Managing Symptoms of Advanced Cancer

Advanced cancer no longer responds to treatment. But there are still things that can be done to help you feel as good as possible for as long as possible. This care, aimed at relieving suffering and improving the quality of life, is called palliative care.

Palliative care focuses on the patient and family rather than the disease. It treats symptoms caused by the cancer. It does not treat the cancer itself. Some health care providers call this supportive care.

Common symptoms that are treated and controlled or relieved by palliative care can include:

  • Pain
  • Breathing problems
  • Appetite loss
  • Weight loss
  • Tiredness (fatigue)
  • Depression and anxiety
  • Confusion
  • Nausea and vomiting
  • Constipation
  • Bowel blockage (obstruction)

Again, the goal of palliative care is to prevent and relieve suffering, and support the best possible quality of life for patients and their families, regardless of the stage of the disease.

Here are some of the symptoms you might have when advanced cancer is in different parts of your body. Not everyone will get all these symptoms, and some of the information here might not apply to you. In many cases, these symptoms are not caused directly by the cancer or can have more than one cause. Your cancer care team can tell you the most about where the cancer is and what symptoms it might cause.

If cancer is in the abdomen (belly)

Fluid in the abdomen (ascites)

Some cancers cause fluid to build up in the abdomen. (This is called ascites [ah-site-eez].) This can make your belly swollen and feel uncomfortable. The fluid can also push on your lungs and make it hard to breathe.

Treatment

The fluid can be removed with a long, hollow needle. This relieves the problem for a while, but the fluid often comes back. If the fluid keeps coming back, sometimes a thin, flexible tube called a catheter can be put through the skin and left in place. A valve at the end of the catheter sticks out of the belly and can be opened to let the fluid drain out.

Bowel obstruction

Cancer in the abdomen sometimes blocks the intestines. This is called bowel obstruction. The blockage keeps food and stool from moving through. This leads to severe cramping, belly pain, and vomiting. If the blockage in the intestine isn’t opened, the pressure that builds up can create a hole (a perforation) that lets the contents of the intestine spill into the abdominal cavity. When this happens, bacteria from the intestine get into the abdominal cavity, leading to a severe infection. This can cause even worse pain with nausea and vomiting. An obstruction is very serious and can be fatal.

Treatment

It’s often very hard to solve this problem with surgery, because many patients are too sick to have an operation. Others may have cancers that are so advanced that even if they can have surgery, it may not help for long. The decision to have surgery should be weighed against the chances of returning to a comfortable life.

An operation called a colostomy may help if only the colon (large intestine) is blocked. In this operation the surgeon cuts the colon above the blockage. The cut end is then connected to an opening (stoma) on the skin of the abdomen (belly). Stool then comes out into a bag that’s put around the opening.

If the bowel is blocked in only one area, a small, stiff tube called a stent may be put through the blocked area to help keep it open. This can be done without surgery, and may be an option for some blockages of the colon and the small intestine.

If surgery or stents to relieve the blockage aren’t practical, treatment of the symptoms is often a good choice for many patients. For instance, the stomach’s contents can be removed through a tube placed through the nose, down the throat, and into the stomach. (This called a nasogastric or NG tube.) The NG tube is attached to a suction device to gently take out the contents of the stomach. This often relieves nausea and vomiting and may help keep pressure from building up and causing a perforation.

If an NG tube is helping, it sometimes can be replaced by a tube that goes right into the stomach through the skin on the belly. (This is called a G tube.)

If needed, you can get a shot (injection) or a patch for pain and nausea. There are drugs that can help stop the production of digestive juices and improve some of the symptoms that go along with a blocked bowel.

Kidney blockage

Cancer in the abdomen can sometimes block the thin tubes (ureters) that carry urine from the kidneys to the bladder. If this happens, you may stop peeing. Urine then backs up in the kidneys, and they stop working. This often makes you feel very tired and sick to your stomach.

Treatment

In many cases, a small, stiff tube called a stent can be threaded up from the bladder and 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 cancer has spread to bones

This topic is covered in detail in Managing Symptoms of Bone Metastases.

If cancer has spread to the brain

The most common symptoms of cancer in the brain are headache or not being able to move part of your body, like an arm or leg. Other symptoms can include sleepiness or problems hearing, seeing, and even urinating. 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

Steroid drugs, such as dexamethasone, reduce the swelling around the tumors and often help with symptoms right away. If the patient had a seizure, medicine will be given to help prevent more of them. If there are only 1 or 2 areas of cancer spread in the brain, they may be removed with surgery or treated with stereotactic radiosurgery (a type of radiation therapy). Some patients, especially those with many tumors in the brain, are treated with regular external beam radiation to the whole brain.

If cancer has spread to the meninges

Some cancers can spread to the meninges – the tissues that cover the brain and spinal cord. This can cause weakness in the arms and legs, slurred speech, trouble swallowing, vision problems, and weakness of the facial muscles.

Symptoms might suggest the cancer has spread to the meninges, but this isn’t seen well on imaging tests like MRI. To diagnose it, a lumbar puncture (spinal tap) must be done to remove some of the fluid that surrounds the brain and spinal cord (called cerebrospinal fluid or CSF). The fluid is looked at under a microscope to see if it contains cancer cells.  

Treatment

Most chemotherapy (chemo) drugs enter the bloodstream but can’t cross into the CSF, meninges, brain, or spinal cord. Because of this, the most common treatment for leptomeningeal spread is to inject chemotherapy right into the cerebrospinal fluid. (This is called intrathecal chemotherapy). This can be done during a lumbar puncture or through a device called an Ommaya reservoir.

An Ommaya reservoir is a dome-like device attached to a thin catheter. The dome part is put under the skin of the scalp, with the catheter going through a hole in the skull and into one of the cavities of the brain (called a ventricle). Intrathecal chemo can be given by putting a needle through the skin and into the dome. The chemo goes through the catheter and into the CSF in the ventricle. The CSF in the ventricle circulates through the other ventricles and into the area around the brain and spinal cord. With an Ommaya reservoir, the patient can get intrathecal chemo without having to get repeated lumbar punctures.

Radiation to the brain and spinal cord can also be used to treat cancer that has spread to the meninges.

If 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 (belly), where the liver is. Usually the pain isn’t bad and is less of a problem than the tiredness and appetite loss.

If there’s a lot of cancer in the liver, it can’t work well. The liver normally keeps levels of a substance called bilirubin in check, but if it isn’t working well, this substance builds up. This build up can lead to a problem called jaundice, which turns your eyes and skin yellow. The liver also removes a number of toxic substances from the blood. When the liver isn’t working well, these substances can build up and lead to the brain not working well, either. This is called hepatic encephalopathy. It can cause confusion, sleepiness, and even coma.

Cancer in the liver can also lead to fluid build-up in your belly, which is described in “If cancer is in the abdomen (belly).”

Treatment

  • If there are fewer than 5 tumors in the liver, they can sometimes be treated with surgery or ablative treatments (See Treating Advanced Cancer for more on ablative techniques.)
  • 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).
  • Hepatic encephalopathy may be treated with a drug called lactulose or certain antibiotics. Patients are also put on a low-protein diet.

If cancer has spread to the chest or lungs

Shortness of breath

Shortness of breath can have a number of causes related to cancer. It can be caused by a tumor blocking the airway so that it’s hard to get air in and out of the lungs. Cancer cells in the lungs can make it hard for oxygen to get into the blood from the lungs. Fluid build-up around the lungs (called a pleural effusion) can also cause shortness of breath (discussed earlier and also below). A tumor blocking blood flow to the heart (called superior vena cava syndrome) or fluid around the heart (a pericardial effusion) are also possible causes. (These are also discussed below.)

Low red blood cell counts (anemia) can also make someone feel short of breath. Anemia is common in people with cancer. (See Anemia in People With Cancer for more on this.)

Symptoms of lung diseases, such as asthma, emphysema, and other diseases not related to cancer can become worse due to cancer. 

All of these problems either prevent the lungs from breathing in enough air, or keep them from getting enough oxygen into the blood.

Treatment

Getting extra oxygen can often be very helpful. It’s in a tank connected to a tube. The end of a little tube goes under your nose or connects to a mask that goes over your mouth and nose so you can breathe in the oxygen.

When possible, treating the cause will help relieve shortness of breath. Treating the cancer with chemotherapy or targeted therapy may help. If there is a single tumor blocking an airway, treatment with radiation may help. Another option is using a flexible tube that is passed down your throat and into the lungs (a bronchoscope) to use laser treatment to shrink a tumor.

Sometimes fluid builds up in the lungs. (This is called pulmonary edema.) This is more common in people with heart problems. The fluid build-up can be treated with diuretics (water pills) and heart medicines.

Anemia can be treated with blood transfusions to help you feel less short of breath.

Morphine-like drugs (opioids) can be used to help relieve the feeling of shortness of breath. Anti-anxiety medicines, like diazepam (Valium®), can also help to reduce cough and ease the distress caused by shortness of breath. Sometimes medicines that help dry up mucus can help, too.

Having trouble breathing can make you feel anxious, worried, and even like you are in a panic. Some patients find these complementary methods helpful to ease the anxiety that can come with breathing problems:

  • Relaxation methods
  • Distraction (watching television, reading, etc.)
  • A fan blowing air on you

Fluid around the lungs (pleural effusion)

Cancer in the chest or lungs may cause fluid to build up in the chest around the lungs. This is called a pleural effusion. The fluid can keep the lungs from filling with air and make you short of breath.

Treatment

  • Removing the fluid with a hollow needle (This is called thoracentesis.)
  • If the fluid keeps coming back, a small, flexible tube (a catheter) can be put through the skin and left in place so the fluid can drain into a bag.
  • To remove the fluid and keep it from coming back, sometimes a procedure called pleurodesis is done. This procedure works to seal the space around the lung to help limit further fluid build-up. A tube is often left in for a couple of days to drain any new fluid that might collect.
  • Treating the cancer with drugs, such as chemotherapy, hormone therapy, targeted therapy, or radiation therapy will lower the amount of fluid being made so that it doesn’t build up

Fluid around the heart (pericardial effusion)

The heart is surrounded by tissue that makes a sac (called the pericardium). It isn’t common, but cancer can spread to this tissue and cause fluid build-up around the heart. (This is called 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.

Treatment

  • Removing the fluid with a long, hollow needle. This procedure, called a pericardiocentesis, is usually done in the hospital because the heartbeat needs to be monitored.
  • To keep the fluid from building up again, a piece of the pericardium may be removed. This is called a pericardial window.

Superior vena cava syndrome

The main vein that returns blood to the heart from the upper body is called the superior vena cava. It runs through the upper middle chest. Tumors in the chest or lung can sometimes press on this vein, blocking the blood flow to the heart. This will make blood  back up in the lungs, face, and arms.

Symptoms can include:

  • Shortness of breath
  • A feeling of fullness or pressure in the head
  • Swelling in the face, neck, and arms
  • Coughing
  • Chest pain
  • Facial redness
  • Swollen neck veins

If not treated, this can affect blood flow to the brain, which can cause confusion, changes in consciousness, or even coma.

Treatment

Superior vena cava syndrome needs to be treated right away. Radiation therapy and/or chemo are often used to shrink the tumor. If this isn’t possible, you may have a small metal tube called a stent put in the vein to keep it open. This tube is put in through a large vein in your arm or neck and then threaded through the blockage. Medicines can also be used to help reduce swelling and remove extra fluid in the body.

If cancer has spread to the skin

Advanced cancer that has spread to the skin can cause lumps or even sores on the skin. These 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.
  • Certain chemo drugs can be put right on the sores and may help dry them up.
  • Antibiotics can help with infections. The antibiotics may either be pills or a cream or powder that is put right on the sores.

The American Cancer Society medical and editorial content team
Our team is made up of doctors and master’s-prepared nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

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National Cancer Institute. Coping With Advanced Cancer. May 2014. Accessed at www.cancer.gov/publications/patient-education/advancedcancer.pdf on November 17, 2016.

Wong SL, Chang AE. Acute Abdomen, Bowel Obstruction, and Fistula. In: Abeloff MD, Armitage JO, Lichter AS, Niederhuber JE. Kastan MB, McKenna WG. Clinical Oncology. Philadelphia, PA. Elsevier; 2008: 791-801.

Last Medical Review: December 16, 2016 Last Revised: December 16, 2016

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