Problems grouped by where the cancer is

In this section we will talk about the symptoms you might have when advanced cancer is in different places in your body. Not everyone will get all the symptoms, and some of the information here may not apply to you. Your doctor can tell you the most about your condition.

Treatment is covered briefly in this section. For more about treatment for a given symptom, see the section, “Managing symptoms of advanced cancer.”

If the cancer is in the abdomen (belly)

Ascites (fluid in the abdomen)

Some cancers can cause fluid to build up in the abdomen. This can make your belly swollen and feel uncomfortable. It can also push on the lungs and make it hard to breathe.

Treatment: The doctor can remove the fluid with a long, hollow needle. This relieves the problem for a while, but it often comes back unless the cancer is treated. If the fluid keeps coming back, sometimes a catheter (a small, flexible tube) can be put through the skin and left in place to allow the fluid to be drained off without having to use a needle.

Bowel obstruction

Cancer that has spread to the abdomen (or grown large enough within the abdomen) can sometimes cause blockage (obstruction) of the bowels. This causes very bad cramping, pain, and vomiting.

Treatment: Colostomy or bypassing the blockage with surgery can help if you are strong enough to have surgery. Placing a stent (hard tube) inside the intestine may also help keep it open. These are explained under "Blocked bowel (bowel obstruction)" in the “Managing symptoms of advanced cancer” section.

Kidney blockage

Cancer in the abdomen can also sometimes block the thin tubes that carry urine from the kidneys to the bladder. (These tubes are called the ureters.) If this happens, you may stop passing urine. The urine then backs up in the kidneys, causing them to stop working. This often leads to feeling very tired and sick to your stomach.

Treatment: In many cases, a small tube called a stent can be threaded up through the ureters to keep them open and allow urine to flow again. Another option is to put a tube through the skin and right into the kidney to allow the urine to drain into a bag outside the body. This is called a nephrostomy.

If the cancer has spread to bones

Cancer spread to bone is sometimes found with x-rays or other imaging tests before symptoms occur. This is often treated with drugs such as a bisphosphonate or denosumab to help prevent (or delay) problems.

Pain

The main symptom from cancer spread to the bones is pain. Even though the cancer may have spread to many places in the bone, it usually only hurts in a few of them.

Treatment may include:

• Drugs that strengthen bones or slow its destruction (bisphosphonates or denosumab)
• Radioactive compounds, such as strontium-89, that are given into a vein
• Radiation therapy to especially painful bones
• Ablative techniques (discussed in the section “Ablative techniques for advanced cancer”)

Broken bones

Sometimes a bone will weaken and break. This most often happens in bones that support your weight, like the thigh bones. But it can also happen to the bones in your back. Cancer in the bone may cause severe pain for a while before the bone actually breaks. See "Broken bones (fractures)" in the “Managing symptoms of advanced cancer” section.

Lowering the risk of broken bones

• Stay away from activities that are hard on your bones (examples: heavy lifting, jogging).
• Ask your doctor about drugs that strengthen bones (such as bisphosphonates or denosumab).
• Any very weak bones may need a protective rod put in by a bone surgeon.

It’s also important to do what you can to lower your risk of falling, which could lead to broken bones:

• Use a cane or walker as needed to keep you steady.
• If you need it, ask for help walking.
• Keep walkways clear.
• Do not change position quickly. This can cause dizziness or unsteadiness. Sit on the side of the bed for a minute or so before standing up.
• Wear rubber-soled slippers or shoes when walking or standing.

Treatment

If a bone has already broken, then something will need to be done to support the bone. Usually surgery is done to put a steel support over the fractured area of the bone. Radiation treatments may be given after surgery to try to prevent any more damage.

High blood calcium levels

When cancer spreads to the bones, it can cause calcium to be released, leading to too much calcium in the blood. This is discussed in more detail in "Hypercalcemia: Too much calcium in the blood," in the “Managing symptoms of advanced cancer” section.

Treatment: High calcium levels are treated with IV fluids and bisphosphonate drugs. Other medicines may be used if these measures don't work.

Pressure on the spinal cord

If cancer spreads to the bones of the spine, it can press on the nerves in the spinal cord. Early symptoms can include back pain and weakness in the legs. The pressure on the spinal cord can cause problems passing urine or even trouble passing stool (so that the person feels constipated). If left untreated, the leg weakness can turn into paralysis, which can be permanent.

Treatment: Treatment includes steroid medicines (like prednisone or dexamethasone) to reduce spinal cord swelling. Radiation therapy is often used to shrink the cancer, and sometimes surgery is needed to remove cancer and/or make the spine more stable.

If the cancer has spread to the brain

The most common symptoms of cancer in the brain are headache or losing movement in part of your body, like an arm or leg. Other symptoms can include sleepiness or problems with hearing, eyesight, and even passing urine. Seizures are another possible symptom of cancer in the brain. They aren't common, but they can be very upsetting and scary for you and those around you.

Treatment

Radiation to the area of cancer in the brain is often helpful. Steroid drugs, such as dexamethasone, can often help with symptoms. Medicines may be given to help prevent seizures. If there are only 1 or 2 areas of cancer spread in the brain, surgery may be done to remove them.

If cancer has spread to the meninges

Some cancers can spread to the meninges – the tissues that cover the brain and spinal cord. This is called leptomeningeal spread. It can cause problems with weakness in the arms and legs, slurred speech, trouble swallowing, vision problems, and weakness of the facial muscles. To diagnose this, the doctor must do a lumbar puncture (spinal tap) to remove some of the fluid that surrounds the brain and spinal cord (called cerebrospinal fluid). The fluid is looked at under a microscope to see if it contains cancer cells.

Treatment

Treatment can include injecting chemotherapy into the cerebrospinal fluid. (This is called intrathecal chemotherapy). Radiation to the brain and spinal cord can also be used.

If the cancer has spread to the liver

Cancer in the liver can make you lose your appetite and feel tired. Some patients feel pain in the upper right part of the abdomen, where the liver is. Usually the pain is not bad and is less of a problem than the tiredness and appetite loss. If there is a lot of cancer in the liver, your eyes and skin may turn yellow. This is called jaundice. You may also have extra fluid in the abdomen (ascites), which is described above (see “If cancer is in the abdomen [belly]”).

Treatment

• If there are fewer than 5 tumors, they can sometimes be treated with surgery or ablative treatments.
• If there are more tumors, chemo may help. This may be given into a vein in your arm or right into a blood vessel leading to the liver.
• Sometimes a procedure can be done to block the blood supply to the cancer (this is called embolization).

You can also find treatment information for your specific symptoms in the "Managing symptoms of advanced cancer" section.

If the cancer is in the chest or lungs

Fluid in the chest (pleural effusion)

Cancer in the chest or lungs may cause fluid to build up around the lungs (pleural effusion). This may make you short of breath. (See "Trouble breathing" in the “Managing symptoms of advanced cancer” section.)

This may be treated by:

• Placing a hollow needle through the skin to remove the fluid that has built up around the lungs. If the fluid builds up again, a catheter (a small, flexible tube) can be put through the skin and left in place to allow the fluid to drain into a bag. Another option is to put a chemical or talc into the space around the lung to prevent further fluid build-up. This is called pleurodesis.
• Drug treatment, such as chemotherapy, hormone therapy, or targeted therapy
• External radiation therapy

Shortness of breath

Cancer in the lungs can cause shortness of breath as it spreads to more and more lung tissue or to the airways that go to the lungs. The lung may even collapse because it isn't being filled up as you breathe.

Treatment may include:

• Getting extra oxygen
• Opioids like morphine to help ease pain and shortness of breath
• Partly destroying the tumor with laser treatment
• Radiation to shrink the tumor

Pericardial effusion

Some cancers can grow into the thin sac surrounding the heart, called the pericardium. This is not common, but it can cause fluid to build up around the heart (a pericardial effusion). The fluid can press on the heart, so that it can't pump blood well. Symptoms can include shortness of breath, low blood pressure, body swelling, and feeling tired.

Removing the fluid with a long, hollow needle can relieve this. This procedure, called a pericardiocentesis, is usually done in a hospital because the heartbeat needs to be monitored. Often this is followed with radiation and/or putting a chemical into the pericardium to prevent further fluid build-up.

If the cancer has spread to the skin

Advanced cancer that has spread to the skin can cause lumps or even sores on the skin, which can be painful and may smell bad if they get infected.

Treatment

• Radiation treatment to lumps or sores on the skin can shrink them and dry them out. This can only be done if you haven't had radiation treatment to the area before.
• Certain chemo drugs can be put right on the tumors and may help dry them up.
• Antibiotics can help with infections. The antibiotics may either be pills or a cream put right on the sores.