The Sol Goldman Pancreatic Cancer Research Center

Is this symptom or side-effect unusual?

We noticed that messages posted in the chat room ask about symptoms and side effects of treatment. Most want to know if a certain condition that you or your loved one is experiencing is unusual or cause for alarm. Below is a table of commonly experienced symptoms of pancreatic cancer and side effects of various treatments.

As always, this information is not a substitute for your physician's advice but a resource that will allow you to realize how your experience relates to other's in similar situations. NOTE: Other symptoms not listed here may arise due to the spread of cancer to distant sites or as a result of chemotherapy or radiation therapy.

Condition Frequency Cause Intervention
Abdominal Distension

(Ascites)
Not uncommon during advanced disease Spread of the cancer to the abdominal cavity
Liver disease
Portal vein thrombosis
Treatment varies depending on the cause.
Abdominal Pain Very common

Approximately 3/4 of patients with advanced disease
Often caused by the tumor growing large enough to push against surrounding organs and nerves. May worsen after eating or when lying down. Also common during recovery from surgery. Pain medication (analgesics) Opiates are very effective if taken regularly and at correct dosage. Opiates frequently cause constipation and may be taken with laxatives.
If pain persists, a celiac nerve block may be considered. This involves the injection of alcohol into the nerves near the pancreas to block the sensation of pain. The injection can be given through the skin, during surgery or during an endoscopic ultrasound.
Anemia

a low red blood cell count

Occasional Often related to chemotherapy. Medication: Erythropoietin
Anorexia
A diminished appetite and/or aversion to food
Common during advanced disease Loss of appetite and signs of physical weight loss.
Weight loss is common to almost all types of cancer.The cancer cells compete with normal cells for nutrients. Also, tumors of the pancreas often interfere with digestion which furthur contributes to weight loss.
It is difficult to treat this weight loss, especially loss of muscle mass.
Nutritional supplements such as Ensure may be of benefit.
Appetite stimulants such as Megace (medroxyacetate) may be of modest benefit.
Occasionally a PEG feeding tube is placed in the stomach during endoscopy.
Back Pain Very common especially during advanced disease Often caused by the tumor growing large enough to push against surrounding organs and nerves. May worsen after eating or when lying down. Pain medication (analgesics)
Opiates are very effective if taken regularly and at correct dosage. Opiates frequently cause constipation and may be taken with laxatives.
If pain persists, a celiac nerve block may be considered. This involves the injection of alcohol into the nerves near the pancreas to block the sensation of pain. The injection can be given through the skin, during surgery or during an endoscopic ultrasound.
Bone Pain Uncommon Spread of the cancer to bone

Medication (Biphosphorates) may be helpful.

Osteomalacia as a result of malnutrition

Vitamin supplements

Bruising Uncommon The anti-cancer drugs given during chemotherapy affect normal cells as well as cancer cells. When normal blood cells are affected, they may not clot well which can lead to easy bruising.

If severe, platelet and blood transfusions may be administered.
Bleeding Uncommon The anti-cancer drugs given during chemotherapy affect normal cells as well as cancer cells. When normal blood cells are affected, the blood cells may not clot well which may cause the patient to bleed easily.

If severe, platelet and blood transfusions may be administered.
Cachexia

General weight loss and wasting of muscles.
Common Usually caused by metastatic disease. It is difficult to treat this weight loss, especially loss of muscle mass.
Nutritional supplements such as Ensure may be of benefit.
Appetite stimulants such as Megace (medroxyacetate) may be of modest benefit.
Chills Common Infection caused by obstruction of the bile ducts and/or biological therapy (vaccines). Antibiotics
May require a stent to relieve obstruction. The stent can be placed endoscopically or percutaneously through the liver.
Hospitalization may be required.
Cramping Fairly common May be present after surgery due to electrolyte imbalances and/or resumption of bowel function.

Only intervention is to correct electrolyte balance.
Diabetes New onset is not uncommon Due to impaired insulin secretion by the pancreas.

Removal of part of the pancreas with the cancer may cure the diabetes.

May also occur after surgical removal of entire pancreas or a portion of it.

Insulin replacement
Diarrhea Very common after surgery Many patients have diarrhea after surgery. This is caused by a lack of pancreatic enzymes which affects digestion. Adjuvant chemotherapy may aggravate pre-existing diarrhea.

Medication to replace pancreatic enzymes taken with meals and possibly dietary changes.
Depression Common Related both to the emotional reaction to the diagnosis and to direct effects of the cancer.

Supportive therapy and/or antidepressant medication.
Fatigue Very common after surgery Surgery, radiation therapy, and/or chemotherapy are all a strain on the body and often cause fatigue.
Malnutrition and anemia also contribute.
There is not much to do other than resting as necessary.
Paradoxically, exercise is important to improve stamina, health diet and psychological support.
Fever Common during advanced disease Obstruction of bile ducts can lead to infection in the bile ducts and possibly the liver. The body's immune response to the infection results in a fever.

Surgical relief of obstruction, stent placement, antibiotics
Rare during vaccine therapy In rare cases biological therapy can also cause fevers.

antipyretics
Hair thinning and hair loss Uncommon with drugs used for PC Anti-cancer drugs used in chemotherapy are chosen because they affect cells that divide rapidly, such as cancer cells and hair root cells. However, this is uncommon, less than 5%, during pancreatic cancer treatment.

There is no way to prevent hair from falling out as a result of chemotherapy. Hair usually begins growing back within one month after the treatment ends.
Uncommon Radiation therapy can cause hair loss in affected area.

Itchiness (Pruritis) Common

May be a symptom of a bile duct obstruction caused by pancreatic cancer.

Occurs due to obstruction of bile ducts- see jaundice below. Surgical relief, stent placement
Jaundice Very common The last portion of the bile duct joins with the pancreatic duct in the back of the head of the pancreas and empties into the duodenum. As a tumor grows in the head of the pancreas the bile duct becomes blocked.
When the duct becomes blocked (obstructed) bile backs up into the liver and enters the bloodstream. This leads to a visible yellowing of the eyes and the skin. As bile is not gettnig to the digestive tract, stool becomes light or clay-colored.
stent placement either endoscopic or percutaneously
Loss of appetite (anorexia) Very common Before diagnosis and during chemotherapy Nutritional supplements such as Ensure.
Appetite stimulants such as Megace (medoxy progesterone) may be helpful.
Mouth sores Uncommon

Occur in patients during chemotherapy treatment
The anti-cancer drugs used in chemotherapy are chosen because they affect cells that divide rapidly, such as cancer cells. The cells of the digestive tract also divide rapidly and are therefore strongly affected by these drugs.
More often occur during 5-Fu chemotherapy. Also occurs with gemcitabine but not quite as often.
Antiseptic and analgesic mouthwashes may be prescribed to numb the discomfort. The sores will heal on their own without medication.
Muscle aches Rare Biological therapy (vaccines) Probably reflects a flu-like reaction and therefore may respond to acetomenophen (e.g. Tylenol)

Nausea Common

30-50% depending on stage
Obstruction of digestive tract by tumor.

Surgical relief or duodenal stent

Radiation therapy Chemotherapy Reglan (Metoclopromide) or other antivomiting drugs may be prescribed.

Rash Uncommon Due to obstruction

There is currently no treatment for these rashes.

Uncommon Biological therapy (vaccines) Topical steroids may be prescribed for rashes developing during vaccine therapy.

Skin irritation   Radiation therapy may cause red, dry, tender, itchy skin in affected area. Darkening of skin may also occur.

Patients should consult their doctor before using lotion or cream on the affected area.
Stool discoloration

Very common see Jaundice  
Swelling during vaccine therapy Very common Occurs near injection site. None. Typically goes away in about a week.

Thrombophlebitis

Inflammation and clotting of veins
Uncommon This condition is marked by inflammation and clotting of veins in the skin. This is the body's response to the cancer or direct spread of the cancer to blood vessels.

Prescription of anticoagulants to prevent clots from forming and potentially causing a stroke.
Urine discoloration Very common Jaundice

The accumulation of bile in the urine makes it appear darker than usual.

stent placement either endoscopically or percutaneously
Vomiting Uncommon

More common during advanced disease
Obstruction of digestive tract and/or bile ducts by tumor. Medication such as Metoclopromide (Reglan), lorezepam (Ativan), steroids, ondansetron, granisetron, tetrahydrocannabinol

Also may be caused by chemotherapy.
Weakness Common Surgery, radiation therapy, chemotherapy and/or malnutrition are all a strain on the body and often cause fatigue.

There is not much to do other than resting as necessary.
Weight loss Very common

Most patients with advanced disease
Loss of appetite and signs of physical weight loss.
Weight loss is common to almost all types of cancer.The cancer cells compete with normal cells for nutrients. Also,tumors of the pancreas often interfere with digestion which furthur contributes to wieght loss.
It is difficult to treat this weight loss especially loss of muscle mass.
Supplemental pancreatic enzymes and nutritional supplements such as Ensure.
Appetite stimulants (medioxyacetate) may be of modest benefit.
Occasionally a PEG feeding tube is placed in the stomach via endoscopy.
Yellowing of skin or eyes Very common Jaundice stent placement either endoscopically or percutaneously