Surgery can be used to:

• remove all or part of a tumour from affected areas, such as the bowel or lymph nodes
• relieve discomfort caused by tumours blocking organs or pressing on nerves
• reduce tumour size (debulking) to help improve outcomes from chemotherapy and radiation therapy
• insert a thin tube (stent) into a blocked organ to create a passage for substances to pass through.

Drugs can travel throughout the body. This is called systemic treatment. Drug therapies include chemotherapy, hormone therapy, immunotherapy and targeted therapy. Some drug therapies:

• can reduce a cancer that is causing pain because of its size or location
• slow the growth of a cancer
• help control symptoms, including pain and loss of appetite
• reduce inflammation and relieve symptoms such as bone pain. 

Radiation therapy can shrink tumours or stop them spreading further. It can also relieve some symptoms, such as pain from secondary cancers in the bones. Y

ou can have radiation therapy in different ways and doses. It can be given in single or multiple visits.

Many people feel shocked, fearful, sad, anxious, guilty or angry when referred to palliative care. Some people feel relief or a sense of inner peace.

It is quite common for people diagnosed with advanced cancer to have continued feelings of depression. Signs of depression include trouble thinking clearly, losing interest in things you used to enjoy, or changes to sleep patterns and appetite.

If you think you may be depressed, it is important to talk to your doctor, because counselling or medicines – even for a short time – can help.

For information about coping with depression and anxiety, call Beyond Blue on 1300 22 4636. For 24-hour crisis support, call Lifeline 13 11 14.

You may find that while some friends and family members are supportive, others may avoid you or not know what to say. This can be difficult, and you could feel isolated or upset.

Advanced cancer can mean changes to your lifestyle – at some point, you may need to leave work, or perhaps stop driving or other activities that are important to you. These changes can cause further sadness or stress.

It will often help to talk to someone. Your partner, family and close friends may be able to offer support, or you might like to talk to:

• members of your palliative care or treatment team
• a counsellor, social worker or psychologist
• your religious leader or spiritual adviser
• a telephone support group or peer support program
• Cancer Council 13 11 20.

Whether you have pain will depend on where the cancer is and its size. Pain is different for everyone, and even people with the same type of cancer can experience different levels of pain.

Palliative care services are specifically trained in pain management. If you do have pain, they will help you control the distress it is causing as much as possible.

Many people need a combination of treatments, such as pain medicines and complementary therapies, to achieve good pain control.

Some people worry about becoming addicted to pain medicine but this is unlikely when medicines are taken palliatively. Your health care team will monitor you to avoid and manage potential side effects.

Taking high-strength opioids (such as morphine) as prescribed will not shorten life – people may even live longer with better quality of life when their pain is treated effectively.

Talk to a specialist palliative care service if the dose you have been prescribed does not relieve your pain. 

Many people with advanced cancer do not feel like eating or drinking. This may be because of the cancer or a side effect of treatment. Loss of appetite may also be caused by anxiety, fatigue or depression.

However, food and drinks help maintain your strength and bowel movements, which improves your quality of life.

Loss of appetite – you don’t need to force yourself to eat. This may make you feel uncomfortable, and cause vomiting and stomach pain.

Try having small meals, eating your favourite foods more frequently, and relaxing your usual dietary restrictions. It is common to feel less hungry as the disease progresses. 

Nausea – you may feel sick (nausea), have reflux or have trouble keeping food down. You will probably be given anti-nausea medicine that you can take regularly to relieve symptoms.

Finding the right one can take time – let your palliative care team know if the dose needs to be adjusted or another medicine can be tried.

Having an empty stomach can make your nausea worse – try to eat something soon after getting up in the morning and then eat small meals and snacks regularly throughout the day.

Try to drink water or other fluids, and consider eating foods with ginger, which can ease nausea.

Difficulty swallowing – if chewing and swallowing become difficult, you may need to change the consistency of your food by chopping, mincing or pureeing.

A speech pathologist can check how well you’re swallowing and advise the best food texture.

Many people have difficulty passing bowel motions (constipation), often as a side effect of opioids, cancer treatments or other medicines, or because of changes to what they’re eating or how much they’re moving.

The usual suggestions for managing constipation, such as drinking lots of water, eating a high-fibre diet and exercising, may not be possible if you feel unwell.

Your treatment team will discuss other ways of managing constipation, such as laxatives and stool softeners.

Fatigue is when you feel very tired, weak, drained and worn out. Cancer-related fatigue is different from tiredness because it is more severe, not the result of recent physical or mental activity, and usually doesn’t get better with rest or sleep.

Fatigue can be caused by the cancer itself, cancer treatment, depression or anxiety, poor sleep, an infection, anaemia, weight loss or medicines.

Your palliative care team may be able to adjust your medicines or treat the cause of the fatigue. A physiotherapist, exercise physiologist or occupational therapist can also help with ways to conserve your energy for fun or important things.

You may find that the fatigue gets worse as the disease progresses – complementary therapies such as meditation and relaxation can reduce distress and help you and your family cope.

Breathlessness (dyspnoea) may be caused by the cancer itself, an infection, a side effect of treatment, anxiety or an underlying disorder such as asthma or emphysema.

Depending on the cause, breathlessness may be managed with taking medicine (such as low-dose morphine), draining fluid from around the lungs, or having oxygen therapy (if your oxygen levels are low). Simple ways to improve breathlessness are to:

• sit near an open window
• use a handheld fan to direct a cool stream of air across your face
• sleep in a more upright position
• listen to a relaxation recording
• listen to our Finding Calm During Cancer podcast 
• see a psychologist to help you manage any anxiety, if the breathlessness leads to panic
• plan out daily activities and take rest breaks - an occupational therapist can help you plan how to conserve your energy.