Managing symptoms

Thursday 1 May, 2014

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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.

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.

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 or hypnotherapy
  • treating the cause of the pain with chemotherapy, radiotherapy or surgery.
"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

Chemotherapy, radiotherapy and surgery may be used to reduce pain, even though they may not be able to treat CUP.

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. 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 relieve pain.

Surgery

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. 

Nausea

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. 

Tips
  • Eat small meals as often as you can.
  • 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 cooking smells.
  • Take anti-nausea medication regularly and before pain medication.
  • Use stress reduction techniques such as meditation or relaxation.
  • Call Cancer Council 13 11 20 for information on dealing with nausea and lack of appetite.

Breathlessness

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.

Tips
  • 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. 

Tips
  • Eat small meals and snacks frequently.
  • Use small dishes so food isn’t ‘lost’ on the plate, such as soup in a cup or dessert in a wineglass.
  • 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 and nutrients.
  • 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 supplements.

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 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
  • anxiety
  • lack of sleep
  • drugs such as analgesics, antidepressants and sedatives
  • anaemia (low red blood cell levels) • infection.
Tips
  • Talk about the fatigue with your friends, relatives and carers so it helps 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, doing stretches or sitting out of bed for meals can help.
  • 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.

Key points

  • 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 more information.
  • 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 be ongoing.
  • 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.

Updated: 01 May, 2014