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Palliative Care for Pancreatic Cancer

Pancreatic cancer is difficult to diagnose, as the elusive symptoms of this condition can persist for years before it’s diagnosed. As a result, diagnosis of pancreatic cancer usually occurs when this disease has reached a later stage, making malignant pancreas tumors the fifth leading cause of cancer-related death.

In less than 20 percent of all cases, pancreatic cancer can be treated with a combination of surgery, chemotherapy and/or radiotherapy. However, for the majority of pancreatic cancer patients, treatment revolves around palliative care, which attempts to minimize symptoms, reduce pain and improve the patient's quality of life, rather than cure the disease itself.

Pain Management: NSAIDs and Morphine

Although pancreatic tumors in early stages tend to be asymptomatic (exist without any recognizable symptoms), as the tumor grows, it may press against surrounding nerves, causing abdominal and back pain. Consequently, palliative care for pancreatic cancer focuses on managing the pain resulting from this condition.

Here’s what is involved in pain management for pancreatic cancer, in order of what is used to treat the least to most serious cases:

taking NSAIDs: These non-steroidal anti-inflammatory drugs (NSAIDs) are usually prescribed for mild to moderate pain.
taking opiods: When NSAIDs cannot provide adequate pain management, opioids, such as morphine, are necessary to relieve intense pain.
anesthetizing nerve cells: If neither NSAIDs nor morphine prove effective, nerve centers may be numbed by directly anesthetizing the celiac plexus, a cluster of nerve cells located in the abdomen. This provides up to five months of pain relief.
cutting nerves: Another procedure, called a thorascopic splanchnicectomy, cuts specific nerves to prevent them from transmitting pain messages from the tumor site to the brain.

Supplemental Pancreatic Enzymes

As cancer of the pancreas progresses, the gland's ability to produce digestive enzymes (such as glucagon and insulin) may become compromised. If this occurs, the body can become incapable of digesting certain substances, causing pancreatic cancer patients to experience poor food absorption, loss of appetite and irregular bowel movements.

Should this occur, prescription medications may be used to supplement or replace pancreatic enzymes, allowing for more normal digestion. For example, if the pancreatic cancer patient becomes unable to produce insulin and, therefore, regulate his blood sugar, he will have to take insulin shots, just as people with type-1 diabetes do.

Palliative Surgery

Once a pancreas tumor metastasizes curative surgery is no longer an option. However, certain surgical procedures are used in palliative care to improve overall quality of life:

Biliary Bypass: If the tumor blocks the small intestine or presses against the liver, bile may accumulate in the gallbladder, reducing the body's ability to digest food. A biliary bypass cuts the gallbladder and reattaches it to the small intestine, allowing bile to drain through the new connection.
Endoscopic Stent Placement: To drain the liver’s bile, doctors use this procedure to implant stent, or small thin tube, into the small intestine. This procedure is usually performed if a tumor is blocking the bile duct.
Gastric Bypass: When the pancreas tumor blocks the flow of food through the stomach, gastric bypass may be necessary to reattach the stomach directly to the small intestine.

Counseling, Comfort and Support

As oncologists and other medical experts work to relieve pancreatic cancer patients’ physical symptoms, these patients will also need to take measures to prevent depression, reduce their stress and promote a healthy mind. Here are some of the types of palliative care used for the mental health of pancreatic cancer patients:

Medication: If you are a cancer patient who suffers from depression or other mood and/or psychiatric disorders, talk to your doctor about possible medication. Keeping your mind healthy will improve your quality of life.
Support groups: Talking to others who suffer from your condition can be comforting, as well as informative. Many churches and community centers host weekly and/or monthly support groups for a variety of conditions, including pancreatic cancer.
Therapy: While those with pancreatic cancer can go to one-on-one therapy, they can also go to group or family therapy. Once you find a therapist with whom you are comfortable, talk to her about whether or not you need family therapy as well to help your family members learn about this condition.

Resources

CancerBACUP (updated 2001). Fluorouracil (5FU). Retrieved March 24, 2003, from the CancerBACUP Web site: www.cancerbacup.org.uk/info/fluorouracil.htm.

CancerBACUP (updated 2001). Gemcitabine (Gemzar). Retrieved March 24, 2003, from the CancerBACUP Web site: www.cancerbacup.org.uk/info/gemcitabine.htm.

Johns Hopkins Pancreas Cancer Web (updated 2003). Medical treatment and research. Retrieved March 24, 2003, from the Johns Hopkins Pancreas Cancer Web site: pathology.jhu.edu/n.web?EP=N&FL=PANCREAS_MEDICAL_TX.

John Hopkins Pathology. (nd). Pain in pancreatic cancer can be controlled. Retrieved March 24, 2003, from the Johns Hopkins Pancreas Cancer Web site: pathology2.jhu.edu/pancreas/pain.cfm.

Mayer, R. (nd). Pancreatic cancer. National Pancreas Foundation. Retrieved March 24, 2003, from the Pancreas Foundation Web site: www.pancreasfoundation.org/pancreaticcancerarticle.html.

National Cancer Institute (updated 2003). Pancreatic cancer. Retrieved March 24, 2003, from the NCI Web site: www.cancer.gov/cancer_information/doc_pdq.aspx?version=patient&viewid=60625b32-15f9-4278-8661-0067ba538ec9#Section_110.

National Cancer Institute (1999). Treating cancer with vaccine therapy. Retrieved March 25, 2003, from the NCI Web site: www.cancer.gov/clinicaltrials/understanding/treating-cancer-with-vaccine-therapy/page2.

Tufts New England Medical Center (nd). Whipple procedure: Pancreatic cancer and pancreatitis. Retrieved March 24, 2003, from the Tufts New England Medical Center Web site: www.nemc.org/surgery/html/general/whipple.htm.

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