On this page: Pain | Nausea | Breathlessness | Lack of appetite | Fatigue | Key points
Symptoms caused by CUP vary from person to person – you may
have none or only a few. What you experience will depend on
the size and location of the cancer and the type of treatment you
receive. Most symptoms can be relieved. There also may be things
that you or your treatment team can do to prevent them.
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.
Pain management is now recognised as a specialised field of
medicine. There are many ways to relieve pain, including:
- pain medications such as paracetamol, non-steroidal
anti-inflammatory drugs (NSAIDs) and opioids
- a pain-relieving nerve block procedure
- epidural or spinal medication
- non-medication methods, such as massage, meditation, yoga
- treating the cause of the pain with chemotherapy, radiotherapy
"When you get pain relief right, there is really nothing
better – even winning the lottery wouldn’t be better." – Jamie
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.
How and where the pain is felt, and how it affects your life, can
change. Regular check-ups with pain management experts can
help keep the pain under control. It’s better to take medication
regularly, rather than waiting for the pain to occur. For more
information see overcoming cancer pain.
Treatments used to relieve pain
and surgery may be used to
reduce pain, even though they
may not be able to treat CUP.
treatment can shrink the size
of a cancer that is pressing
on nerves or organs and
relieve some types of pain. The
number of treatments varies,
but they may be fewer than
when radiotherapy is used in
early-stage cancer. Different
types of radiotherapy may be
used. Radioactive injections of
strontium are sometimes used
when the cancer has spread to
many places in the bone – the
radioactive drug settles in the
bones near the cancer and
helps to stop its growth and
Surgery may be
done to remove an isolated
tumour; treat a serious
condition like a bowel
obstruction that is causing
pain; or improve outcomes
from chemotherapy and
radiotherapy by reducing the
size of the cancer.
Feeling sick in the stomach (nauseated) is an unpleasant symptom
that can be caused by:
- the cancer itself
- 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 for pain
- 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. Tell your doctor or nurse so
they can treat you. They may prescribe anti-nausea medication or
drugs that lower blood calcium levels, or suggest dietary changes.
- Eat small meals as often as
- Eat cold foods, such as
sandwiches, salads, stewed
fruit or jelly.
- Have food or drink with
ginger, e.g. ginger ale, ginger
tea or ginger cake.
- Avoid strong odours and
- Take anti-nausea medication
regularly and before pain
- Use stress reduction
techniques such as
meditation or relaxation.
- Call Cancer Council 13 11 20 for information on
dealing with nausea and lack
Some people with CUP experience breathlessness. You may find
the feeling of being breathless frightening. Feeling anxious can
make breathlessness worse. Some of the causes include:
- fluid surrounding the lungs (pleural effusion)
- having an infection in the lungs
- the cancer itself
- anaemia (low red blood cell count)
- 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 cavity) or
medication prescribed for an infection or other lung problem.
A low dose opioid medication (often used for strong pain) is
sometimes used to ease the distress of breathlessness.
- Sit up to ease your breathing or
lean forward to rest on a table.
You might want to try sleeping
in a more upright position.
- Try to relax or practise
breathing techniques. A
physiotherapist can help you
with different techniques, or
listening to a meditation CD or
relaxation CD might be useful.
- Use a fan or open a window
to get a draught of air moving
near your face.
- Try breathing in time with
someone else, especially
slowing your breath. This can
be done during a breathless
episode, or you can do it at
other times as practice for
when you need it.
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. If you are feeling sick (nauseated) or have a
sore mouth, this may also make you not want to eat.
ou may go through periods of having no appetite. This may last
a few days or weeks or it could be ongoing. You may be unable to
eat the way you used to.
- Eat small meals and snacks
- Use small dishes so food isn’t
‘lost’ on the plate, such as
soup in a cup or dessert in a
- Avoid fatty or sugary food.
- Eat moist food, e.g. scrambled
eggs or stewed fruit, which is
less irritating to a sore mouth.
- Eat more of your favourite
foods – follow your cravings.
- Add an egg, ice-cream or fruit
to a drink to increase calories
- Use lemon juice and salt to
add flavour to bland food.
- Try sipping clear liquids
followed by something light
such as biscuits.
- Let your doctor or nurse know
if you’re not eating properly
due to a sore mouth, as this
can be treated.
- Ask your dietitian if you can
use nutrition supplements
to help slow weight loss and
maintain muscle strength.
A dietitian can also advise
you about other useful
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 their
tiredness is worse than any pain or nausea they experience.
Tiredness can be caused by a range of things such as:
- progression of the cancer
- cancer treatment such as chemotherapy or radiotherapy
- poor nutrition causing loss of weight and muscle tone
- lack of sleep
- drugs such as analgesics, antidepressants and sedatives
- anaemia (low red blood cell levels)
- Talk about the fatigue with your
friends, relatives and carers so
it helps them understand how
- Plan to do things at the time
of day when your tiredness is
- 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, doing stretches
or sitting out of bed for meals
- Have a short rest during the
day. Naps can refresh you
without making it hard for you
to sleep at night.
- Call Cancer Council 13 11 20 for information about
managing your fatigue.
- Treatment for CUP can affect
the body in different ways
and cause various symptoms.
- Not everyone experiences
all the same symptoms.
There are ways to treat the
symptoms you have.
- Depending on the cancer and
treatment(s) given, you may
experience other symptoms
not listed in this chapter. Your
health care team can provide
- Pain is a common symptom
for people diagnosed with
CUP. It can usually be
controlled using medication.
- Nausea can be caused by
many things. Eating small
meals may help.
- Treatment of breathlessness
will depend on the cause.
Relaxation and breathing
techniques may help.
- Lack of appetite is a common
problem faced by people
with CUP. This may last a few
days or weeks or be it could
- Fatigue can be a major issue
for many people. It may be
caused by anaemia.
- Talk to your health care team
about any of the symptoms
that you experience, as they
may be able to suggest ways
to manage them.
Reviewed by: A/Prof Linda Mileshkin, Consultant Medical Oncologist,
Division of Cancer Medicine, Peter MacCallum Cancer Centre, VIC; Karen Hall, Nurse Counsellor,
Helpline, Cancer Council SA and Clinical Nurse, Oncology/Haematology Inpatient Unit, Flinders
Medical Centre, SA; A/Prof Chris Karapetis, Director of Clinical Research, Medical Oncologist,
Flinders Centre for Innovation in Cancer, SA; A/Prof Claire Vajdic, Team Leader, Cancer Aetiology and
Prevention Group, Prince of Wales Clinical School, Lowy Cancer Research Centre, University of NSW,
NSW; and Robyn Wagner, Consumer.