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Controlling sickness in advanced cancer

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This page tells you about controlling sickness when you have advanced cancer. There is information about

 

What advanced cancer is

Advanced cancer means the cancer has

  • Spread from where it started
  • Come back some time after you were first treated

It is not always possible to cure advanced cancer. But even if your cancer can't be cured, treatment is available to control your symptoms, such as feeling or being sick. This page gives information about the most common causes of sickness in people who have advanced cancer.

 

Sickness caused by a blocked bowel

Sometimes a cancer in the tummy (abdominal) area, such as ovarian or stomach cancer, can grow so that the tumour completely blocks the bowel. This is called a bowel obstruction. The waste from food you have digested cannot get past the blockage. Some cancers can also stop the bowel working properly by pressing on the nerves that keep the bowel working smoothly.

This will cause quite a few symptoms such as

  • Feeling bloated and full
  • Pain
  • Feeling sick
  • Vomiting large amounts
  • Constipation

Doctors can help to relieve sickness caused by a blocked bowel in various ways. If you are otherwise relatively well, you may be able to have a tube called a stent put into the bowel during endoscopy. Or the surgeon can remove the blocked section of bowel. It may be possible to close up the bowel again during the operation. Or you may need to have a stoma. A stoma is an opening onto the tummy (abdomen). Your bowel motions come out of the opening and collect in a waterproof bag that you stick to your skin over the stoma opening. Once the stoma has worked, you take off the bag and throw it away, then clean the area and stick on a new bag. There is information about bowel surgery and having a stoma in the section about surgery for bowel cancer.

You may want to talk over having this operation with your close family and friends, as well as your doctor and clinical nurse specialist. No one can say how much you will benefit from the operation. The cancer may not come back to block the bowel again. But it is quite a big operation at a time when you are likely to be feeling low.

If you are very ill and aware that this is probably the final few weeks of your life, you may not want to have major surgery. There are other ways of relieving your symptoms. One way is to put a very thin tube down your nose and into your stomach. This is called a nasogastric tube (NG tube). The tube is attached to a bag and drains off the fluid that builds up in your stomach. This stops you being sick. You need to empty the bag every so often. Having a tube down your nose sounds very unpleasant. But you don't notice it so much after a while. And it is more comfortable than feeling sick and bringing up all the fluid that collects.

Instead of an operation, doctors can use a drug called octreotide to help control the symptoms of a blocked bowel. Octreotide reduces the amount of fluid that builds up in your stomach and digestive system and helps to stop you feeling and being sick. Unfortunately octreotide can't control the symptoms of a blocked bowel for more than a few weeks. But it can help to make you a lot more comfortable during that time.

 

Sickness caused by constipation

Constipation can make you feel very sick. It is a good idea to talk this over in detail with a doctor or specialist nurse. Don't be embarrassed to ask for help with constipation. The longer you leave it the more problems it can cause. You can ease the problem by eating a lot of fibre in your diet and drinking plenty of fluids, but you may also need to take a laxative. Your doctor can prescribe one. Ginger is a good natural remedy for sickness caused by constipation. If you like the taste, try eating stem ginger or crystallised ginger. Or sip ginger beer or ginger ale slowly.

Many hospital and community nurses can help with constipation, and you can ask them for advice about preventing or relieving it. There are books and booklets about preventing constipation, some of which are free. Look at the coping with cancer reading list page for more details. There is a separate section about constipation which has detailed information.

It is important to remember that if you have constipation with severe abdominal cramping pain and vomiting, don't take laxatives. Contact your doctor or specialist nurse as soon as possible, as your bowel may be blocked.

 

Sickness caused by dehydration

Dehydration means there is not enough fluid in your body. It can affect how your body works and cause symptoms such as feeling and being sick, confusion and tiredness. If you have advanced cancer you may not feel like eating or drinking much. But do try to drink every hour or two, even if it is only sips of water. If you are dehydrated and not drinking much, your doctor may want you to have some fluids through a drip.

It is possible for you to have fluids through a needle into your skin, rather than into a vein. This is called subcutaneous hydration or hypodermoclysis. A nurse can show you and your relatives how to connect the tubing to the needle and switch the fluids on and off. You can have the infusion connected up overnight only so that it doesn't get in the way during the day. This can work very well and is easier to manage than a drip into a vein. You can have fluids in this way at home. And you can have the support you need from district nurses or specialist symptom control nurses.

 

Sickness caused by chemical imbalances

There is normally a fine balance of chemicals in our bodies. The balance can be upset by

Kidney problems

You may have kidney problems if your cancer is in your kidney or blocking the tubes that drain it. Kidney problems can also occur if you are dehydrated. If your kidneys are not working properly, it can make you feel sick. Anti sickness medicines are the best way to try to control this.

Liver problems

You may have liver problems if your cancer started in your liver, or more commonly, has spread into the liver. If your liver isn't working as well as it should, it can make you feel sick. Anti sickness medicines are the best way to try to control this.

High calcium levels in the blood

Too much calcium in your blood is called hypercalcaemia (pronounced hyper-kal-seem-ia). This is a common cause of sickness in people with cancer that has spread into the bones. The cancer cells make the bone cells break down and release calcium into the blood.

Some types of cancer also affect the way that the body controls calcium levels. The cancer makes the body produce too much calcium, so the level in the blood gets too high.

If you have high calcium levels, the symptoms you may have include

  • Extreme tiredness (fatigue) and lethargy
  • Feeling weak
  • Not wanting to eat much (anorexia)
  • Constipation
  • Loss of concentration and interest in doing things
  • Mild confusion

If the hypercalcaemia is not treated then the symptoms become much worse. You will need to see your doctor if you think this is happening to you. There are very effective drugs for helping to control high calcium levels. They are called bisphosphonates (bis-fos-fon-ate). You have to have some of these drugs through a drip into a vein but others come as tablets.

It is very important that you tell your doctor if you have symptoms of a high calcium level. If not treated, hypercalcaemia can make you more and more drowsy until you are sleeping nearly all the time. If still not treated, you may go into a coma and eventually die from this.

There is detailed information about hypercalcaemia and how it is treated in this section. There is more information about coping with the practical and emotional aspects of advanced cancer in the dying with cancer section.

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Updated: 27 June 2013