Symptom Management

Largely because of the location of the pancreas -- surrounded by several organs in the upper abdomen and a rich network of nerves -- most patients with pancreatic cancer will need pain management during the course of their treatment. Effective pain management can be key to effective therapy: a growing body of research suggests that allowing pain to go untreated has many adverse effects, and may negatively affect survival.

Memorial Sloan-Kettering physicians and staff pioneered the field of psycho-oncology by recognizing the unique emotional and psychological needs of cancer patients, and have led a worldwide movement to alleviate the suffering caused by cancer pain. Our interdisciplinary Pain and Palliative Care Service ensures that patients who have pain are identified and treated appropriately and effectively, and our Integrative Medicine Service extends that tradition by offering access to the best of complementary therapies, such as acupuncture, hypnotherapy, and more. The majority of pancreatic cancer patients here are successful in controlling their pain.

The majority of patients with advanced pancreatic cancer are not candidates for surgical removal of the tumor, which in most cases has spread beyond the pancreas. Since pain is a frequent symptom for these patients, techniques to reduce pain have been investigated and have been shown to improve a patient's quality of life. In recent studies, a surgical technique known as neurolytic celiac plexus block (NCPB) has been shown to improve patients' pain level, mood, and life expectancy.

The pain experienced by patients with pancreatic cancer involves a cluster of nerve fibers known as the celiac plexus, so named because of its location in the abdomen near the celiac artery. Although the exact mechanical explanation for the pain remains poorly understood, experts believe that pancreatic cancer cells invading this nerve cluster are responsible. Consequently, doctors have discovered that disrupting pain signals from nerves passing through the celiac plexus can significantly reduce pain levels for pancreatic cancer patients.

Traditionally the neurolytic celiac plexus block procedure has been performed under x-ray guidance, in what is known as a percutaneous approach. Memorial Sloan-Kettering physicians have recently shown that by performing this procedure laparoscopically -- using a specially designed instrument called a laparoscope that can be conducted through small incisions in the abdomen -- a patient's pain can be reduced without incurring substantial side effects. The laparoscopic NCPB is performed at the time of operative staging -- a pre-treatment diagnostic procedure in which surgeons use a laparoscope to view the pancreas and surrounding organs to determine the extent of the disease.

Accounting for only 20 minutes of additional time in surgery, this new technique allows surgeons the ability to obtain an excellent view of the celiac plexus at the time of staging laparoscopy. As a result, our surgeons feel that this approach should be at least as effective as the percutaneous approach with fewer potential side effects.

You may occasionally need to take medicines to help digest food and maintain the proper blood sugar level, particularly if pancreatic cancer and its treatment interfere with production and flow of digestive enzymes and insulin. These drugs and their dosages may be modified through the course of your follow-up care, based on changes in your condition. Nutritional consultations are another important part of treatment and follow-up for patients with pancreatic cancer and pancreatic cancer survivors. Memorial Sloan-Kettering's Integrative Medicine Service offers nutritional counseling within a broad program of healing regimens that address the mind, body, and spirit.