Controlling sickness in advanced cancer

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 sickness.

Advanced cancer means that the cancer has spread from where it started or has come back some time after you were first treated. 

Up to 7 out of 10 people (up to 70% of people) with advanced cancer have nausea and vomiting.

Some people may have more than one cause of sickness and it may not always be linked to the cancer itself. For example, you might feel sick if you have an infection. 

Blocked bowel

Sometimes a tumour in the tummy (abdominal) area, such as ovarian or stomach cancer, can grow to completely block 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:

• muscles that keep the bowel working
• nerves that keep the bowel working
• the gut lining

This causes symptoms such as:

• feeling bloated and full
• pain
• feeling sick
• vomiting large amounts
• constipation

Doctors help to relieve sickness caused by a blocked bowel in various ways.

Surgery

You might be able to have a tube called a stent put into the bowel. Or the surgeon can remove the blocked section of bowel. It might be possible to close up the bowel again during the operation. Or you might need to have a stoma. A stoma is an opening onto the 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.

No one can say how much you will benefit from the operation. The cancer might 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. Talk through your concerns about the operation with your doctor and cancer specialist nurse or friends and family.

You might not want to have major surgery if you are very ill and aware that this is probably the final few weeks of your life. There are other ways of relieving your symptoms.

Surgery may not be possible if you have more than one blockage in the bowel.

Nasogastric tube

One way to relieve your symptoms 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 helps you to stop being sick.

Drugs

Hyoscine butylbromide (Buscopan) can reduce spasms in the digestive system and reduce the amount of fluid in the gut. The other drug you might have is called octreotide. Octreotide also reduces the amount of fluid that builds up in your stomach and digestive system and helps to stop you feeling and being sick.

You might have one of these types of medication instead of an operation.

Constipation

Don't be embarrassed to ask for help with constipation. The longer you leave it the more problems it can cause. You can ease constipation by eating lots of fibre and drinking plenty of fluids, but you might also need to take a laxative. Your doctor can prescribe one.

Ginger is a good natural remedy for sickness caused by constipation. Try eating stem ginger or crystallised ginger. Or sip ginger beer or ginger ale slowly.

Many hospital and community nurses can help with constipation. Ask them for advice about preventing or relieving it.

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
• tiredness

You might not feel like eating or drinking much if you are living with advanced cancer. But try to drink every hour or two, even if it is only sips of water. Your doctor might give you fluids through a drip if you are dehydrated and not drinking enough.

It’s possible for you to have fluids through a needle into your skin, rather than into a vein. This is called subcutaneous hydration.  You can have the infusion connected up overnight only so that it doesn't get in the way during the day. It is sometimes possible to have fluids in this way at home with support from district nurses or symptom control nurses.

Chemical imbalances

Kidney problems

You might 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. Kidneys that are not working properly can make you feel sick. Anti sickness medicines are the best way to try to control this.

Liver problems

You could have liver problems if your cancer started in your liver, or more commonly, has spread into the liver. Feeling sick can be caused by your liver not working as well as it should. 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.

Symptoms of high calcium levels include: 

• extreme tiredness (fatigue) and lethargy
• feeling weak
• not wanting to eat much
• constipation
• loss of concentration and interest in doing things
• mild confusion

Help for you

It can feel very overwhelming trying to cope with feeling sick from advanced cancer. Talk to your doctor if your symptoms are not improving with help.