Cancer | Pancreatic Cancer | Pancreatic Cancer Symptom Management

Very often pancreatic cancer is accompanied by one or more unpleasant symptoms; one of the goals of cancer therapies is to resolve or lessen the severity of these symptoms. Unfortunately, cancer treatments themselves may also cause symptoms. Commonly cancer patients experience a range of symptoms, varying in severity. These include pain, fatigue, poor appetite, nausea and vomiting. It is important to discuss any symptoms with your doctor or nurse so that management strategies can be discussed, and if needed, medications prescribed to control the severity of symptoms.

Pancreatic cancer can often cause abdominal and back pain. The pancreas lies within an area of the abdomen crisscrossed with nerves and blood vessels. An individual may experience pain when the cancer presses upon these nerves or other organs.

Pain can be treated and managed. There are several methods available to treat cancer pain. These methods include pain medications (opioid and non-opioid), radiation, surgery and forms of nerve block, including celiac plexus block (CPB) or celiac plexus neurolysis (CPN). Some individuals choose to supplement these methods with alternative or complimentary therapies such as acupuncture, biofeedback, guided imagery and relaxation techniques.

Celiac plexus block (CPB) or celiac plexus neurolysis (CPN) is sometimes performed for pain control. These procedures block a group of nerves in the abdomen called the celiac plexus, which can deliver sensations of pain from the abdomen to the brain. CPN involves the injection of an agent, usually alcohol, to permanently destruct nerves. CPB involves the injection of medications such as corticosteroids and numbing medications. This approach usually only lasts a few months and is not intended to permanently destroy nerves.

Different approaches are possible for performing celiac plexus block or neurolysis. CPB and CPN can be performed percutaneously using a needle that is inserted through the skin and guided into position by the use of imaging such as computed tomography (CT) or endoscopic ultrasound (EUS) guidance. A needle can be advanced using an endoscope with ultrasound guidance into the region of the celiac plexus, and either alcohol or numbing agents with corticosteroids can be injected.

Radio frequency ablation (RFA) is one of the newest forms or techniques being used for pain control during which radiofrequency waves are delivered down the needle to generate just enough heat to destroy the nerves. It is not yet known which is the best way to perform a nerve block. The doctor will discuss with you if this is an appropriate option for the patient and will refer the patient to see one of our pain specialists in this area. It is important to note that these procedures do not provide relief for everyone but most patients will have a reduction in their pain.

For a variety of reasons pancreas cancer can lead to unintentional weight loss. Sometimes this is due to stomach symptoms such as fullness, gas, belching, diarrhea, and commonly, constipation. Individuals often describe a loss of appetite, food aversions, nausea and vomiting. These stomach and intestinal symptoms can be caused by the cancer itself or by the treatments prescribed to treat the cancer. The best approach for finding effective ways to manage these symptoms is to discuss them with the doctor or nurses. There are many methods and resources available to help improve these symptoms.

Pancreatic enzymes are used to improve digestion of foods and prevent symptoms such as frequent, fatty bowel movements. These can occur in persons who have a blockage between the pancreas and the intestine or who have had surgery to remove all or part of the pancreas. Pancreatic enzymes are given to replace the natural substances normally made by the pancreas. These enzymes break down proteins, fats and starches from food into smaller substances to help absorption by the intestine. This allows the body to use these substances for energy. Some patients may not need any pancreatic enzymes, while others may need a large amount of enzymes in order to relieve their symptoms. Pancreatic enzymes are taken by mouth usually with food and water several times a day, often with every meal or snack. The number of times per day that you take pancreatic enzymes depends on your condition and on how well you respond to treatment. The doctor will prescribe the number of pills and how often to take them. Most likely, the patient will start on a low dose and gradually increase the dose depending on the patient's response to treatment and diet. Pancreatic enzymes may control symptoms but cannot cure the condition. The patient should continue to take pancreatic enzymes even if they feel well.

Fatigue is an extremely common symptom associated with cancer and cancer treatments. Feelings of fatigue can range from tiredness to exhaustion, can vary in frequency and often has multiple causes. It is important to inform the experience of fatigue with healthcare providers. There are many resources available to help patients cope with fatigue and conserve their energy.

Everyone who is diagnosed with cancer will react differently and will experience varying levels of stress and emotional upset throughout their cancer care. These symptoms and fears usually lessen as a person adjusts to the diagnosis. Not all persons with cancer experience depression. The cause of depression is unknown. Risk factors may or may not be cancer-related and some people with cancer may have a higher risk for developing depression. The symptoms of major depression include a depressed mood on most days, loss of interest or pleasure in most daily activities, changes in sleeping habits, nervousness, sluggishness, poor concentration and constant thoughts of death or suicide. At times, these symptoms are due to a medical condition. Major depression may be treated with a combination of counseling and medications. Several therapies are helpful in the treatment of depression related to cancer. Most therapy programs are offered in either individual or group settings and include support groups, cancer education and classes on relaxation skills, coping, yoga and meditation. Some patients seek counseling from someone who understands life-threatening illnesses, such as a medical social worker, psychologist or chaplain. Patients without obvious symptoms of depression may also benefit from counseling.

This information is for educational purposes only and is not intended to replace the advice of your doctor or health care provider. We encourage you to discuss with your doctor any questions or concerns you may have.