11) Is this symptom or side-effect unusual?

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11) Is this symptom or side-effect unusual?

We noticed that many of the messages posted in the chat room ask about syptoms and side effects of treatment. Most of you want to know if a certain condition that you or your loved one is experiencing is unusual or cause for alarm. Below is a table of commonly experienced symptoms of pancreatic cancer and side effects of various treatments.

As always, this information is not a substitute for your physician's advice but a resource that will allow you to realize how your experience relates to other's in similar situations. NOTE: Other symptoms not listed here may arise due to the spread of cancer to distant sites or as a result of chemotherapy or radiation therapy.

Reported symptoms and side effects
Condition	Frequency	Cause	Intervention
Abdominal Distension (Ascites)	not uncommon during advanced disease	Spread of the cancer to the abdominal cavity	Treatment varies depending on the cause.
		Liver disease
		Portal vein thrombosis
Abdominal Pain	very common approximately 3/4 of patients with advanced disease	Often caused by the tumor growing large enough to push against surrounding organs and nerves. May worsen after eating or when lying down. Also common during recovery from surgery.	Pain medication (analgesics) Opiates are very effective if taken regularly and at correct dosage. Opiates frequently cause constipation and may be taken with laxatives. If pain persists, a celiac nerve block may be considered. This involves the injection of alcohol into the nerves near the pancreas to block the sensation of pain. The injection can be given through the skin, during surgery or during an endoscopic ultrasound.
Anemia a low red blood cell count	occasional	Often related to chemotherapy.	Medication: Erythropoietin
Anorexia a diminished apetite and/or aversion to food	common during advanced disease	Loss of appetite and signs of physical weight loss. Weight loss is common to almost all types of cancer.The cancer cells compete with normal cells for nutrients. Also, tumors of the pancreas often interfere with digestion which furthur contributes to wieght loss.	It is difficult to treat this weight loss especially loss of muscle mass. Supplemental pancreatic enzymes and nutritional supplements such as Ensure. Appetite stimulants (medroxyacetate) may be of modest benefit. Occasionally a PEG feeding tube is placed in the stomach via endoscopy.
Back Pain	very common especially during advanced disease	Often caused by the tumor growing large enough to push against surrounding organs and nerves. May worsen after eating or when lying down.	Pain medication (analgesics) Opiates are very effective if taken regularly and at correct dosage. Opiates frequently cause constipation and may be taken with laxatives. If pain persists, a celiac nerve block may be considered. This involves the injection of alcohol into the nerves near the pancreas to block the sensation of pain. The injection can be given through the skin, during surgery or during an endoscopic ultrasound.
Bone Pain	uncommon	Spread of the cancer to bone	Medication (Biphosphorates) may be helpful.
Bone Pain	uncommon	Osteomalacia as a result of malnutrition	Vitamin supplements.
Bruising	uncommon	The anti-cancer drugs given during chemotherapy effect normal cells as well as cancer cells. When normal blood cells are effected, they may not clot well which can lead to easy bruising.	If severe, platelet and blood transfusions may be administered.
Bleeding	uncommon	The anti-cancer drugs given during chemotherapy effect normal cells as well as cancer cells. When normal blood cells are effected, the blood cells may not clot well which may cause the patient to bleed easily.	If severe, platelet and blood transfusions may be administered.
Chills	common	Infection caused by obstruction of the bile ducts and/or biological therapy (vaccines).	Antibiotics May require a stent to relieve obstruction. The stent can be placed endoscopically or percutaneously via the liver. Hospitalization may be required.
Cramping	fairly common	May be present after surgery due to electrolyte imbalances.	Only intervention is to correct electrolyt balance.
Diabetes (new onset)	common	Due to impaired insulin secretion by the pancreas as a result of abnormal hormone secretion by the pancreatic cancer.	Removal of part of the pancreas cancer often cures the diabetes.
Diabetes (new onset)	common	May also occur after surgical removal of entire pancreas or a portion of it.	Insulin replacement
Diarrhea	very common after surgery	Many patients have diarrhea after surgery. This is caused by a lack of pancreatic enzymes which effects digestion. Adjuvant chemotherapy may aggravate pre-existing diarrhea.	Medication to replace pancreatic enzymes and possibly dietary changes.
Depression	common	Related both to the emotional reaction to the diagnosis and to direct effects of the cancer.	Supportive therapy and/or antidepressant medication.
Condition	Frequency	Cause	Intervention
Fatigue	very common after surgery	Surgery, radiation therapy, and/or chemotherapy are all a strain on the body and often cause fatigue. Malnutrition and anemia also contribute.	There is not much to do other than resting as necessary. Paradoxically, exercise is important to improve stamina, health diet and psychological support.
Fever	Common during advanced disease	Obstruction of bile ducts can lead to infection in the bile ducts and possibly the liver. The body's immune response to the infection results in a fever.	Surgical relief of obstruction, stent placement, antibiotics
Fever	rare during vaccine therapy	In rare cases biological therapy can also cause fevers.	antipyretics
Hair thinning and hair loss	uncommon with drugs used for PC	Anti-cancer drugs used in chemotherapy are chosen because they effect cells that divide rapidly, such as cancer cells and hair root cells. However, this is uncommon, less than 5%, during pancreatic cancer treatment.	There is no way to prevent hair from falling out as a result of chemotherapy. Hair usually begins growing back within one month after the treatment ends.
Hair thinning and hair loss	uncommon	Radiation therapy can cause hair loss in affected area.
Itchiness (Pruritis)	Common during advanced disease	Occurs due to obstruction of bile ducts- see jaundice below.	Surgical relief, stent placement
Jaundice	very common	The last portion of the bile duct traverses through the pancreas before entering the duodenum and is liable to blockage. When the duct becomes blocked (obstructed) bile backs up into the liver and enters the bloodstream. This leads to a visible yellowing of the skin, eyes and bowel movements.	Surgical relief (cholecystectomy), stent placement
Loss of appetite (anorexia)	very common	Chemotherapy	Nutritional supplements such as Ensure. Megace (medoxy progesterone) may be helpful.
Mouth sores	uncommon occur in patients during chemotherapy treatment	The anti-cancer drugs used in chemotherapy are chosen because they effect cells that divide rapidly, such as cancer cells. The cells of the digestive tract also divide rapidly and are therefore strongly effected by these drugs. More often occur during 5-Fu chemotherapy. Also occurs with gemcitabine but not quite as often.	Antiseptic and analgesic mouthwashes may be prescribed to numb the discomfort. The sores will heal on their own without medication.
Muscle aches	rare	Biological therapy (vaccines)	Probably reflects a flu-like reaction and therefor may respong to acetomenophen (e.g. Tylenol)
Nausea	common 30-50% depending on stage	Obstruction of digestive tract by tumor.	Surgical relief
Nausea	common 30-50% depending on stage	Radiation therapy Chemotherapy	Metoclopromide or other antivomiting drugs may be prescribed.
Rash	common	Due to obstruction during advanced stages of disease	There is currently no treatment for these rashes.
Rash	uncommon	Biological therapy (vaccines)	Topical steroids may be prescribed for rashes developing during vaccine therapy.
Skin irritation		Radiation therapy may cause red, dry, tender, itchy skin in affected area. Darkening may also occur.	Patients should consult their doctor before using lotion or cream on the affected area.
Stool discoloration	very common	Jaundice
Condition	Frequency	Cause	Intervention
Swelling during vaccine therapy	very common	Occurs near injection site.	None. Typically goes away in about a week.
Thrombophlebitis inflammation and clotting of veins	uncommon	This condition is marked by inflammation and clotting of veins in the skin. This is the body's response to the cancer or direct spread of the cancer to blood vessels.	Prescription of anticoagulants to prevent clots from forming and potentially causing a stroke.
Urine discoloration	very common	Jaundice The accumulation of bile in the urine makes it appear darker than usual.	Surgical relief (cholecystectomy), stent placement
Vomiting	uncommon More common during advanced disease	Obstruction of digestive tract and/or bile ducts by tumor.	Medication such as Metoclopromide, lorezepam, steroids, ondansetron, granisetron, tetrahydrocannabinol
Vomiting	uncommon More common during advanced disease	Also may be caused by chemotherapy.
Weakness	common	Surgery, radiation therapy, chemotherapy and/or malnutrition are all a strain on the body and often cause fatigue.	There is not much to do other than resting as necessary. See fatigue
Weight loss	very common Most patients with advanced disease	Loss of appetite and signs of physical weight loss. Weight loss is common to almost all types of cancer.The cancer cells compete with normal cells for nutrients. Also,tumors of the pancreas often interfere with digestion which furthur contributes to wieght loss.	It is difficult to treat this weight loss especially loss of muscle mass. Supplemental pancreatic enzymes and nutritional supplements such as Ensure. Appetite stimulants (medioxyacetate) may be of modest benefit. Occasionally a PEG feeding tube is placed in the stomach via endoscopy .
Yellowing of skin or eyes	very common	Jaundice	Surgical relief (cholecystectomy), stent placement

* No two patients with pancreas cancer are identical. The appropriate treatment of individual cases varies greatly depending on the patient's medical and surgical history. The information expressed in this Web page is not medical advice. It is meant only to educate health care professionals and patients about the current status of treatment and research at Hopkins. Before making any medical decisions, patients are advised to consult with their personal physicians.

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