Supportive care (controlling symptoms) for pancreatic cancer

Macmillan Cancer Support Medical Reference

For many people with pancreatic cancer, the main aim of treatment is to control symptoms. Treating symptoms is known as supportive care. Chemotherapy, radiotherapy and surgery can all be used to control symptoms. You may also be offered additional treatments or procedures to relieve any symptoms you have.

Treating jaundice

If a tumour blocks the bile duct it can cause jaundice. The main treatment for this is to relieve the blockage with surgery or by using a tube called a stent.

Treating pain

Pain caused by pancreatic cancer can usually be well controlled. If you are in pain, it’s important to let your nurse or doctor know as soon as possible so that you can be given appropriate treatment. Doctors and nurses who specialise in controlling pain and other cancer symptoms are called palliative care specialists. They are based in hospitals, hospices, palliative care units and pain clinics, and work with you, your GP, district nurses and other health professionals to make sure that your pain is controlled.

Giving your doctor or nurse as much information as you can about your pain will help them to assess it and plan treatments. You may want to tell them:

• how your pain rates on a scale of 0 (no pain) to 10 (worst pain)
• what words best describe your pain (for example, is it dull, sharp, shooting or aching?)
• what makes the pain better or worse
• how your pain affects everyday activities.

There are many painkilling drugs available to treat different types and levels of pain. They come in different forms including tablets, liquid medicines and skin patches. Painkillers can also be given by injection or infusion into a vein.

Cancer treatments such as chemotherapy or radiotherapy can also be used to relieve pain. They work by shrinking the cancer.

Nerve blocks

If your pain can’t be well controlled with painkillers, your doctor may suggest that you have a procedure called a nerve block. This stops pain messages from getting to the brain by blocking the nerves themselves. It’s usually done by injecting an anaesthetic such as alcohol into the nerve. Sometimes the nerve can be cut rather than injected. This needs a general anaesthetic and is more likely to be done when a person is having other surgery, such as bypass surgery.
There are different names for nerve blocks depending on which nerves need to be treated. If you have persistent pain in your abdomen and back, this may be due to the tumour pressing on a network of nerves at the back of your abdomen called the coeliac plexus. This type of pain can usually be treated very effectively with a coeliac plexus nerve block.

There are different ways of doing a nerve block. Your doctor may inject into the nerve through your back. Pictures from a CT scan help guide the doctor to the right place. Your skin is numbed with a local anaesthetic injection. The doctor then puts a long, fine needle through your back and into the nerve, which is then injected with alcohol.

Nerve blocks can also be carried out using endoscopic ultrasound (EUS). The doctor passes an ultrasound probe down the endoscope to produce a picture of the inside of your body on a monitor. When the doctor sees the coeliac plexus on the monitor, they pass a needle down the endoscope to inject alcohol into the nerves to deaden them.

After a nerve block, your blood pressure may be low for a day or two. This may make you feel a bit light-headed and dizzy, particularly when you stand up.