Long term physical effects after pancreatic cancer treatment

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People can feel fatigued (extreme tiredness) for up to a year after treatment for pancreatic cancer and potentially longer. Though this is frustrating, it is normal, and you need to give yourself time to recover. Other long-term effects of pancreatic cancer are detailed below.

• Nausea and vomiting
• Lack of appetite
• Diabetes
• Pancreatic Enzyme Replacement Therapy
• Lymphoedema
• Osteoporosis
• Fertility

Nausea and vomiting

Nausea and vomiting can be a side effect of treatment for a long time. There are many reasons why you may feel or be sick after the disease. Some people find that chemotherapy causes long term changes in their taste and smell and what they prefer to eat.  

There are many ways of dealing with nausea and vomiting, avoiding strong smelling foods or cooking smells can be helpful as can eating and drinking products with a taste of lemon, ginger or mint.

Some people find it helps to change the temperature of food and eat things that are cold or at room temperature. Adjusting the texture of food may also help, and taking your time over making sure you chew properly and eat at your own pace.

Some people require medication to prevent nausea and vomiting, you will need to discuss this with your GP if you think you may need this.  

Lack of appetite

Some people find that during their pancreatic cancer treatment they lose their appetite and once treatment has finished this does not always immediately return. You may have lost weight over the course of your disease and treatments and therefore the pressure to eat may be quite high from friends and family. Speaking to your dietitian about loss of appetite can be helpful as there may be solutions to the problem in the form of supplements.  

Replacing low fat with full fat options can help you to gain weight. As can fortifying meals by adding cream or milk powder to food such as soups, mash potato and porridge. If you can only manage soft, easy to eat foods such as soup or puddings you can be prescribed fortified versions of these.  

You may also be prescribed high calorie drinks to help maintain or increase your weight if you don’t feel like eating. These can come in a variety of flavours and juice or milk forms to suit your taste. 

Diabetes

After some or all of the pancreas is removed, people often develop diabetes. This type of diabetes is called Type 3c. You may not have heard of this before your illness.

It means that your pancreas is no longer able to produce enough insulin, the hormone that controls the blood sugar levels in your body. You may have tablet medication or need to inject insulin to replace what is lost after pancreatic cancer surgery. Some people are able to have an insulin pump, which places a needle under the skin and gives a continuous infusion of insulin throughout the day.

If you develop the symptoms of diabetes, then speak to your GP who will be able to test for the condition. You may then be referred to an endocrinologist (a specialist doctor) or diabetic nurse who will be able to recommend treatments to best control your diabetes.  

Diabetes can be difficult to manage at first as you learn the best way to keep your blood sugars under control. Over time, this should become easier. 

Symptoms of diabetes include; 

• Fatigue 
• Needing to urinate often 
• Feeling very thirsty 
• Weight loss 
• Blurred vision 

People who are diabetic sometimes have numbness or tingling in their hands or feet. This is called peripheral neuropathy. If this happens to you, you may not notice any cuts or bruises to the skin, and they can take longer to heal than usual. You will need to take care of your hands and feet and if you can’t, you will need to ask someone close to you for help or make regular appointments with podiatrists (foot care specialists).  

Pancreatic Enzyme Replacement Therapy (PERT)

One of the functions of the pancreas is to release “pancreatic juices” containing enzymes. This juice helps the body to digest food and absorb all its nutrients. When the pancreas is removed or damaged by pancreatic cancer, this juice cannot be produced, and the body cannot take all the nutrients it needs from your diet. Symptoms of this happening include:

• More frequent bowel movements that may be loose 
• Pale, smelly stools that float 
• Weight loss despite good appetite 
• A lot of flatulence (wind)

If you have any of these signs, then contact your GP or specialist nurse. More information on PERT.

Lymphoedema

After some treatments for pancreatic cancer, fluid can build up in the body tissues and create swelling. This can often happen after surgery. Lymph fluid is normally present in all body tissues. It is carried into areas of the body by blood vessels and then drains back out through lymph nodes. When the lymph nodes are removed during surgery, blocked or damaged by the tumour the fluid cannot drain back out and the area swells.  

You can help to control lymphoedema by exercising to keep the lymph fluid moving and taking care of your skin when it is swollen to prevent infection or damage. Sometimes compression bandages are used to prevent the swelling and massage to promote lymphatic drainage can help.  

Osteoporosis

Due to malabsorption caused by pancreatic cancer and sometimes treatments for this disease, you may be at high risk of developing osteoporosis. This is a condition that weakens bones so that they become more likely to break. If you do have malabsorption, then pancreatic enzyme replacement will reduce your risk of osteoporosis.  

Fertility

The effect of pancreatic cancer on your fertility will depend on your age, any other conditions you have and the treatments you are given.  

Gemcitabine may affect male sperm for some time after treatment. Chemotherapy may also induce early onset menopause in women under menopausal age. If you have any concerns regarding long term fertility after pancreatic cancer and you have not already, discuss these with your specialist nurse or GP.