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 cancers 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. 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 cancers

While advanced cancers 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: 

• Pain
• Depression and anxiety
• Fatigue and weakness
• Loss of appetite
• Weight changes
• Nausea and vomiting
• Constipation
• Belly swelling (ascites)

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 shortness of breath and bowel and kidney blockages. These are very serious situations and require treatment right away.

Shortness of breath (dyspnea)

Shortness of breath is one of the most common symptoms that people with advanced cancer can have. Shortness of breath can have many causes. It can be caused by cancer or cancer treatment. It may also be caused by other problems such as infection, low blood counts, or other lung conditions.

Being short of breath can be very troubling. It can limit what people are able to do and can make fatigue, anxiety, and depression worse. Not everyone whose cancer has advanced will become short of breath, but it helps to know what to expect, when to call your doctor, and how it might be managed.

Shortness of breath can happen quickly or build over time. If you have shortness of breath that comes on quickly, be sure to call your doctor right away. This may be caused by a problem that needs to be treated as soon as possible.

 Call 911 if new shortness of breath starts suddenly and doesn’t get better; your skin, mouth, or nail beds look pale or blue in color; or if you have chest pain or pressure, trouble speaking, dizziness, or weakness.

For many people with advanced cancers, shortness of breath comes on over time rather than quickly. It may get better then get worse again but doesn’t totally go away. For many people, shortness of breath gets worse with certain movement or activity.

Managing shortness of breath depends on the cause. Talk to your cancer care team about what you might be able to do to help, and if there are treatments that might work for you.

If you have talked with your doctor and don’t need to immediately be seen or treated for shortness of breath, there are things that can help make you more comfortable.

• Set up a fan so that it is directed at your cheek.
• Sit up or raise your upper body to a 45° angle by raising the bed or using pillows behind your back.
• Inhale deeply through your nose and exhale slowly through puckered lips. For example, exhale for twice as long as it took to inhale. (This is called pursed-lip breathing.)
• Try mindfulness and relaxation strategies.
• Try ways to distract yourself, such as by listening to music, watching TV, or reading.
• Try self-management techniques.
• Ask about acupressure or reflexology and find out if it’s available in your area.
• Ask your doctor whether there are medicines or treatments that might help you.

Oxygen may be helpful, but only if your blood oxygen levels are low.

Keep in touch with your cancer care team and let them know if your shortness of breath gets worse or doesn’t get better with treatment.

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.