November is Pancreatic Cancer Awareness Month

By Wendy Kaplan, MS, RDN, CSO, CDCES, CDN

Medical Nutrition Therapy (MNT) is essential for most cancer patients, but even more so for patients with high-risk cancers, such as pancreatic cancer. Maintaining your weight as much as possible can help improve nutritional status, physical functioning, help maintain muscle mass, and enhance the overall quality of life. Therefore, MNT should be incorporated as early as possible to optimize nutritional status. 

The most common type of pancreatic cancer is adenocarcinoma— a cancer of the exocrine cells that can lead to pancreatic exocrine insufficiency. The pancreas produces enzymes that help break down the food we eat and therefore plays a major role in digestion, absorption, and overall nutritional status. When you don’t absorb enough calories and nutrients, you lose weight, increasing the potential for malnutrition.

Most patients with pancreatic cancer lack the enzyme lipase, which is essential for the digestion of fat. As a result, patients may experience the following symptoms: cramping, foul-smelling gas and stools, frequent stools, floating stools, diarrhea, light or yellow-colored stools, and unexplained weight loss. Since these symptoms can show up before, during, and after treatment, it is very important for the Registered Dietitian Nutritionist to continually monitor for these symptoms and address them as soon as possible, along with the interdisciplinary team. 

In addition to experiencing fat malabsorption, patients also experience other NIS (nutrition impact symptoms) due to surgery, systemic treatment agents, and radiotherapy. Common symptoms include poor appetite, early satiety, nausea, vomiting, constipation, diarrhea, excessive gas, and diabetes.

There are other contributors to diarrhea beyond enzyme issues. For example, some patients develop new-onset lactose intolerance or C. diff (also known as Clostridium difficile or C. difficile) due to bacterial growth in a part of the intestine. Others may present with dumping syndrome (rapid gastric emptying) from Whipple surgery. 

Communication is key. Registered Dietitian Nutritionists should always be aware of medications, and other possible contributing factors to symptoms patients are experiencing. For example, if a patient is on narcotics to control pain, this can lead to constipation which may mask diarrhea. I have noticed bowel habits and symptoms changes when coming on/off narcotic medication. Equally as important is for the patient to report any new symptoms and changes in symptoms.

Working with an oncology RDN throughout treatment and survivorship is imperative to help mitigate any nutrition implications of the disease. In addition to symptom management, Registered Dietitian Nutritionists actively help patients get situated with pancreatic enzymes concerning dosing and timing. Most importantly, MNT can help improve treatment outcomes and empower patients to play a role in their care.


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