People experience many different symptoms when they have advanced cancer. Common symptoms include pain, nausea, a lack of appetite, breathlessness and tiredness. As the disease progresses, these symptoms can vary in intensity and frequency, placing different limitations on your body.
Tip: There may be times when you need immediate advice about your symptoms. Find out which doctor or nurse you can contact at any hour of the day or night for urgent advice.
Many people with advanced cancer worry they will be in pain. Not everyone will experience pain as the cancer progresses, and those who do may find their pain comes and goes. Pain depends on the location of the cancer and its size. If you do experience pain, it can usually be controlled. Pain management is recognised as a specialised field for doctors and nurses. Palliative care services specialise in pain management.
There are many ways to relieve pain, including:
"I found the decision to take morphine regularly difficult. Having made it, I have been taking the slow-release tablets for 18 months with no appreciable side effects. Without the morphine, the pain would be too debilitating for me to continue doing all the things I do now."
You may need to use more than one of these pain-relieving methods. And it may take time to find the right pain-control measure for you. If something doesn’t work, there may be other things you can try – ask your doctor to discuss these options.
How and where the pain is felt and how it affects your life can change. Regular reviews by pain management experts can help keep the pain under control. It’s better to take medication regularly, rather than waiting for the pain to build up.
Medications that relieve pain are called analgesics. They may be mild, like aspirin, paracetamol or non-steroidal anti-inflammatory drugs (NSAIDS) or relatively strong, like opioids.
Pain medications may be taken as tablets, other oral mixtures, suppositories, patches and injections, or self-regulating pumps.
The pain specialists will assess your needs to work out the right drug, its dose, and how it will be delivered (for example, if you have a tablet or injection). They also help you control any side effects caused by the pain medication, such as constipation.
Make sure you understand how much medication you should take and how often (the dosage). A diary/instruction sheet can often help, and examples can be found in the Overcoming Cancer Pain booklet.
Morphine is one of the most common opioid drugs used to control moderate to severe cancer pain. It is very effective and comes in quick-acting and long-acting forms. It can be taken for a long time, in increasing doses if needed. It doesn’t have to be only for when the pain is really bad.
Many people are concerned about taking opioids. However, addiction is not a major concern when morphine is taken to relieve pain. Morphine is most effective when taken regularly. It is better to treat the pain early than wait to treat the pain when it builds up. People usually experience side effects when they take morphine, most of which settle down after a few days.
Managing morphine side effects
|Drowsiness||This decreases after a couple of days so you can carry on normal activities and be pain free.|
|Nausea||If you have difficulty tolerating morphine because of the nausea it causes, you may have to change medication.|
|Constipation||This can be prevented by taking laxatives regularly.|
Even though they may not be able to cure the cancer, chemotherapy, radiotherapy and surgery are used to reduce pain from advanced cancer.
You may have a nerve block if cancer is affecting the nerves and causing pain. A block is when the nerves are directly targeted with pain-relieving medication.
A pain specialist or an anaesthetist usually performs the nerve block procedure. The affected nerve is injected with a drug, such as a local anaesthetic. This makes the nerve unable to send pain signals to the brain. The pain relief is usually temporary; how long it lasts will depend on the type of drugs used. The medication chosen to block the nerve depends on the nerve involved and its role in the body. A nerve block may be used if other pain control methods are unsuccessful. It is usually used in combination with other medications, such as analgesics or antispasmodics.
Feeling sick in the stomach (nausea) is an unpleasant symptom that can be caused by treatment with chemotherapy or radiotherapy or the location of the cancer.
Many people talk about anticipatory nausea, the response your body learns when you know it is chemotherapy time again. Even if you are no longer having chemotherapy, you may still feel a surge of nausea if you’re going past the place where you were treated. You don’t have to put up with nausea. Tell your doctor or nurse so they can identify the cause and give you the right treatment. They may prescribe anti-nausea medication or suggest dietary changes.
Feeling nauseous may also be a symptom of high levels of calcium in the bloodstream (hypercalcaemia). This is more common in certain types of advanced cancer and there are many other symptoms. You may need a drug that lowers calcium levels in the blood.
"At first I couldn’t think about eating without thinking about throwing up. Drinking ginger beer helped control the nausea."
People with advanced cancer often experience a lack of appetite. This can result from the illness, treatment, tiredness, an altered sense of taste, pain, lack of activity, depression, nausea or vomiting.
You may go through periods of not wanting to eat. This may last a few days or weeks or it could be ongoing, you may just be unable to eat the way you used to. There are ways to make mealtimes more appealing if you have lost your appetite.
Read Cancer Council’s Nutrition and Cancer booklet for tips on dealing with nausea and lack of appetite.
Some people with advanced cancer experience trouble breathing or breathlessness. You may find the feeling of being breathless quite frightening. Feeling anxious can make breathlessness worse. Let your doctor or nurse know if you feel like this as there may be treatment that helps.
Shortness of breath can be caused by:
Treatment will depend on the cause of the breathlessness. You may need your lungs drained or medication prescribed to treat an infection or other lung problem. Opioids can ease the distress of shortness of breath, just as they ease the distress of pain. Side effects may include constipation and drowsiness. If breathlessness is ongoing, you may be offered portable oxygen.
For many people, extreme or constant tiredness (fatigue) can be a major problem. It can be very distressing for the person experiencing it and for those around them. Some people say their tiredness is worse than any pain or nausea they experience.
Tiredness can be caused by a range of things, such as:
Tell the doctor or nurse if you think you are becoming weaker or more fatigued. The cause may be something treatable, like anaemia or a mineral imbalance. You may be referred to an occupational therapist who can show you techniques for conserving your energy.
|Feeling sick||Lack of appetite|