Is this symptom or side effect unusual?

As always, this information is not a substitute for your physician's advice but rather an educational resource to help you relate your experience to others in a similar situation.

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.

List of symptoms and side effects

Below is a list of commonly-experienced symptoms of pancreatic cancer and side effects of various treatments.

Abdominal Distension (Ascites)   

Frequency: Not uncommon in patients with advanced disease

Causes: Spread of the cancer to the abdominal cavity; Liver disease; Portal vein thrombosis

Intervention: Treatment varies depending on the cause.

Abdominal Pain   

Frequency: Very common; Approximately 3/4 of patients with advanced disease

Cause: 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.

Intervention: 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   

Frequency: Occasional

Cause: Often related to chemotherapy.

Intervention: Medication - Erythropoietin

Anorexia - a diminished appetite and/or aversion to food   

Frequency: Common

Cause: Loss of appetite and discomfort after eating. 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 further contributes to weight loss.

Intervention: 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 feeding tube (PEG) is placed in the stomach during endoscopy.

Back Pain   

Frequency: Very common especially in patients with advanced disease

Cause: Often caused by the tumor growing large enough to push against surrounding organs and nerves. May worsen after eating or when lying down.

Intervention: 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.

Bleeding   

Frequency: Uncommon

Cause: 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.

Intervention: If severe, platelet and blood transfusions may be administered.

Bone Pain   

Frequency: Uncommon

Cause: Spread of the cancer to bone

Intervention: Medication (Biphosphorates) may be helpful

Purple line

Cause: Osteomalacia (thinning of the bones) as a result of malnutrition

Intervention: Vitamin supplements

Bruising   

Frequency: Uncommon

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

Intervention: If severe, platelet and blood transfusions may be administered.

Cachexia - General weight loss and wasting of muscles   

Frequency: Common

Cause: Usually caused by metastatic disease (cancer that has spread).

Intervention: 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   

Frequency: Common

Cause: Infection, sometimes caused by obstruction of the bile ducts.

Intervention: Antibiotics.
May require a stent to relieve obstruction. The stent can be placed endoscopically or percutaneously through the liver.
Hospitalization may be required.

Cramping   

Frequency: Fairly common

Cause: May be present after surgery due to electrolyte imbalances and/or resumption of bowel function.

Intervention: Only intervention is to correct electrolyte balance.

Depression   

Frequency: Common

Cause: Related both to the emotional reaction to the diagnosis and to direct effects of the cancer.

Intervention: Supportive therapy and/or antidepressant medication. Seek treatment if you are depressed!

Diabetes   

Frequency: New onset is not uncommon

Cause: Due to impaired insulin secretion by the pancreas.

Intervention: Removal of part of the pancreas with the cancer may improve the diabetes.

Purple line

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

Intervention: Insulin replacement

Diarrhea   

Frequency: Very common after surgery

Cause: 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.

Intervention: Medication to replace pancreatic enzymes taken with meals and possibly dietary changes.

Fatigue   

Frequency: Very common after surgery

Cause: Surgery, radiation therapy, chemotherapy, and the cancer itself are all a strain on the body and often cause fatigue.
Malnutrition and anemia also contribute.

Intervention: There is not much to do other than resting as necessary.
Paradoxically, exercise is important to improve stamina, health diet and psychological support. Transfusions can address any anemia.

Fever   

Frequency: Common during advanced disease

Cause: 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.

Intervention: Surgical relief of obstruction, stent placement, and/or antibiotics

Purple line

Frequency: Rare during immunotherapy

Cause: In rare cases biological therapy can also cause fevers.

Intervention: Antipyretics

Hair thinning and hair loss   

Frequency: Uncommon with drugs used for PC

Cause: Anti-cancer drugs used in chemotherapy are chosen because they affect cells that divide rapidly, such as cancer cells. They can also impact hair root cells. However, this is uncommon, less than 5%, during pancreatic cancer treatment.

Intervention: 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.

Purple line

Frequency: Uncommon

Cause: Radiation therapy can cause hair loss in affected area.

Intervention: 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.

Itchiness (Pruritis)   

Frequency: Common

Cause: May be related to jaundice (yellowing of the eyes) secondary to a bile duct obstruction caused by pancreatic cancer.

Intervention: Surgical relief, stent placement

Jaundice   

Frequency: Very common

Cause: 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 (bowel) . As a tumor grows in the head of the pancreas the bile duct can become 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 getting to the digestive tract, stool becomes light or clay-colored.

Intervention: Stent placement either endoscopic or percutaneously

Loss of appetite (anorexia)   

Frequency: Very common before diagnosis and during chemotherapy

Cause: Can be caused by the general effects of the cancer, by the cancer blocking part of the bowel, or by the effects of therapy.

Intervention: Nutritional supplements such as Ensure.
Appetite stimulants such as Megace (medoxy progesterone) may be helpful. In rare cases, the placement of a stent in the duodenum may help alleviate an intestinal blockage.

Mouth sores   

Frequency: Uncommon; Occur in patients during chemotherapy treatment

Cause: 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

Intervention: Antiseptic and analgesic mouthwashes may be prescribed to numb the discomfort. The sores will heal on their own without medication.

Muscle aches   

Frequency: Rare

Cause: Biological therapy (vaccines)

Intervention: Probably reflects a flu-like reaction and therefore may respond to acetomenophen (e.g. Tylenol)

Nausea   

Frequency: Common; 30-50% depending on stage

Cause: Obstruction of digestive tract by the cancer.

Intervention: Surgical relief or duodenal stent

Purple line

Cause: Radiation therapy Chemotherapy

Intervention: Reglan (Metoclopromide) or other antivomiting drugs may be prescribed.

Rash   

Frequency: Uncommon

Skin irritation   

Frequency: Uncommon

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

Intervention: Patients should consult their doctor before using lotion or cream on the affected area.

Stool discoloration   

Frequency: Very common

Cause: 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 (bowel) . As a tumor grows in the head of the pancreas the bile duct can become 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 getting to the digestive tract, stool becomes light or clay-colored.

Intervention: Stent placement either endoscopic or percutaneously

Swelling during vaccine therapy   

Frequency: Very common

Cause: Occurs near injection site.

Intervention: None. Typically goes away in about a week. May be an infection if associated with a fever.

Thrombophlebitis - Inflammation and clotting of veins   

Frequency: Uncommon

Cause: 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. Blood clots are particularly dangerous when they are in the lungs.

Intervention: Prescription of anticoagulants to prevent clots from forming and potentially causing a stroke.

Urine discoloration   

Frequency: Very common

Cause: Jaundice; The accumulation of bile in the urine makes it appear darker than usual.

Intervention: Stent placement either endoscopically or percutaneously

Vomiting   

Frequency: Uncommon; More common during advanced disease

Cause: Obstruction of the digestive tract and/or bile ducts by tumor.

Intervention: Medication such as Metoclopromide (Reglan), lorezepam (Ativan), steroids, ondansetron, granisetron, tetrahydrocannabinol. In some cases the placement of a stent can alleviate intestinal blockages.

Purple line

Cause: Also may be caused by chemotherapy.

Intervention: Medication such as Metoclopromide (Reglan), lorezepam (Ativan), steroids, ondansetron, granisetron, tetrahydrocannabinol

Weakness   

Frequency: Common

Cause: Surgery, radiation therapy, chemotherapy and/or malnutrition are all a strain on the body and often cause fatigue.

Intervention: There is not much to do other than resting as necessary.

Weight loss   

Frequency: Very common; Most patients with advanced disease

Cause: 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 further contributes to weight loss.

Intervention: 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   

Frequency: Very common

Cause: 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 (bowel) . As a tumor grows in the head of the pancreas the bile duct can become 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.

Intervention: Stent placement either endoscopically or percutaneously

Next: Diagnosis