What causes pancreatic cancer pain?

You may get pain from the cancer in the pancreas, or from pancreatic cancer that has spread to other parts of the body (advanced or metastatic cancer).

Pancreatic cancer can affect the nerves or organs near the pancreas. This can cause pain in the tummy area (abdomen) or the back. Read more about nerve pain.

Pancreatic cancer can sometimes block the duodenum (the first part of the small intestine), which means that food can’t easily flow out of the stomach. This can cause pain and discomfort, as well as making you feel full and be sick. A tube called a stent can be put into the duodenum to treat these symptoms.

If the cancer has spread to the liver, it can make the liver grow larger, and cause pain.

Sometimes, pancreatic cancer can cause fluid to build up in the tummy area. This is called ascites and it can cause pain and discomfort. A small drain may be put into your tummy to drain the fluid. This can help you feel more comfortable. Speak to our specialist nurses on our Support Line for more information on ascites.

The pancreas plays an important role in digesting food, as it produces enzymes that help to break down the food. Pancreatic cancer can affect this, which means that food is not properly digested. This can cause lots of symptoms, including tummy discomfort or pain such as cramps, lots of wind, and bloating.

Pancreatic enzyme replacement therapy (PERT) can help manage problems with digesting food, including pain and discomfort. They replace the enzymes that your pancreas would normally produce and break down food. Brands include Creon®, Pancrease®, Nutrizym® and Pancrex®.

If you are having any problems with your diet and eating, or haven’t been told about pancreatic enzymes, speak to your doctor, nurse or dietitian.

Some cancer treatments can cause short-term or longer-term pain. These include surgery, stents and chemotherapy.

Surgery for pancreatic cancer

You may have surgery, depending on your cancer.

• If there are no signs that the cancer has spread outside of the pancreas, you may be able to have surgery, to remove your cancer.
• Some people with cancer that can’t be removed by surgery may have bypass surgery, to treat a blocked bile duct or a blocked duodenum. This can help deal with symptoms such as sickness or jaundice.

It is normal to have some pain and discomfort for a few weeks after surgery. This is usually controlled with painkillers. For the first few days, painkillers can be given through an epidural (a drip in your spine), or through patient controlled analgesia (PCA). A PCA is when painkillers are given to you through a drip in your arm. If you have pain, you press a button to control the PCA, which will give you the pain relief. Once your pain has reduced, you can take painkillers as tablets.

It is important to speak to your hospital team if you have any problems with pain when you get home after your surgery. If you get sudden tummy pain or your pain gets worse, call your surgical team.

You may have some pain and discomfort for a few months after your operation. This is normal. You may have tingling or occasional sharp pains in your tummy as your muscles heal and your nerves regrow. This may be a sign that your tummy is starting to repair. It can also be a sign that you are doing too much lifting and bending, and your body needs more time to heal.

Stents

A stent is a small tube that is used to open a blocked bile duct or a blocked duodenum. This can help treat symptoms such as jaundice or sickness.

There is a risk that your stent can get infected or move out of place. This can cause sudden tummy pain. Tell your doctor or nurse about any pain straight away. They can give you painkillers to help manage your pain, or antibiotics to treat any infections.

Chemotherapy for pancreatic cancer

Chemotherapy is one of the main treatments for pancreatic cancer. It can help to control the cancer and manage symptoms, but it can sometimes cause discomfort and pain. This may depend on the type of chemotherapy drug you are having.

Chemotherapy can sometimes damage the nerves in your arms, hands or feet. This can cause pain and tingling or numbness in these areas. This is called peripheral neuropathy, and you may need painkillers to help with it.

Chemotherapy can also cause:

• a sore mouth and mouth ulcers
• sore palms of your hands and soles of your feet
• joint or muscle pains
• diarrhoea or constipation which can be uncomfortable
• bloating and discomfort in your tummy.

Tell your doctor or nurse if you have any of these or any other side effects while having chemotherapy.

If you are having chemotherapy and have any pain or tightness in your chest, or any pain or swelling in your arms or legs, contact your doctor or nurse straight away.

Constipation is when you have problems emptying your bowels. This can be very uncomfortable and cause pain. You may also feel bloated or feel sick.

There are a few causes of constipation. You may be more likely to get constipation if you are not moving around much, or if the cancer has affected your digestion. Some chemotherapy drugs or opioid painkillers, such as morphine, can also cause constipation.

There are ways to deal with constipation. For example, you should be given medicines called laxatives to take with opioid painkillers to prevent constipation.

Many things can affect the way you feel pain, including:

• how you feel about dealing with pain
• stress and worry – about the pain, cancer, or other things
• depression
• your spiritual or religious beliefs
• your relationships with other people, like your family or medical team.

Your doctor or nurse should regularly check the emotional impact of the symptoms of pancreatic cancer, including pain. This is to check that you are getting the treatment and support you need. Make sure you speak to your doctor or nurse about how you are feeling, especially if you are struggling at all.

There are things that can help you cope with the emotional effects of pancreatic cancer. Your medical team can offer emotional as well as medical support. And you may also be able to have counselling. Some people find that complementary therapies such as massage can help manage pain and the emotional impact.