Symptoms depend on where the tumour and metastases are located. Pancreatic and bile duct cancers typically spread to the liver, abdominal cavity, and lungs, but sometimes to other organs as well. Read on for more information about the most common symptoms caused by metastases.
Yellow skin (jaundice)
Pancreatic and bile duct cancers often block the bile duct, leading to disruptions in bile flow. As a result, the skin and whites of the eyes turn yellow, urine turns dark, and because the pigmented substance in the bile can’t reach the colon and give stools their regular brown colour, stools turn gray. The skin and whites of the eyes turning yellow (also called “jaundice”) is often the first symptom of pancreatic or bile duct cancer. Obstructed bile ducts may be widened by placing a prosthesis, also called a stent. The stent is usually inserted into the bile duct through the stomach using an endoscopy procedure. This will gradually make the jaundice better.
Pain
There is a nerve bundle (also called “plexus”) near the pancreas and bile duct. If a tumour presses on the nerve bundle, it causes pain beginning in the upper abdomen and sometimes radiating to the back. Morphine-like pain medicines, as well as medicines for treating nerve pain, are effective in treating this pain. Additionally, it may be possible to use a plexus block to stop the nerves from sending pain signals. The plexus block procedure is done using computed tomography (CT) guidance.
Shortness of breath and other respiratory symptoms
In many cases, individual metastases in the lungs don’t cause any major symptoms. As the metastases increase in number, they may cause shortness of breath or coughing. Shortness of breath can be treated with medications, radiation therapy (if a tumour is obstructing the bronchi), or by removing excess fluid from around the lungs.
Liver metastases and build-up of fluid in the abdomen
In many cases, individual metastases in the liver don’t cause any major symptoms. Symptoms usually first appear once there is a large number of metastases and liver function starts to suffer. Impaired liver function causes swelling (oedema) in the legs and feet, a build-up of fluid in the abdomen, and bile flow disruptions, leading to fatigue and loss of appetite.
A build-up of fluid in the abdominal cavity can also be caused by the cancer spreading to the abdomen. As a result, the belly becomes large and swollen. The fluid can be removed either by performing a one-time ascitic tap or by inserting a drainage catheter that can be used to remove the fluid over the course of several days. This usually provides immediate symptom relief. Fatigue and loss of appetite can be relieved with corticosteroids, while compression bandaging or socks can be used to relieve oedema.
Bowel function disorders
Cancer can spread to the abdominal cavity and disrupt bowel function, causing nausea and constipation. Both nausea and constipation can be relieved effectively with medications.
Sometimes a bowel obstruction may occur. This may require surgery. Symptoms of bowel obstruction include constipation, nausea, vomiting, and stomach pain. Bowel obstruction requires acute medical treatment – contact the unit responsible for your care or visit the emergency department. In the case of advanced cancer, if surgery is not an option, symptoms of bowel obstruction can also be relieved with medication.
Fatigue and loss of appetite
Advanced cancer causes fatigue and leads to a gradual loss of appetite. Pancreatic and bile duct cancers also cause malnutrition. In advanced cancer, enhanced nutrition therapy may not improve the patient’s condition; at this stage, it’s more important to have small, frequent portions of energy-dense foods according to the patient’s preferences. Ways to try and reduce fatigue include getting fresh air and appropriate physical activity. It’s also important to adhere to a regular sleep-wake cycle. Additionally, corticosteroid medicines can be used to ease fatigue and improve appetite temporarily. At the end of life, the patient’s strength decreases, fatigue intensifies, and the need for sleep and rest increases.
Psychological strain
Having an illness puts strain on the mind too. Living with a long-term illness includes both good and bad moments. It’s good to talk to the care team about how you’re coping mentally. Depression and anxiety can be managed both by talking and with medication. Peer support may also be helpful.
