Managing symptoms

Sunday 1 May, 2016

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On this page: Pain | Nausea | Lack of appetite | Breathlessness | Fatigue | Key points


This section discusses the most common symptoms and side effects experienced during treatment for CUP. However, these will vary from person to person – you may have none or only a few, or you may experience others not mentioned here. Most symptoms and side effects can be relieved and some can even be prevented.

Pain

Many people with CUP worry that they will be in pain. Not everyone will experience pain, and those who do may find it comes and goes. Pain depends on the location of the cancer and its size. If you do experience pain, it can usually be controlled. There are many ways to relieve pain, including:

  • pain medicines such as non-steroidal anti-inflammatory drugs (NSAIDs), paracetamol and opioids
  • an injection of pain-relieving drugs into the spinal canal (epidural or spinal block)
  • relaxation therapies, such as massage, meditation or hypnotherapy
  • treating the cause of the pain with chemotherapy, radiotherapy or surgery.

You may need to use more than one pain-relieving method. It may take time to find the right pain-control measure for you. If one method doesn’t work, you can try something else.

Treatments used to relieve pain

Chemotherapy, radiotherapy and surgery are common cancer treatments. They may also be used as palliative treatment to reduce pain, even though they may not be able to treat the CUP itself.

Chemotherapy

This treatment can shrink the size of a cancer that is pressing on nerves or organs and causing pain.

Radiotherapy

This can relieve some types of pain. Different types of radiotherapy may be used. The radioactive form of the metal strontium is sometimes used when the cancer has spread to many places in the bone – the drug is injected and settles in the bones near the cancer. It helps to stop the cancer’s growth and relieves pain.

Surgery

Surgery may be used to remove an isolated tumour; to treat a serious condition like a bowel obstruction that is causing pain; or to improve the impact of chemotherapy and radiotherapy by reducing the size of the cancer.

Pain management experts

Your GP or oncologist may be able to prescribe effective treatment for your pain, but if you are still uncomfortable, ask about seeing

a palliative care specialist. Good pain control is one of the major contributions that a specialist palliative care team can make for someone whose pain is difficult to manage.

How and where the pain is felt, and how it affects your life, may change. Regular check-ups with pain management experts can help keep the pain under control. It’s better to take your pain medicine regularly, rather than waiting for the pain to occur.

For more information see Overcoming Cancer Pain or call Cancer Council 13 11 20.

Nausea

Feeling sick in the stomach (nauseated) is an unpleasant symptom that may be caused by the cancer itself. Other causes include:

  • treatment with chemotherapy or radiotherapy
  • stress or anxiety
  • an imbalance of minerals in the blood, e.g. calcium
  • drugs that control other symptoms, e.g. morphine given for pain
  • the kidneys not working properly
  • oral thrush infection, sometimes related to chemotherapy
  • a bowel blockage (obstruction)
  • increased pressure around the brain as a result of cancer in the brain or cancer affecting the fluid around the spinal cord.

You don’t have to put up with nausea. Your doctor or nurse can suggest treatments such as anti-nausea drugs and dietary changes.

Tips for easing nausea
  • Eat small meals as often as you can.
  • Eat cold foods, such as sandwiches, salads, stewed fruit or jelly.
  • Avoid strong odours and cooking smells.
  • Have food or drink with ginger, e.g. ginger ale, ginger tea or ginger cake.
  • Take anti-nausea medicine regularly and before taking pain medicine.
  • Use stress-reduction techniques such as meditation or relaxation.
  • Call Cancer Council 13 11 20 for more information on dealing with nausea and lack of appetite.

Lack of appetite

Lack of appetite is a common problem faced by people with CUP. Some people don’t feel like eating because of stress from the diagnosis and treatment. The treatment may also change the way food tastes or smells. You might also not want to eat much if you are feeling sick (nauseated) or have a sore mouth, but these problems can often be treated, so let your treatment team know.

You may go through periods of having no appetite. These may last a few days or weeks, or the lack of appetite could be ongoing. You may be unable to eat the way you used to. If you are trying to overcome a lack of appetite, eat when you feel like it and what you feel like. For example, you may find it easier to have your main meal at lunch. Follow your cravings and eat more of your favourite foods.

Tips for when you don’t feel like eating
  • Have small meals and snacks frequently.
  • Use small dishes so food isn’t ‘lost’ on the plate, e.g. serve soup in a cup or dessert in a wineglass.
  • Choose full-fat foods over low-fat, light or diet versions.
  • Use lemon juice and salt to add flavour to bland food.
  • Sip fluids throughout the day. Add eggs, ice-cream or fruit to drinks to increase kilojoules.
  • If you have a sore mouth, eat moist food, such as scrambled eggs or stewed fruit.
  • Ask your dietitian if you can use nutrition supplements to help slow weight loss and maintain muscle strength.

Breathlessness

Some people with CUP experience breathlessness. You may find the feeling of being breathless frightening. Feeling anxious can make breathlessness worse. Causes of breathlessness include:

  • fluid surrounding the lungs (pleural effusion)
  • an infection in the lungs
  • the cancer itself
  • anaemia (low levels of red blood cells)
  • pressure from a swollen abdomen
  • chronic breathing disorders, such as asthma or emphysema.

Treatment will depend on what is causing the breathlessness. You may need fluid drained from the chest (pleural tap) or medicine for an infection or other lung problem. A low-dose opioid medicine (also used for strong pain) is sometimes prescribed.

Tips to help your breathing
  • Use a fan or open a window to get a draught of air moving near your face.
  • Sit up to ease your breathing or lean forward to rest on a table. Also try sleeping in a more upright position.
  • Try breathing in time with someone else and focus on slowing your breath.
  • Relaxation or breathing techniques may help. A physiotherapist can teach you these, or you could listen to a meditation or relaxation CD.
  • Watch the Lung Foundation's Managing Your Breathlessness video.

Fatigue

For many people, extreme and 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 they find their tiredness harder to manage than their pain or nausea.

Tiredness can be caused by a range of things such as:

  • the cancer itself
  • cancer treatment such as chemotherapy or radiotherapy
  • poor nutrition causing loss of weight and muscle tone
  • anxiety
  • lack of sleep
  • drugs such as pain medicines, antidepressants and sedatives
  • anaemia (low levels of red blood cells)
  • infection.
Tips for managing fatigue
  • Talk about the fatigue with your friends, relatives and carers to help them understand how you feel.
  • Plan to do things at the time of day when your tiredness is least severe.
  • Try to do gentle exercises. Research shows this reduces tiredness, helps preserve muscle strength and gives a sense of normality. Even activities such as walking to the letterbox or getting up for meals can help.
  • A short nap of no more than 30 minutes during the day can refresh you without making it hard for you to sleep at night.
  • Call Cancer Council 13 11 20 for more information about coping with fatigue.

Key points

  • Cancer and its treatment can affect the body in different ways and cause various symptoms and side effects.
  • Depending on the cancer and the treatment(s) that you are having, you may experience other symptoms and side effects not listed in this section. Ask your treatment team for more information.
  • If you are experiencing symptoms or side effects, there are a number of ways to manage them.
  • Pain is a common symptom for people diagnosed with CUP. It can usually be controlled by medication, so tell your treatment team about any pain.
  • Nausea can be caused by many things. Eating small meals may help. You can also talk to your treatment team about medication or dietary changes to manage nausea.
  • Lack of appetite is a common problem faced by people with CUP. This may last a few days or weeks or it could be ongoing. Try to increase your kilojoule intake by choosing full-fat products, adding extra ingredients to drinks, and following your cravings.
  • Breathlessness may have various causes and can feel frightening. If you become breathless, try to get a flow of air from a fan or window moving near your face. Relaxation and breathing techniques may also help.
  • Fatigue can be a major issue. It may be caused by anaemia. Ways to manage the tiredness include planning your day, doing gentle exercise and taking a short nap.
  • Talk to your treatment team about any symptoms or side effects that you experience.

Reviewed by: A/Prof Linda Mileshkin, Medical Oncologist, Peter MacCallum Cancer Centre, VIC; Dr Sarwan Bishnoi, Medical Oncologist, Adelaide Cancer Centre, SA; Dave Clark, Consumer; Dr Jan Maree Davis, Area Director, Palliative Care Service, Calvary Health Care and St George Hospital, NSW; Linda Tompsitt, Cancer Nurse 13 11 20, Cancer Council WA; Catherine Trevaskis, Gastrointestinal Cancer Specialist Nurse, The Canberra Hospital, ACT.

Updated: 01 May, 2016