denton describes how he coped with fatigue (tiredness) during his treatment for prostate cancer.

About our cancer information videos

Coping with fatigue

Denton describes how he coped with fatigue (tiredness) during his treatment for prostate cancer.

About our cancer information videos


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.


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. This means you are not absorbing nutrients from food properly and you may lose weight. If you have diarrhoea, it may help to avoid fatty or high-fibre foods. Try to drink plenty of fluids, especially water. Your doctor may prescribe tablets to help you digest food.

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 three large meals.

If your appetite is not good, medicines such as steroids 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.

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


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 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. 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 building up of fluid.


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. A blood clot may cause symptoms such as:

  • pain
  • redness and swelling in a leg
  • breathlessness and chest pain.

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
  • take short walks regularly
  • 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.

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.