Pancreatic Cancer: Managing Symptoms & Side Effects

Pictured: Hans Gerdes Hans Gerdes (center), Director of the Gastrointestinal Endoscopy Unit, is one of many specialists who provide nutritional and medical support to help patients cope with treatment side effects.

At Memorial Sloan Kettering, controlling the symptoms of pancreatic cancer and the side effects of treatment is just as important as controlling the progression of the disease. Our doctors are experienced in using a variety of approaches to help patients with pancreatic cancer preserve quality of life for as long as possible.

As it progresses, pancreatic cancer usually affects multiple organs and can cause symptoms such as pain, nausea, and jaundice. Surgery to remove pancreatic tumors can interfere with digestion, and chemotherapy and radiation therapy can cause side effects such as nausea and fatigue.

Learn more about the symptoms of pancreatic cancer, some common side effects of treatment, and how we can help you manage them.

Pain Management

Many patients with advanced pancreatic cancer experience intermittent or constant pain in the abdomen or back. This pain often occurs when pancreatic cancer cells invade a cluster of nerves in the lower abdomen called the celiac plexus, from which sensory nerves in the pancreas, gallbladder, biliary tract, and other nearby organs grow.

Opioid analgesics such as morphine can effectively relieve pain in most patients with pancreatic cancer. However, in some patients, these medications are not completely effective or can cause unacceptable side effects such as constipation, nausea, drowsiness, and itching.(1)

Gastroenterologists, radiologists, pain specialists, and surgeons at Memorial Sloan Kettering are experienced in performing a procedure called neurolytic celiac plexus nerve block (NCPB), in which an anesthetic is injected into the celiac plexus to disrupt pain signals. NCPB has been shown to provide long-lasting pain relief for 70 to 90 percent(2) of patients with advanced pancreatic cancer. NCPB has been shown to significantly reduce pain and may also improve mood and life expectancy for patients with advanced pancreatic cancer.(3) There are several techniques for performing NCPB.

  • Percutaneous NCPB (Neurolytic Celiac Plexus Block) – Using CT as a guide, a local anesthetic is injected with a needle directly into the celiac plexus. Side effects of this procedure include muscle and limb weakness.
  • Laparoscopic NCPB – To avoid side effects associated with percutaneous NCPB, surgeons at Memorial Sloan Kettering developed(4) a less invasive method in which a laparoscope, which is inserted through a small incision in the abdomen, is used to deliver an anesthetic to the celiac plexus.
  • NCPB with Endoscopic Ultrasound (EUS) – During an endoscopic ultrasound, a small probe is inserted through the mouth and into the stomach to obtain a detailed view of the celiac plexus. An anesthetic is then injected directly into the celiac plexus. 

Treatments for Jaundice and Itching

When a pancreatic tumor blocks the bile duct, a tube that carries bile (a digestive fluid that helps break down fats) from the liver to the gallbladder and small intestine, it can cause a buildup of waste products such as bilirubin in the liver. This can cause symptoms including a yellowing of the skin (jaundice) and itching.

At Memorial Sloan Kettering, specialists in interventional radiology and gastroenterology have expertise in minimally invasive techniques for draining a blocked bile duct. In some cases, doctors can place a hollow tube called a stent into the duct to relieve a blockage. These techniques can relieve discomfort and improve a patient’s quality of life.

Treatments for Digestive Problems

Many treatments for pancreatic cancer interfere with the production of digestive enzymes and insulin. Patients often need to take medications and enzymes to aid in digestion and to maintain blood sugar levels. Pancreatic cancer patients and survivors may also benefit from nutritional counseling to help modify their diet.

Rehabilitation Services

Following medical treatment or surgery for pancreatic cancer, you may notice changes in your strength, flexibility, balance, and endurance. Our comprehensive Rehabilitation Services can help to improve your quality of life.

At Memorial Sloan Kettering, physical therapists work closely with the medical team to design individualized exercise programs that can help you increase your strength, endurance, and balance after treatment. We offer patients valuable techniques to increase mobility without increasing pain and discomfort after surgery. Our occupational therapists can help you learn about the changes you may experience during and after treatment and about adaptive equipment and techniques that can increase your independence during daily activities such as bathing, dressing, and walking.

Investigating Treatments for Depression

Our doctors are also developing new approaches for the prevention and treatment of depression in pancreatic cancer patients. We are evaluating a novel counseling method to help patients with late-stage pancreatic cancer and other cancers find meaning and hope in the face of their illness.

In addition, we are investigating the role of cytokines — naturally occurring chemicals involved in inflammation — in the development of depression in pancreatic cancer patients. Understanding the relationship between cytokines and depression could offer the opportunity to develop new medical treatments for preventing and treating depression in people with pancreatic cancer.

We also offer a variety of counseling and support services for our patients.