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The information provided here is meant to give you a general idea about each of the medications listed below. Only the most general side effects are included, so ask your doctor if you need to take any special precautions. Use each of these medications as recommended by your doctor, or according to the instructions provided. If you have further questions about usage or side effects, contact your doctor.

Medications may help to either prevent or reduce side effects of treatment, or to manage certain side effects once they occur. Since you can develop these symptoms from the treatment and/or from the cancer itself, it is essential that you discuss any concerns you have with your doctor.

Some of the complications of pancreatic cancer that will require supportive care include the following:

  • Development of diabetes
  • Problems digesting food
  • Weight loss
  • Pain
  • Nausea or vomiting
  • Depression

Development of Diabetes

If your treatment includes surgery to remove part or all of your pancreas, you may develop diabetes . Diabetes occurs when your body can no longer produce insulin or becomes resistant to the hormone.

A functioning pancreas produces insulin naturally. Insulin helps you digest food, breaking down carbohydrates into smaller chemical units (glucose) that your body can use for energy or can store for future use. Insulin keeps your blood glucose (or blood sugar) within a normal, healthy range.

If your pancreas is not functioning properly, or if you have had surgery to remove some or all of your pancreas, you may develop diabetes and will need to be given insulin, usually in the form of an injection. Treating diabetes includes regularly testing your blood glucose level, giving yourself insulin shots, and monitoring your diet. Your doctor will teach you how to care for this condition.

Taking Insulin

The main forms of insulin include:

  • Humulin
  • Novolin
  • Velosulin

Insulin must be injected just under your skin, often several times a day. The medication can be given through injections with a small syringe or by wearing an insulin pump that automatically and regularly provides a dose of insulin throughout the day. There are a number of different forms of insulin, ranging from short-acting to long-acting varieties. You may need to utilize more than one type.

You’ll probably have to test your blood sugar levels two or more times each day to monitor your response to the insulin. Since diet and exercise affect blood sugar levels, you will need to adjust these important aspects of your life.

Side Effects of Insulin Therapy

Side effects can occur if blood sugar levels go too high or too low.

Symptoms of high blood sugar include:

  • Excess thirst
  • Increased appetite
  • Frequent urination
  • Fatigue

Symptoms of low blood sugar include:

  • Feeling shaky or jittery
  • Dizziness, fainting
  • Confusion
  • Sweating
  • Fast heartbeat
  • Blurry vision

When to Contact Your doctor

Always contact your doctor if you have any of the following:

  • Seizures
  • Fainting
  • Chest pain
  • Difficulty breathing
  • Yellow eyes or skin
  • Easy bleeding or bruising

Problems Digesting Food

As the cancer destroys pancreatic cells, normal digestive function is impaired. In addition, if you have had all or part of your pancreas surgically removed, you may have trouble digesting and using the nutrients from your food. You may need to take enzyme tablets with your meals to help solve this problem.

Pancrelipase (Pancrease, Creon, Cotazym) contains enzymes similar to those produced by a healthy pancreas. These enzymes help you digest your food, breaking it down into smaller chemical units that your body can use for energy.

Always swallow your pill or capsule whole. Do not break up the medicine or chew it, which can cause mouth irritation. Your doctor will tell you how many to take, ranging from one to four, with each meal or snack.

Possible side effects of pancreatic enzymes include:

  • Mouth irritation
  • Skin rashes
  • Diarrhea
  • Nausea
  • Abdominal cramps or pain

When to Contact Your doctor

Always contact your doctor if you have any of the following:

  • Pain or diarrhea
  • Stools that look greasy or float on the toilet water
  • Difficulty breathing or wheezing

Weight Loss

Weight loss may occur when your appetite is severely decreased due to the cancer. You may need to take dietary supplements, drink nutritional supplements (such as Boost or Ensure), or receive some nutrition through a tube placed directly into your stomach or intestine. Tell your doctor if you are losing weight; he or she can refer you to a registered dietitian (RD).

Pain

Pain in pancreatic cancer can be quite severe and debilitating. If you are having an operation, your surgeon may choose to cut some of the nerves that carry pain messages from your pancreas and the surrounding area to your brain. Alternatively, alcohol can be injected into these nerves to deaden the painful sensations.

If you are not having surgery, similar types of nerve-deadening injections may be given directly through the skin of the abdomen. You and your doctor should discuss what kinds of pain medications are available. The goal will be to relieve your pain as much as possible, while still allowing you to enjoy as much of life as possible.

The pain medications commonly given for pancreatic cancer are opioid analgesics:

  • Hydrocodone (Dilaudid)
  • Morphine (Oramorph, MS Contin)
  • Methadone (Dolophine)
  • Oxycodone (Roxicodone, Oxycontin)
  • Fentanyl patch (Duragesic)
  • Acetaminophen combined with:
    • Oxycodone (Percocet)
    • Hydrocodone (Vicodin)

Possible side effects of opioid analgesics include the following:

  • Dizziness
  • Light-headedness or feeling faint
  • Drowsiness
  • Nausea or vomiting
  • Constipation—A study found that the medication methylnaltrexone (Relistor) can rapidly relieve this side effect.

Nausea and Vomiting

Nausea and vomiting may occur if the tumor is blocking part of the gastrointestinal tract, if you are constipated, or as side effects of chemotherapy or radiation .

Depression

Depression is commonly experienced in patients diagnosed with pancreatic cancer. Often, the depression is noted before the diagnosis of cancer is made. If you are feeling the symptoms of depression—extreme fatigue, lack of interest in things that once mattered to you, mood swings—talk with your doctor.

If appropriate, your doctor can recommend therapy, support groups, medications, or other means of managing depression.

Revision Information

  • DiMagno E. Pancreatic carcinoma. In: Cecil Textbook of Medicine. 21st ed. Philadelphia, PA: WB Saunders Company; 2000: 750-752.

  • Freelove R, Walling AD. Pancreatic cancer: diagnosis and management. Am Fam Physician. 2006;73:485-492.

  • Lohr JM. Medical treatment of pancreatic cancer. Expert Rev Anticancer Ther. 2007;7:533-544.

  • What is cancer of the pancreas? American Cancer Society website. Available at: http://www.cancer.org/ . Updated 2007. Accessed June 25, 2008.

  • What you need to know about cancer of the pancreas. National Cancer Institute website. Available at: http://www.cancer.gov/cancerinfo/wyntk/pancreas#2 . Accessed June 25, 2008.

  • Yip D, Karapetis C, Strickland A, et al. Chemotherapy and radiotherapy for inoperable advanced pancreatic cancer. Cochrane Database Syst Rev. 2006;3:CD002093.

  • 6/25/2008 DynaMed Systematic Literature Surveillance http://www.dynamicmedical.com/what.php : Thomas J, Karver S, Cooney GA, et al. Methylnaltrexone for opioid-induced constipation in advanced illness. N Engl J Med. 2008;358:2332-2343.

  • 11/30/2010 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : US Food and Drug Administration. Propoxyphene: withdrawal—risk of cardiac toxicity. US Food and Drug Administration website. Available at: http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm234389.htm . Published November 19, 2010. Accessed November 30, 2010.