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Essential guide to Pancreatic Cancer Follow-up and Support, including lifestyle changes, enzyme therapy, nutritional care, and managing the risk of recurrence.
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The pancreas is the engine of digestion. When it is compromised by cancer or altered by surgery, malnutrition becomes a primary concern. The inability to properly digest food leads to weight loss, muscle wasting (sarcopenia), and a weakened immune system, all of which can hinder recovery and tolerance to treatment. Therefore, nutritional management is not secondary; it is a central pillar of care.
A critical component of this management is Pancreatic Enzyme Replacement Therapy (PERT). Since the pancreas may no longer produce sufficient enzymes to break down fats and proteins, patients must take prescription enzyme capsules with every meal and snack. These capsules effectively mimic the pancreas’s function, allowing the body to absorb nutrients. Proper dosing is essential and is titrated based on the meal’s fat content and the patient’s symptoms.
Dietary adjustments are also necessary. Patients are often advised to eat smaller, more frequent meals rather than three large ones to reduce the digestive load. High-calorie, high-protein foods are encouraged to maintain muscle mass. In cases of severe weight loss, oral nutritional supplements or even temporary tube feeding may be employed to ensure the patient has the strength to endure chemotherapy or surgery.
Pancreatic cancer or its surgical treatment can lead to pancreatogenic diabetes (Type 3c diabetes). This form of diabetes is distinct from Type 1 and Type 2 because it involves the loss of both insulin (which lowers blood sugar) and glucagon (which raises blood sugar). This dual loss can make blood sugar levels volatile and more complex to control, posing a risk for both hyperglycemia (high blood sugar) and hypoglycemia (low blood sugar).
For patients who undergo total pancreatectomy, the condition is immediate and permanent, requiring lifelong insulin therapy. For others, the severity depends on how much healthy pancreatic tissue remains. Management requires frequent blood glucose monitoring and close collaboration with an endocrinologist. Modern continuous glucose monitors (CGMs) are highly beneficial for these patients, providing real-time data to prevent dangerous drops in blood sugar.
Control of blood sugar is not just about long-term health; high blood sugar can impair wound healing after surgery and increase the risk of infection. Therefore, strict glycemic control is integrated into the perioperative and oncological care plan. Education about the signs of low and high blood sugar is vital for patients and their caregivers.
Pain is a significant symptom in pancreatic cancer, usually caused by the tumor infiltrating the retroperitoneal nerves. Effective pain management is a moral and clinical imperative. The World Health Organization’s analgesic ladder is often followed, but for pancreatic cancer, early intervention is key. This is not limited to oral medications; it involves procedural interventions that target the source of the pain directly.
A Celiac Plexus Block is a standard procedure where a pain specialist or gastroenterologist injects an anesthetic or neurolytic agent (like alcohol) into the bundle of nerves behind the pancreas. This blocks the transmission of pain signals to the brain. This can be done via Endoscopic Ultrasound or through the skin (percutaneously). By reducing the pain at the source, patients can often lower their dosage of opioid medications, thereby reducing side effects like sedation and constipation.
Palliative care is often misunderstood as end-of-life care. In reality, supportive (palliative) care begins at diagnosis. It focuses on symptom management—treating nausea, addressing sleep disturbances, and managing depression or anxiety. Early integration of palliative care has been shown in clinical studies to not only improve quality of life but also to extend survival by ensuring patients are physically able to continue with their cancer treatments.
For patients who have undergone successful curative treatment, the post-treatment phase shifts to surveillance. The goal is to detect any recurrence of the cancer at the earliest possible stage. Surveillance schedules typically include physical exams, CA 19-9 blood tests, and CT scans of the chest, abdomen, and pelvis every 3 to 6 months for the first 2 years, then annually for up to 5 years.
Survivorship care also addresses the long-term physical and emotional effects of the disease. This includes managing chronic digestive issues, adjusting to a “new normal” regarding energy levels, and addressing the psychological impact of the diagnosis (“scanxiety”—the anxiety preceding check-up scans). Rehabilitation services, including physical therapy to rebuild core strength after abdominal surgery, are encouraged.
Support groups and psycho-oncology services play a vital role. Connecting with others who have navigated the same path provides emotional validation and practical advice. Liv Hospital emphasizes a holistic approach, recognizing that recovery is not just the absence of a tumor but the restoration of the patient’s well-being.
Send us all your questions or requests, and our expert team will assist you.
If you have had surgery that removed a significant portion of your pancreas, or if a tumor blocks the pancreatic duct, you will likely need enzyme replacement therapy permanently. The pancreas does not regenerate its exocrine function, so the external enzymes are necessary to digest food and prevent malnutrition.
The itching (pruritus) is caused by bile salts in the skin. The most effective treatment is to relieve the biliary obstruction, usually by placing an endoscopically placed stent. Until that procedure is done, doctors can prescribe specific medications (bile acid sequestrants) and antihistamines, and advise keeping the skin cool and moisturized.
Recurrence signs can be nonspecific but may include renewed unexplained weight loss, a return of abdominal or back pain, rising CA 19-9 levels in blood tests, or new digestive difficulties. However, some recurrences are asymptomatic and only detected on routine surveillance scans.
Yes, and it is encouraged. Light to moderate exercise, such as walking or gentle yoga, can help combat cancer-related fatigue, improve mood, and maintain muscle mass. The intensity should be tailored to how you feel each day, and it is important to rest when the body demands it.
Palliative care is supportive care provided at any stage of the illness, even while undergoing curative treatments such as chemotherapy or surgery, to manage symptoms and improve quality of life. Hospice is a specific type of palliative care reserved for the end of life when curative treatments are stopped. You can receive palliative care without being in hospice.
Almost 90% of cancer-related deaths result from metastatic disease, which happens when cancer spreads from its original site to other parts of the body. Understanding
Nearly 1 in 5 cancer patients see their cancer come back, often because the cancer has spread without being caught early. This makes it crucial
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