Pancreatic cancer is a complicated disease, usually affecting multiple organs and both the quality and length of a patient’s life. However, coordinated care by a multidisciplinary team of clinician-researchers with experience and expertise in treating the cancer and its related symptoms can help ensure quality of life for longer periods than has been possible in the past.

In many pancreatic cancers, control of symptoms is as important as treatment aimed at controlling the disease. When the disease is too widespread to be removed, palliative surgery or minimally invasive interventions may help prevent blockage of bile ducts and relieve symptoms such as jaundice, itching of the skin, nausea, vomiting, and fever. Because cancer of the pancreas and its treatment may interfere with production of digestive enzymes and insulin, patients may need to take medicines to help them digest food and maintain the proper blood sugar level.

Here is some additional information about symptom management for patients with pancreatic cancer.

• Pain The pain of pancreatic cancer may be constant or intermittent, and can be caused by the spread of tumors to the network of nerves surrounding the pancreas. The pain associated with pancreatic cancer is now usually controllable. To learn more about Memorial Sloan Kettering’s approach to pain management and palliative care, visit the section of the overview on Pain Management.
• Itching and Jaundice For patients whose disease can not be treated by surgery, itching and jaundice caused by blockage of the biliary tree by a pancreatic tumor can be managed by biliary drainage and stent placement. Depending on the location of blockage, biliary drainage and stent placement is performed by an interventional radiologists or a gastroenterologist.
• Weight Loss Weight loss can result when cancer interferes with the basic food-processing functions of the pancreas. Patients may have problems digesting fatty foods. Endocrine cancers can sometimes cause problems with sugar metabolism, a condition that can be recognized by blood tests and, in rare cases, can be a cause of diabetes. Nutrition counseling and support are vital components of pancreatic cancer care.
• Fatigue and Depression Memorial Sloan Kettering clinicians recognize that fatigue and depression are common in patients with pancreatic cancer. Our team monitors for these symptoms so that patients may receive prompt and caring management of fatigue and depression through our inpatient psycho-oncology services and outpatient Counseling Center.

Minimally Invasive Techniques for Pain Relief

By the time most patients receive a diagnosis of pancreatic cancer, their disease may be too advanced to be treated surgically. Pain is a frequent and debilitating symptom for these patients. Although the exact reason remains poorly understood, it is thought that the pain may be caused when pancreatic cancer cells invade a cluster of nerves in the abdomen known as the celiac plexus. A procedure known as neurolytic celiac plexus block (NCPB), which involves injecting a local anesthetic to disrupt pain signals from the celiac plexus, has been shown to significantly reduce pain and improve mood and life expectancy for patients with advanced pancreatic cancer.

Traditionally, NCPB has been performed percutaneously (using a needle) by injecting the anesthetic directly into the celiac plexus with x-ray guidance. However, this procedure has been associated with side effects such as muscle and limb weakness. Memorial Sloan Kettering physicians have recently shown that by performing this procedure laparoscopically — using a specially designed instrument called a laparoscope that can be inserted 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 diagnostic procedure in which surgeons use a laparoscope to view the pancreas and surrounding organs to determine the extent of the disease. This 20-minute laparoscopic procedure allows surgeons 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.

Alternatively, NCPB can be performed under the guidance of endoscopic ultrasound (EUS), in which a small probe is inserted through the mouth and into the stomach to obtain a detailed view of the celiac plexus. During this procedure, a local anesthetic can be injected directly into the celiac plexus. As with the laparoscopic approach, endoscopic NCPB is felt to be at least as effective as the percutaneous approach, with fewer potential side effects.

Nutrition

Patients with pancreatic cancer 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.

Pain 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 important to improving the effectiveness of therapy: a growing body of research suggests that inadequate treatment of pain has many adverse effects and may decrease 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. At Memorial Sloan Kettering, the majority of pancreatic cancer patients are successful in controlling their pain.