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 shrink a cancer that is causing pain because of its size or location
• slow the growth of the 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. You can have radiation therapy in different ways and doses. It can be given in single or multiple visits.

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 or interfere with your breathing – people may even live longer with better quality of life when their pain is treated. 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.

Constipation can also cause nausea and appetite issues. 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 you’re swallowing.

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.

Breathlessness (dyspnoea) is an uncomfortable feeling of being short of breath. It 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.

Fatigue is a feeling of extreme tiredness or weakness. It is different from normal tiredness, as it doesn’t always go away 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 explain how to modify your activities to help you conserve your energy.

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.

You will probably experience a range of emotions. Many people feel shocked, fearful, sad, anxious, guilty or angry. Others 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. Visit Beyond Blue and Lifeline for more information.

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, stop driving or give up other activities that are important to you. These changes can cause further sadness or stress.

Your partner, family and close friends can offer support, or you might prefer 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 on 13 11 20.