Managing Advanced Cancer

Many advanced cancers can’t be cured, but they can most often be treated. You should know if the goal of treatment is to cure the cancer, slow its growth and help you live longer, or relieve symptoms. Even if the goal is not to cure the cancer, physical symptoms can be managed most of the time.

Making treatment choices

Treatment choices for advanced cancer depend on the type of cancer, where the cancer started, and how much it has spread into the area around it. In general, cancer that has spread will need treatment that reaches all parts of the body, such as chemotherapy, targeted therapy, immunotherapy or hormone therapy. These treatments are taken by mouth or infused into the blood. Local therapies, such as surgery or radiation, only treat a certain part of the body but can help prevent or relieve certain symptoms.  And relieving symptoms like pain, constipation, upset stomach, and vomiting can help you feel better. Something can almost always be done to help maintain or improve your quality of life.

The goal of any cancer care is to give you the best possible quality of life. You want to feel as good as you can for as long as you can. Talk to your cancer care team about what’s important to you. Tell them what you want to be able to keep doing. You have the right to be the decision-maker in planning your treatment.

Some people might want to continue cancer treatment if there’s a chance the treatments may help. Others might decide that the side effects or other burdens of cancer treatment, such as cost, travel and time away from home, are not worth the possible benefits. So some people may decide that they no longer want this type of treatment. This may be hard for some of your loved ones to accept, but you have the right to make this decision. It often helps to include your loved ones in these tough choices. Either way, you should get to make the decisions that are best for you.

Managing symptoms of advanced cancer

While advanced cancer cannot be cured, 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 and treatment. Some health care providers call this supportive care.

You might have many symptoms when cancer is in different parts of your body. Not everyone will get all of these symptoms. 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.

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

You can find more information about these symptoms on cancer.org.

Cancer that has spread to certain parts of the body such as the brain, bone, liver, and lungs may cause other symptoms. You can find more information about these metastases in other pages in this section.  

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.

Other symptoms you may have include bowel and kidney blockages These are very serious situations and require treatment right away.

Bowel blockage

Cancer in the abdomen (belly) sometimes blocks the bowels. The blockage (obstruction) keeps food and stool from moving through. This leads to severe cramping, belly pain, and throwing up. If the blockage in the bowels isn’t opened, the pressure that builds up can create a hole (a perforation) that lets the contents of the intestine spill into the abdomen. Bacteria from the intestine can cause a severe infection. This can cause even worse pain, and nausea and vomiting. An obstruction is very serious and must be treated right away.

It can be hard to treat obstructions with surgery because many patients are too sick. Other times the cancers are so large that surgery may not help for long. The risks of surgery should be compared to the chances of returning to a comfortable life.

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 a stent won’t work operations called colostomies or ileostomies may help. The surgeon cuts the large or small bowel above the block. 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 surgery or stents aren’t practical, treatment of the symptoms may be the good choice. 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 other problems.

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 or a patch for pain and nausea. There are medicines that can decrease the amount of liquids made by the stomach and improve some of the symptoms.

Kidney blockage

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

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 let urine 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.

 

The American Cancer Society medical and editorial content team

Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

Krouse RS. Malignant bowel obstruction. J Surg Oncol. 2019;120(1):74-77.

Matsuura H, Arase S, Hori Y. Ureteral stents for malignant extrinsic ureteral obstruction: outcomes and factors predicting stent  failure. Int J Clin Oncol. 2019; 24(3):306-312. 

National Cancer Institute. Coping with advanced cancer. Cancer.gov. Updated June 2020. Accessed August 14, 2020.

References

Krouse RS. Malignant bowel obstruction. J Surg Oncol. 2019;120(1):74-77.

Matsuura H, Arase S, Hori Y. Ureteral stents for malignant extrinsic ureteral obstruction: outcomes and factors predicting stent  failure. Int J Clin Oncol. 2019; 24(3):306-312. 

National Cancer Institute. Coping with advanced cancer. Cancer.gov. Updated June 2020. Accessed August 14, 2020.

Last Revised: September 10, 2020

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