Late-Stage Pancreatic Cancer: Key Symptoms to Expect and How to Stay as Comfortable and Strong as Possible

Pancreatic cancer usually doesn't cause symptoms until it's advanced. That’s why most people are diagnosed at stage III or IV. At that point, the cancer has spread outside your pancreas, and you may have symptoms affecting your digestive system and other parts of your body. While these can be very uncomfortable, there are medical strategies to help you manage them, plus things you can do for yourself to help you feel better.

When the tumor grows large enough to press against nearby nerves or other organs, or block your digestive tract, it can cause pain in your upper or middle belly. You may feel it all the time or off and on, and it can be worse when you lie down or after you eat. 

Leaning forward can relieve the pressure, and a heating pad may help. Your doctor will likely prescribe pain medication and may recommend a procedure to block the nerve signals.

You may not feel hungry for many reasons, including treatment side effects and symptoms like pain and digestive issues. 

Your doctor can prescribe medication to boost your appetite, and potentially cannabis products, if that’s legal where you live. It may sound obvious, but choose foods that look, smell, and taste appealing, and try eating smaller amounts more often. Nutritional supplement drinks or smoothies may be easier to digest.

You can quickly lose muscle mass along with overall weight for other reasons: Without enough digestive enzymes from your pancreas, you can't absorb nutrients correctly; and the cancer itself makes you burn extra calories.

To counter this, you may get supplements to take with meals to boost digestive enzymes. And try maximizing your diet with nutrient- and calorie-dense choices like cheese and peanut butter. A dietitian can help you plan.

This can also result from reduced digestive enzymes, and it's a common side effect of chemotherapy. Your doctor can recommend an over-the-counter or prescription medication. Stick to a clear liquid diet, like broth and gelatin, until it's under control. Then you can move on to bland, easy-to-digest food like the BRAT diet (bananas, rice, applesauce, and toast). Diarrhea can dehydrate you quickly, so have about a cup of fluids (water, clear broth, etc.) after each loose stool.

Not enough digestive enzymes can also lead to constipation. Opioid pain relievers can cause it, too. Medication and diet changes are the main treatments. If you take an opioid, your doctor may have you take a laxative or stool softener every day. It can also help to increase the amount of insoluble fiber in your diet – the kind in wheat bran, brown rice, and leafy greens. Other strategies: Drink plenty of water and stay physically active.

It's common for pain to spread, or radiate, from your belly to your middle or upper back as the tumor presses against abdominal nerves or your spine. To get relief, you can try:

• OTC pain relievers like NSAIDs
• Heat or ice 
• Physical therapy
• Mind-body strategies like relaxation, meditation, or cognitive behavioral therapy
• Complementary treatments like massage, acupuncture, or hypnotherapy

You may need prescription painkillers or a nerve block.

Pancreatic cancer can spread to your bones, causing aching or throbbing pain in spots including your spine or ribs. Treatment is usually with NSAIDs or prescription painkillers, plus medication to strengthen your bones. You might have chemotherapy or radiation.

Bone pain can be worse at night. Using a heating pad before bed may relieve pain and relax you enough to help you sleep.

It's common for cancer treatments, including chemotherapy, to upset your stomach. Your stomach also may not empty normally if the tumor causes a blockage or compresses your nerves. Your doctor may recommend an anti-nausea medication. The FDA has approved two drugs derived from cannabis for treating chemo-related nausea.

Other things that may help:

• Cold, clear liquids 
• Ginger tea or candy
• Deep breathing exercises
• Avoiding an empty stomach

This goes beyond simply feeling tired, and can come from the cancer, your treatment, or symptoms like pain that keeps you up at night.

Your doctor can look for treatable causes, like anemia or a nutrient deficiency. Exercise is a great way to boost your energy. Just clear it with your doctor and don't push yourself too hard. Conserve your energy by tackling high-priority tasks first and outsourcing errands like grocery shopping.

You may get jaundice if the tumor blocks the duct that sends bile from your liver into your digestive system, causing it to back up into your bloodstream. Besides making your skin yellow, this can cause intense itching.

Prescription medication can treat the itch. Some ways to soothe your skin include bathing less often in warm (not hot) water, using thick moisturizers, and wearing loose clothing made from breathable fabrics.

Jaundice can also cause brownish urine and light brown or gray stools. And when you don't have enough bile and pancreatic enzymes to digest fats correctly, your stools may be greasy, smell bad, or float in the toilet. 

Enzyme replacement supplements can help with some of these symptoms, but you can't do much about jaundice on your own. Tell your doctor if you're having these symptoms. You may need a procedure to clear your bile duct.