Controlling symptoms of advanced pancreatic cancer

About advanced pancreatic cancer

Advanced pancreatic cancer means the cancer has either:

• started to grow into the nearby blood vessels or spread to 4 or more nearby lymph nodes – this is called locally advanced or stage 3 pancreatic cancer

• spread to other parts of the body – doctors call this metastatic cancer or stage 4 pancreatic cancer

Pancreatic cancer that has spread cannot usually be removed or cured.

Your doctor may suggest treatment to try to slow the cancer’s growth and help you feel as well as possible. Treatments such as chemotherapy or radiotherapy can sometimes help to shrink the cancer. Other treatments such as stents can treat symptoms such as a blockage in the bile duct or first part of the small bowel.

Find out about treatments for pancreatic cancer

Symptoms of advanced pancreatic cancer

The symptoms of early pancreatic cancer are very vague. But it causes more symptoms as it grows or spreads.

Unfortunately, pancreatic cancer has usually already spread when it is diagnosed. This means that many of the symptoms’ people have when they first see their doctor are of advanced pancreatic cancer. These symptoms might include:

• feeling generally unwell or tired

• feeling or being sick

• loss of appetite

• unexplained weight loss

• tummy (abdominal) pain, discomfort or bloating

• yellowing of the whites of the eyes and skin (jaundice) – it can be more difficult to notice skin changes in brown or black skin

• changes in your bowel habits

Advanced pancreatic cancer can also cause:

• a build up of fluid in your abdomen (ascites)

• a blockage in your bile duct or small bowel

Read more about the symptoms of pancreatic cancer

Other symptoms of advanced pancreatic cancer

Other symptoms can depend on where the cancer has spread to. Where the cancer has spread to is called a secondary cancer or metastasis.

The most common places for pancreatic cancer to spread is the:

• liver

• space in your abdomen that contains your bowel and other organs (peritoneal space)

• lungs

Less often it can spread to the bone and areas including the skin.

Find out more about the symptoms and treatment of secondary cancer

Managing tiredness and feeling unwell

Tiredness (fatigue) is a common symptom of advanced cancer. You may feel the tiredness overwhelms you especially if you don’t have any energy at all.

Let your doctor or nurse know if you’re very tired. They can check what is causing it and they might be able to prescribe medicine or other treatments to help. For example, cancer can cause low levels of red blood cells in your body. This can make you feel very tired. Doctors call this anaemia. Your doctor can treat the anaemia which may give you more energy.

Resting

It’s important to rest throughout the day. Resting regularly can help you feel less tired and more able to cope. You don't have to sleep during these times. Just sitting or lying down will help.

Exercise

Exercising can be hard when you feel very tired. Research has shown that daily light to moderate exercise can give you more energy. Going for a gentle walk is enough. Gentle exercises in bed or standing up can help if you can’t move around easily. 

Your hospital ​physiotherapist​ or community ​palliative care​ team might be able to help you plan an exercise programme that suits your needs.

Sleeping

You might feel more tired if you have trouble sleeping at night. It can help to change a few things about when and where you sleep.

Get more tips on managing fatigue when you have cancer

Treating a blockage in the bowel or bile duct

The cancer might block the bile duct or part of the small bowel. This means digestive juices or food cannot pass through. A blockage causes pain, sickness and makes you feel very unwell. You normally need to go to the hospital if this happens.

Your doctor might put a tube called a stent into your bile duct or bowel to allow bile or food to pass through.

A few people might have surgery instead of a stent. The aim of surgery is to create a passage around the blockage. This is called bypass surgery.

Bypass surgery is a big operation and you have to be well enough to have it.

Find out more about surgery and stents to relieve symptoms

Medicine to relieve symptoms of a blocked bowel

Your doctor might suggest medicines including:

• somatostatin

• octreotide

They work by reducing the amount of fluid that builds up in your stomach and digestive system. This helps to stop you being sick and can relieve bloating.

You might have somatostatin with steroids for advanced pancreatic cancer. The steroids help to reduce any swelling that is making the blockage worse.

These medicines might relieve symptoms at first, but the symptoms might come back.

Managing loss of appetite and weight loss

You might not feel like eating and may lose weight. This could be for several reasons including the cancer itself or the treatment.

The pancreas has several functions including making enzymes. These help digest your food. If the pancreas isn't working very well then you won't be able to absorb food properly. So you may lose weight and won’t get the amount of nutrients and vitamins your body needs.

You usually take enzyme supplements to help with this. Doctors call this pancreatic enzyme replacement therapy (PERT).

Tips that might help with loss of appetite and weight loss

• Eating several small meals and snacks throughout the day can be easier to manage.

• Ask your doctor or dietitian to recommend high calorie drinks to sip if you are worried about losing weight.

• Eat whatever you feel like eating rather than what you think you should eat.

• Eat plenty of calories when you can to make up for times when you don’t feel like eating.

• Drink plenty even if you can't eat.

• Don't fill your stomach with a large amount of liquid before eating.

• Try to eat high calorie foods to keep your weight up.

Find out more about your diet and pancreatic cancer

Managing pain caused by pancreatic cancer

You might be very worried about having cancer pain. Although pain is common in pancreatic cancer, there are painkillers you can have to help.

The sooner you have treatment for your pain, the easier it can be brought under control.

Painkillers are also called analgesics or analgesia. There are many different types and strengths of painkillers suitable for different types of pain. There are also different ways to have them. This includes:

• tablets and capsules

• liquids

• patches

• injections or as a drip into your bloodstream (intravenous) or under your skin (subcutaneous)

The type of painkiller you need depends on how bad the pain is. Simple painkillers like paracetamol, are suitable if you have mild pain. If you have moderate pain, you might have weak opioid painkillers such as codeine. This is a morphine based medicine. For ongoing or severe pain, you usually have stronger opioid painkillers.

A doctor or nurse can judge which type of painkiller is best for you. The important thing is that you have the right type of painkiller for your pain and the right dose.

There are other types of medicine to control pain such as anti inflammatory drugs such as ibuprofen (Nurofen). And some people may use complementary methods of pain control alongside painkillers, for example acupuncture or reflexology.

Read about controlling cancer pain

Side effects of painkillers

Many painkillers have common side effects.

Most opioids cause constipation so it helps to start taking regular stool softeners or laxatives. They can also cause:

• dizziness

• drowsiness

• feeling or being sick

These side effects usually happen because you are not used to the drug. After a few days they lessen and disappear. Many doctors give an anti sickness drug with opioids for the first week or so.

Your healthcare team keep a close eye on you to check that the pain relief is working and to help with side effects, if you have any.

Cancer treatments

Cancer treatments can help to control pain. The cancer in the pancreas might be pressing on a nerve or another organ and causing pain. If treatment can shrink the cancer, the pressure on the nerve or organ may ease and you might have less pain.

It can take several weeks before you get the full benefits of cancer treatments. So you need to carry on taking painkillers in the meantime. You may find you can cut down on them when you know how well the cancer treatment is working at easing the pain.

Find out about cancer treatments to reduce pain

Nerve pain

Many people with pancreatic cancer have nerve pain. This is because the cancer can put pressure on large groups of nerves as it grows. People often describe nerve pain as burning, tingling or shooting pain.

Drugs normally used to treat other health conditions such as depression or epilepsy can also help with nerve pain. You may have these alongside other painkillers. For example:

• amitriptyline is an anti depressant - it can also help to reduce pain that is difficult to treat with other painkillers

• gabapentin is an anti convulsant drug - this means that it helps to control seizures (fits), but it can also relieve burning or tingling pain. Doctors may also use other anti convulsant drugs

Nerve blocks

If you have pain that is very difficult to treat, your doctor may suggest a nerve block. This is a way of killing or deadening a nerve to stop it causing pain.

A nerve block is named after the nerves that it blocks.

The coeliac plexus is a complicated web of nerves at the back of the tummy (abdomen). A coeliac plexus block stops signals that can cause you to feel pain in your upper abdomen.

Find out more about nerve blocks

Other ways to control pain

As well as painkillers, there are other ways to help control pain. These include TENS machines and acupuncture.

There are also things that you, your family or friends can do to help to control your pain.

Read about other things you can do to reduce cancer pain

Treatment for a swollen tummy (ascites)

The swelling is due to a build up of fluid called ascites. It can make your clothes feel tighter. Your abdomen might feel bloated. And you might also find it difficult to sit comfortably or to move around.

Your doctor might drain off the fluid by putting a small flexible tube into the abdomen. They normally use an ultrasound scan to make sure the tube is in the right place. Draining off the fluid helps you to feel more comfortable.

Sometimes the fluid builds up again over a few weeks. If this happens, you might have the fluid drained again. Or your doctor might put a long term drain into your abdomen. This means you can drain the fluid off at home and you won’t need to go to hospital each time.

Read more about ascites

Coping with bowel problems

You might pass pale, offensive smelling stools (poo) that float. This is called steatorrhea (fatty poo). This can be due to you not having enough digestive enzymes to break down your food.

Cancer can cause bowel problems such as diarrhoea or constipation. They can also be caused by cancer treatments or other medicines. For example, painkillers commonly cause constipation.

Talk to your doctor or nurse if you have bowel problems. They can help by giving you medicine. And they can refer you to a dietitian for advice on what to eat or drink.

Find out about bowel problems

The palliative care team

Palliative care aims to relieve symptoms of cancer and improve your quality of life. You can have it at any stage after a diagnosis of advanced cancer.

Members of the palliative care team are experts at controlling symptoms. They can help you to stay as well as possible for as long as possible.

Most cancer units have palliative care teams and they are also in hospices and many general hospitals. Many palliative care teams also have home care services so they can visit you at home.

Find out more about palliative care