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NCCN Guidelines for Patients



Pancreatic Cancer, Version 1.2017


Supportive care

Pain | Malnutrition | Advance Care


You may have pain caused by the cancer. Pain can

occur when the tumor grows into nearby nerves or

presses against other organs. Pain can be treated

with various types of medication (such as opioids,

which are morphine-like drugs). Another treatment

is to inject alcohol (ethanol) into nerves around the

pancreas to destroy them. This procedure is called

a celiac plexus neurolysis, or nerve block. The

procedure can be performed under either CT or

EUS guidance. Some patients may also benefit from

radiation therapy, with or without chemotherapy, to

help relieve the pain.

Malnutrition or trouble eating

Healthy eating is always important. It includes eating

a balanced diet, eating the right amount, and drinking

enough fluids. Pancreatic cancer or its treatment

may make healthy eating a challenge by causing you

to feel not hungry, have abdominal cramps, or have

trouble digesting food. A registered dietitian who is an

expert in nutrition and food can help.

You may also need drugs for diabetes. Diabetes is

a disease that causes high levels of sugar in the

blood. You may need pills that replace your digestive

enzymes because your pancreas has been removed

or isn’t working well because of the tumor. Digestive

enzymes are proteins that help to break down

(digest) eaten food for the body.

Advance care planning

Talking with your doctor about your prognosis can

help with treatment planning. If the cancer can’t be

controlled or cured, a care plan for the end of life can

be made.

Advance care planning is useful for:



Knowing what to expect



Making the most of your time



Lowering the stress of caregivers



Having your wishes followed



Having a better quality of life



Getting good care

Advance care planning starts with an honest talk

between you and your doctors. You don’t have

to know the exact details of your prognosis. Just

having a general idea will help with planning. With

this information, you can decide at what point you’d

want to stop chemotherapy or other treatments, if at

all. You can also decide what treatments you’d want

for symptom relief, such as radiation, surgery, or


Another part of the planning involves hospice care.

Hospice care doesn’t include treatment to fight the

cancer but rather to reduce symptoms caused by

cancer. Hospice care may be started because you

aren’t interested in more cancer treatment, no other

cancer treatment is available, or because you may

be too sick for cancer treatment. Hospice care allows

you to have the best quality of life as possible. Care

is given all day, every day of the week. You can

choose to have hospice care at home or at a hospice