Symptoms & side effects

Monday 30 April, 2012

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On this page: Fatigue | Feeling low or depressed | Pain | Jaundice | Reviewers


People with pancreatic cancer often have some symptoms and side effects. Many of these can be well controlled with the appropriate treatment, such as medication, surgery or counselling.

The most common symptoms and side effects are discussed below. You probably won't experience them all – your situation will depend on if you have an exocrine or neuroendocrine tumour, and what kind of treatment you receive.

Discuss how you're feeling with your medical team. Your doctor may be able to prescribe medication or change your treatment to control your symptoms.

For further information, call Cancer Council on 13 11 20.

Fatigue

Fatigue means feeling very tired and lacking energy to do day-to-day things. It's the most common side effect associated with cancer treatment.

Fatigue for people with cancer is different from normal tiredness because the feeling of exhaustion doesn't always go away with rest or sleep. Everyday tasks such as bathing, cleaning, shopping, eating and cooking may leave you feeling completely exhausted.

Even talking to those close to you can sometimes feel too tiring. It's not uncommon for people with pancreatic cancer to feel very tired a lot of the time.

If fatigue continues for a long period of time you may lose interest in things that you usually like doing, or you may feel unable to concentrate for very long. It can affect how you feel about yourself and others, which may impact on your close relationships.

If you're feeling low, talk to your doctor. You may be depressed, which can make fatigue worse.

Many people with cancer don't report fatigue to their doctor because they think that nothing can be done about it. However, your medical team can give you advice and helpful tips about managing your tiredness.

Feeling low or depressed

Many people feel low or depressed after a cancer diagnosis, during treatment or when they're recovering. Don't be surprised if you feel unhappy at times.

Some people feel sad or depressed because of the changes the cancer has caused. Others are frightened about the future.

There's a difference between feeling down and feeling depressed. You may be depressed if you're in a low mood for most of the time, or if your sadness lasts two weeks or more. A list of the symptoms of depression can be found at the Beyond Blue website.

Depression won't go away by itself – you'll need specific treatment. Being honest about how you feel will help your doctor give you advice about the type of support and care you need. There are many effective treatments for depression, including both medication and non-medication options, such as counselling.

Pain

Although people feel pain in different areas and in different ways, pancreatic cancer, in general, can cause pain in the centre of the abdomen and in the middle part of the back.

Most pain can be well controlled with pain-relief tablets. Opioids, such as morphine, oxycodone and fentanyl, are very effective if taken at the correct dose. Side effects from opioids include nausea and constipation, but these can be relieved with anti-nausea medications and laxatives. Other drugs that block nerve pain (such as gabapentin) may also be useful.

If pain is severe or difficult to control, you may have pain-relieving medication injected into the nerves of your back. This is known as a nerve block or celiac axis block.

For more information on managing pain, call Cancer Council on 13 11 20.

You may be concerned about becoming addicted to pain-relieving medication. These drugs rarely cause addiction problems when taken at the appropriate dose for pain relief.

Jaundice

Bile is a yellow-green liquid produced by the liver that's important for breaking down fats during digestion. It's stored in the gall bladder and travels via the bile duct to the small bowel. If cancer presses on the bile duct, it can cause a blockage and prevent bile from passing into the small bowel. Bile then builds up in the bloodstream, causing symptoms of jaundice such as:

  • yellowish skin and eyes
  • itchy skin
  • reduced appetite, poor digestion and weight loss
  • dark urine and pale stools.

Having a stent

Bypassing or relieving the obstruction with double bypass surgery or a stent by endoscope can relieve the jaundice. A stent is a metal or plastic tube that's put into the blocked bile duct to hold it open so bile flows more freely.

The stent is inserted during a procedure known as an endoscopic retrograde cholangio-pancreatography (ERCP). An ERCP involves passing an endoscope into the bile duct via your mouth, stomach and duodenum. X-rays are used to position the stent across the blockage to keep it open. You'll have sedation for the procedure. You can have an ERCP as an outpatient or you may stay in hospital for one or two days.

Jaundice usually disappears over 2 to 3 weeks but the itchy skin often goes away in 3 to 4 days. Your appetite will improve and you may gain some weight.

pancreas with tumour pressing on bile duct


Reviewed by: Dr David Chang, Pancreatic and Upper Gastrointestinal Surgeon, Sydney South West Area Health Service and Research Fellow, Pancreatic Cancer Research Group, Garvan Institute of Medical Research, NSW; Professor Andrew Biankin, Head, Pancreatic Cancer Research Group, Garvan Institute of Medical Research, Consultant Hepato-Pancreato-Biliary, Upper GI Surgeon, Sydney South West Area Health Service, NSW, and Clinical Lead, Australian Pancreatic Cancer Genome Initiative; Annie Angle, Oncology Nurse, Cancer Council Victoria; Dr Lorraine Chantrill, Medical Oncologist, Macarthur Cancer Therapy Centre, Campbelltown Hospital, NSW; Leslye Dunn, Consumer; Helen Gooden, Manager, Multimedia Cancer Support Grants, Cancer Council NSW; Barbara Hunter, Consumer; A/Prof Lara Lipton, Medical Oncologist, Cabrini and Royal Melbourne Hospital, VIC; Barry Ranson, Consumer; Meg Rogers, Cancer Nurse Coordinator, Upper Gastrointestinal Service, Advance Practice Nurse, Peter MacCallum Cancer Centre, VIC; Karen Tokutake, Medical Oncology and Haemotology Dietitian, Prince of Wales Hospital, NSW; and Belinda Vangelov, Senior Oncology Dietitian and Clinical Educator, Prince of Wales Hospital, NSW.
Updated: 30 Apr, 2012