Managing Swelling in Patients Undergoing Chemotherapy for Pancreatic Cancer

Q: Managing Swelling in Patients Undergoing Chemotherapy for Pancreatic Cancer

Hello： 1. I cannot provide an answer without understanding the medical condition. 2. Eating eggs does not supplement albumin; albumin is produced by the liver and is not directly absorbed from any food. 3. Edema is a clinical manifestation that can accompany m

Lower extremity edema due to chemotherapy for pancreatic cancer?

Hello Dr.
Chen, my father is 71 years old and has stage 4 pancreatic cancer.
He is currently undergoing chemotherapy with Gemcitabine and Abraxane, and he has completed his 13th cycle.
Starting from the 13th cycle, he has also begun radiation therapy.
After several rounds of chemotherapy, my father started experiencing edema in his feet, particularly in the soles.
This swelling is especially noticeable the day after chemotherapy, usually lasting for 1 to 3 days, where it subsides in the morning and returns in the evening.
I have researched and consulted with doctors, and they have indicated that this is a side effect, as it resolves on its own, accompanied by some numbness but no pain.
Overall, my father's condition seems stable.
However, during the 12th and 13th cycles, the edema has noticeably worsened, affecting not only his soles but also his calves and thighs, with the duration of swelling increasing; for instance, the swelling from the 12th cycle lasted a week.
Although it still subsides somewhat in the morning, it is more pronounced compared to before.
I previously asked the doctor about this, and they did not mention any ascites.
Compared to earlier when the edema was less pronounced, he has experienced fewer episodes of diarrhea (about twice a day, which is normal for him).
I wonder if the reduced diarrhea (which used to be more frequent) is related to the retention of fluids.
When he had more diarrhea, he was losing weight, and now he is maintaining around 46 kg, with the edema causing his weight to rise to about 47 kg (he is 155 cm tall).
I would like to ask Dr.
Chen: 1.
Is the edema a result of cumulative side effects from chemotherapy? 2.
I have read that it might be due to low albumin levels; would it be beneficial for my father to consume more eggs for supplementation? 3.
At what point should we seek medical attention for the edema, and which specialty should we consult? I have many questions, and I appreciate your response.
Thank you.

Cha Cha, 30~39 year old female. Ask Date: 2022/06/02

Dr. Chen Yunfang reply Oncology

Hello: 1.
I cannot provide an answer without understanding the medical condition.
2.
Eating eggs does not supplement albumin; albumin is produced by the liver and is not directly absorbed from any food.
3.
Edema is a clinical manifestation that can accompany many different diseases, so ultimately, I do not know the extent of his cancer condition.
However, I believe that aside from his oncologist, there are likely no other specialists willing to take over his care.
Thank you.

Reply Date: 2022/06/02

More Info

Managing swelling in patients undergoing chemotherapy for pancreatic cancer can be a complex issue, particularly when considering the various factors that contribute to edema (swelling) in this patient population. In your father's case, who is undergoing chemotherapy with Gemcitabine and Abraxane, and has recently started radiation therapy, it is important to understand the potential causes and management strategies for his swelling.

1. Chemotherapy Side Effects: The swelling your father is experiencing, particularly in the lower extremities, can indeed be a side effect of chemotherapy. Chemotherapy can lead to fluid retention due to several mechanisms, including changes in blood vessel permeability, kidney function, and the body's overall fluid balance. As the treatment progresses, cumulative side effects may become more pronounced, which could explain the increased severity of his edema after the 12th and 13th cycles of treatment.
2. Hypoalbuminemia: You mentioned the possibility of low albumin levels contributing to the swelling. Hypoalbuminemia (low levels of albumin in the blood) can lead to a decrease in oncotic pressure, causing fluid to leak into the interstitial spaces and resulting in edema. Encouraging your father to consume protein-rich foods, such as eggs, can be beneficial. However, it is essential to monitor his overall nutritional status and consider consulting a dietitian who specializes in oncology nutrition. They can provide tailored dietary recommendations to help improve his protein intake and overall nutritional health.

3. When to Seek Medical Attention: It is crucial to monitor the severity and duration of the swelling. If the edema becomes persistent, significantly affects his mobility, or is accompanied by other concerning symptoms (such as shortness of breath, chest pain, or significant weight gain), it is advisable to seek medical attention promptly. In such cases, a visit to his oncologist is appropriate, as they can evaluate whether the swelling is related to chemotherapy, assess for potential complications (such as heart or kidney issues), and determine if any adjustments to his treatment plan are necessary.

4. Potential Management Strategies: In addition to dietary modifications, there are other strategies that may help manage swelling:
- Elevation: Encouraging your father to elevate his legs when sitting or lying down can help reduce swelling.

- Compression: Compression stockings may be beneficial in managing lower extremity edema, but they should be used under medical guidance.

- Diuretics: In some cases, physicians may prescribe diuretics to help manage fluid retention, but this decision should be made by his healthcare team based on a thorough evaluation of his condition.

5. Monitoring Weight and Symptoms: Keeping track of your father's weight and any changes in his symptoms is vital. If he experiences significant fluctuations in weight (especially if he gains more than 2-3 pounds in a day), or if the swelling does not improve with conservative measures, it is essential to contact his healthcare provider.

In conclusion, while some degree of swelling can be a common side effect of chemotherapy, the increasing severity in your father's case warrants careful monitoring and possibly further evaluation by his healthcare team. Open communication with his oncologist about these changes is crucial to ensure that he receives the appropriate care and support throughout his treatment journey.

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