Do What You Can to Ease Side Effects of Treatment for Pancreatic Cancer

It is likely that the cancer itself and the treatment you get will cause symptoms and side effects. In this section, you’ll learn more about how to respond to some of the most common symptoms and side effects from treating pancreatic cancer.

You may not have all of these. We’ve listed them in alphabetical order so you can quickly find help when you need it.

Anemia (Low red blood cell levels)

Throughout your treatment, your doctor will take small samples of your blood for testing. One thing he or she is checking is your level of red blood cells. A  low red blood cell count is called anemia. Red blood cells carry oxygen throughout the body. If your body does not have this oxygen, you may feel tired. Decreased red-blood-cell counts can be caused by blood loss, chemotherapy or radiation, or the cancer itself.

If your doctor tells you that you have anemia, take these actions to feel better.

• Take short rests when you’re tired. Avoid long naps during the day so that you can sleep well at night.

• Add mild exercise, such as walking, to your daily routine. It may help you sleep better, and can help increase your energy.

• Balance activity with rest. Save your energy for important tasks.

• Drink plenty of water. Dehydration leads to increased fatigue.

• Talk with your doctor about medications or treatments that may help manage your anemia.

Anxiety and depression

Many people may feel blue, anxious, or distressed after being told they have cancer. This is normal, and these feelings may continue or come back throughout treatment.

Taking these actions may ease your mental stress.

• Talk with your family or friends.

• Consider joining a cancer support group or finding a cancer “buddy” who can help you cope.

• Ask your doctor about medications for depression and anxiety.

Bleeding and Bruising

Certain kinds of chemotherapy may reduce your blood platelet count. Without enough platelets (which is called thrombocytopenia), your blood may have trouble clotting. Even a minor injury may cause you to bleed or bruise.

If your doctor tells you that your platelet count is low, take these actions to avoid causing injuries that could lead to uncontrolled bleeding.

• Call your doctor if you develop a rash, bleeding, or bruising.

• Protect your skin from cuts and scrapes, and be very careful when using sharp objects.

• Take steps to prevent constipation, which can lead to hemorrhoids and bleeding.

• Use a soft toothbrush to prevent bleeding gums. Ask your doctor if it's okay to floss.

Constipation

This may be a side effect of chemotherapy or some pain medicines. Constipation includes difficult or infrequent bowel movements. It ranges from mildly uncomfortable to painful. Taking pain medications often leads to constipation, so it’s wise to take these preventive actions. These same steps may give you relief if you are already constipated.

• Drink plenty of fluids, especially water and prune juice.

• Eat foods high in fiber, such as cereals, whole grains, fruits, and vegetables.

• Exercise.

• Take stool softeners or a laxative only as prescribed by your doctor.

Diabetes

If your entire pancreas was removed, your body can no longer make the hormones insulin and glucagon. You’ll need to take these two hormones, as well as pancreatic enzymes, to help digested food get to the rest of your body. You’ll take these steps to manage diabetes.

• Learn how to inject insulin and test your blood for sugar (glucose). The diabetes educator at your hospital or your nurse will help you learn and practice these techniques.

• Meet with a dietitian to learn how to select foods to help keep your glucose levels steady.

• Be diligent about testing your blood sugar as prescribed and following the recommended diet

• Keep all your follow-up appointments.

• Ask questions about anything you don’t understand.

Diarrhea

This may be a side effect of chemotherapy or changes in digestion after surgery. Diarrhea includes loose or frequent bowel movements, or both. It may lead to dehydration if you don’t take these precautions. Many drugs can cause bowel changes.

• Avoid milk and milk products if you already have diarrhea or if you are lactose-intolerant.

• Avoid gas-producing vegetables, dried fruit, fiber cereals, seeds, popcorn, nuts, corn, and beans.

• Eat low-residue, low-fiber foods, such as those included in the BRAT diet (bananas, rice, applesauce, and toast).

• Drink more fluids, such as water and broth, to prevent dehydration.

• Ask your doctor about medications that may help.

Hair loss (alopecia)

Most chemotherapy drugs given to treat pancreatic cancer do not cause hair loss. But if you do lose your hair, it can be upsetting because baldness is a visible reminder that you are being treated for cancer. Keep in mind that your hair will grow back after treatment.     

Try these coping tips.

• Consider cutting your hair before treatment starts.

• Think about getting a wig, hat, or scarf before your hair loss starts. That way, you can get a wig that matches your hair and you’ll be ready with head coverings, if you choose to use them.

• Because your scalp may be more sensitive to temperature and sun, protect it with sunscreen and hats or scarves.

Increased infections

Throughout your treatment, your doctor will take small samples of your blood for testing. One thing he or she is checking for is your level of white blood cells. Many types of chemotherapy can cause low white blood cell counts. This condition is called neutropenia. Without enough white blood cells, your body may not be able to fight infection. If your doctor tells you that your white blood cell count is low, take these actions to stay healthy:

• Avoid crowds or people with colds.

• Wash your hands often or use hand sanitizer throughout the day to kill germs.

• Call your doctor right away if you have any of these signs of infection:

• A fever of 100.5°F or higher when you take your temperature by mouth

• Severe chills

• A cough

• Pain or a burning sensation during urination

• Any sores or redness

Mouth sores (mucositis)

Some types of chemotherapy may cause mouth sores. These may hurt and make eating an unpleasant experience.

To prevent sores in your mouth, take these actions.

• Brush your teeth after meals and before bedtime. Check with your doctor about flossing.

• Keep your mouth and lips clean and moist.

• Use sugar-free candies or gums to increase moisture in your mouth.

To ease the pain if you get sores in your mouth, take these actions.

• Avoid alcohol and mouthwashes containing alcohol because they may irritate the sores.

• Avoid hot, rough, or spicy foods because they may irritate the sores.

• Avoid tobacco because it may irritate the sores. Smoking can also make you more susceptible to sores.

• Ask your doctor about topical mouth medications.

• Ask your doctor or nurse about taking over-the-counter pain medication, such as Tylenol (acetaminophen), if necessary.

• Call your doctor or nurse if your temperature reaches 100.5° F or higher.

Nausea or vomiting

Nausea or vomiting as a result of chemotherapy, radiation treatment, or the cancer itself may range from barely noticeable to severe. It may help you to understand the different types of nausea.

• Acute-onset nausea and vomiting occurs within a few minutes to several hours after chemotherapy. The worst episodes tend to be five to six hours after treatment, and the symptoms end within the first 24 hours.

• Delayed-onset vomiting develops more than 24 hours after treatment.

• Anticipatory nausea and vomiting are learned from previous experiences with vomiting. As you prepare for the next dose of chemotherapy, you may anticipate that nausea and vomiting will occur as it did previously, which triggers the actual reflex.

• Breakthrough vomiting occurs despite treatment to prevent it. It requires additional treatment.

• Refractory vomiting occurs after one or more chemotherapy treatments--essentially, you’re no longer responding to antinausea treatments and need to try different medicines.

To prevent nausea, take these actions.

• Ask your doctor about getting a prescription medicine to control nausea and vomiting. Make sure you take it as directed. If you are vomiting and cannot take the medicine, call your doctor or nurse.

• If you have bothersome nausea and vomiting, even though you are taking your medicine, call your doctor or nurse. They may increase or change your medicine.

To help ease nausea or vomiting if you have it, try these tips.

• Try eating foods and drinking beverages that were easy to take or made you feel better when you had the flu or were nauseated before. These might be bland foods, sour candy, pickles, dry crackers, ginger ale, flat soda, or others.

• Do not eat fatty or fried foods, very spicy foods, or very sweet foods.

• Eat room-temperature or cold foods. The smells from hot foods may make your nausea worse.

• Ask your doctor or nurse if he or she can help you learn a relaxation exercise. This may make you feel less anxious and more in control, and decrease your nausea.

• Ask your doctor or nurse about using acupressure bands on your wrists, which may help to decrease your nausea.

Numbness, tingling, or muscle weakness in your hands or feet (peripheral neuropathy)

If you have numbness, tingling, or weakness in your hands and feet, you may have nerve damage called peripheral neuropathy. This can be a side effect of some types of chemotherapy. Other signs of this problem are ringing in your ears or trouble feeling hot or cold. If you have symptoms such as these, take precautions to protect yourself.

• Take extra care walking and moving so that you don’t fall. Wear only well-fitting shoes.

• Use warm, not hot, water for bathing to prevent burns. Consider using a shower chair or railing.

• If your daily activities become too difficult, ask your doctor for a referral to an occupational therapist or a physical therapist. They can help teach you new ways of doing things so that you can stay as active as possible.

• Take extra care when driving because you may have trouble feeling the gas and brake pedals. Ask friends and family to drive you places.

Nutrition problems

Surgery to remove all or part of the pancreas can affect how your body digests food. So can any blockages caused by tumors. You may have problems digesting food. Your body may not absorb nutrients as well as it should. Try some of these steps to help the problem.

• If your pancreas no longer makes hormones, work with a diabetes educator or your nurse to learn what you need to do to replace those hormones. The educator can also help you adjust meal planning and take other steps to maintain your health.

• If your pancreas no longer makes enzymes to aid digestion, ask your doctor about enzyme tablets. These medications can replace the enzymes your body no longer makes.

• If you find that you are having trouble getting enough nutrition, see a dietitian. This person can help you plan meals that provide enough nutrition, without causing you excess discomfort.

• If you have no appetite or feel full after eating just a small amount, be sure to tell your doctor. He or she may have ways to help.

Skin dryness or irritation

This may be a side effect of radiation therapy. Follow these tips for relief.

• Check with your doctor or nurse about protecting your skin from sun exposure, by wearing sunscreen of at least 15 SPF (sun protection factor). Don't apply sunscreen or other lotions to your skin without first checking.

• Ask your doctor or nurse what kind of lotion you can use to moisturize and soothe your skin. Don’t use any lotion, soap, deodorant, sunblock, cologne, cosmetics, or powder on your skin within two hours after radiation treatment because they may cause irritation.

• Wear loose, soft clothing over the treated area. Cotton underwear can help prevent further irritation.

• Don’t scratch, rub, or scrub treated skin. After washing, gently blot dry.

• Don’t bandage skin with tape. If you must bandage it, use paper tape, and ask your nurse to help you place the dressings so that you can avoid irritation.

• Don’t apply heat or cold to the treated area. Bathe only with lukewarm water because it’s less dehydrating.

• If you must shave the treated area, use only an electric shaver because it causes less skin irritation. Don’t use lotion before shaving. And don’t use hair-removal products. Both may irritate your skin.

• Keep your nails well trimmed and clean so you don’t accidentally scratch yourself.

Thinking and remembering problems

You may have mild problems with concentration and memory during and after chemotherapy. Being tired can make this worse.

Taking these actions may help.

• Make lists and write down important information.

• Use other tools to help organize your life, such as calendars, pill dispensers, or alarm clocks.

Tiredness or fatigue

Tiredness is a very common side effect of surgery, chemotherapy, and radiation treatments. Anemia (low red blood cell counts) can cause it. You may feel only slightly tired, or you may suffer from extreme fatigue that doesn't get better with rest. Taking these actions may help increase your energy level. Fatigue can last several weeks after treatment ends.

• Take short rests when you feel tired. Avoid long naps during the day so that you can sleep well at night.

• Add mild exercise, such as walking, to your daily routine. It may help you sleep better.

• Save your energy for important tasks.

• Take action to treat a poor appetite, because eating improperly can make you tired.

• If your fatigue is severe, is getting worse, or lasts a long time, ask for help with routine tasks that can drain your energy, such as grocery shopping or housework. Some people reduce their hours at work..