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This section is about some of the symptoms that may occur if you have cancer. It describes the wide variety of treatments available for controlling symptoms and discusses some of the support services that can help.
Symptoms can usually be well controlled by you, your family and friends, and members of the medical and nursing team caring for you.
You may have one or more of the symptoms described in this section, but you’re unlikely to have more than a few of them. Some symptoms are only likely to occur with particular types of cancer|, and some symptoms can be caused by cancer treatments|. Sometimes one symptom can affect another one, for example pain| may make it difficult to sleep. If you find a symptom is particularly troublesome, it’s important to let your medical team know so they can arrange for appropriate help| and treatment.
Fatigue| is feeling excessively tired or exhausted all or most of the time. It’s one of the most common, and sometimes one of the most difficult, problems for people with cancer. Fatigue may be due to the cancer itself, or it may be a result of other symptoms like breathlessness|, pain or anaemia (a low red blood cell count). It can also be a side effect of cancer treatment. For some people fatigue gradually improves after a course of cancer treatment has ended, while for others it remains a persistent problem.
The effects of fatigue can vary from person to person. Telling your doctors and nurses about how fatigue affects you can help them provide the best care for you. Note how your fatigue affects your ability to carry out daily activities and how much rest you need. This will help you identify the things that make your fatigue better or worse and can also help you plan activities for when you’re feeling stronger. You may like to use a symptom diary|.
Some causes of fatigue can be treated. For example, tiredness caused by anaemia can be helped by having a blood transfusion|. Sometimes a course of steroids| can help relieve fatigue.
Planning ahead and prioritising the most important tasks will help make sure you’re able to do the things that are most important to you. Getting help with some tasks will mean that you may have more energy to do the things you enjoy. For example, many supermarkets now offer online shopping with home delivery. You could also think about rearranging your home to make things easier, such as having your bedroom as close to the toilet as possible, and arranging your kitchen with frequently used items stored within easy reach. An occupational therapist can provide gadgets to make everyday chores easier to manage.
Try sitting down to do everyday tasks like washing, dressing and preparing food. Carry heavy items like laundry or shopping in a trolley. Having a mobile or cordless phone means you don’t have to rush to answer the telephone. A baby monitor is a good way of talking to someone in another room without having to get up, especially at night.
Research has found that doing some exercise can help relieve the symptoms of fatigue. Going for a short walk can be a good start. Your doctor, nurse or physiotherapist can advise you about how much and which type of exercise would be helpful for you.
The Shopmobility, Motability and Blue Badge schemes may be able to help you get out and about. Ask your nurse or social worker for details.
You may find that your cancer treatment centre has a course on managing fatigue that your hospital doctor, nurse or physiotherapist can refer you to.
Many people with cancer have sleeping difficulties at some point during their illness. There can be a number of reasons for this, including anxiety| and symptoms such as pain and breathlessness. These symptoms can often be treated, so speak to your doctor about them. For example, if you have pain, ask your doctor about long-acting painkillers that will last through the night.
Some people may benefit from having a short nap during the day. However, too much sleep during the day can cause problems sleeping at night - try limiting yourself to one or two sleeps each day if you can’t sleep at night. If possible, avoid sleeping in the late afternoon or evening.
If you do have difficulty sleeping at night, remember your body will still benefit from lying quietly in bed resting, even if you’re not asleep.
Sleeplessness can sometimes be a sign of depression|. Talking through your worries and concerns may be helpful. Some people benefit from counselling or relaxation therapy|.
Sometimes a short course of sleeping pills can help you get back to a regular sleeping pattern, or help you through a particularly difficult time. They usually work by helping you get to sleep, so they’re best taken before bedtime rather than in the middle of the night.
Cancer and some cancer treatments| can cause problems with eating and digestion|. These problems might include loss of appetite, feeling sick |(nausea), heartburn|, indigestion| and hiccups|. Other cancer symptoms such as constipation|, pain and breathlessness can also lead to eating problems.
If your appetite is poor, try having smaller, more frequent meals, rather than larger plates of food three times a day.
You can add high-protein powders to your normal food, or you can replace meals with nutritious, high-calorie drinks. These are available from most chemists and can be prescribed by your GP. You can also ask to be referred to a dietitian at the hospital. They can advise you on which foods are best for you and whether any food supplements would be helpful. If you’re not in hospital your GP can arrange this for you.
If you need help with cooking or shopping, a district nurse or social worker can give you information about Meals on Wheels or a home help. You could also see if someone else could prepare your meals, so that you’re not too tired to eat by the time they’re ready.
If you’ve lost weight and are finding it difficult to put it back on, your doctor may prescribe a short course of steroids or a drug called megestrol acetate (Megace®)| to boost your appetite. Your GP or palliative care team| will discuss this with you to decide the most appropriate drug for you.
People who have very advanced cancer| may find that they become weak and their body is not able to absorb food very well. In this case, it’s best to eat what you want when you feel able to. In some cases steroids or other medication may help.
You might find it helpful to watch our slideshow of tips for coping with a poor appetite|.
Cancer and cancer treatments can sometimes cause nausea (feeling sick) and vomiting (being sick)|. Treatment will be based on the most likely cause of your nausea. If something like pain, a raised calcium level or another chemical imbalance is causing your sickness, it’s important that this is treated.
Your doctors may prescribe an anti-sickness (anti-emetic) drug. These often work better when they’re taken regularly so that the sickness doesn’t have a chance to come back. They’re usually given as tablets, but if you can’t keep tablets down there are other ways to have them. Some anti-sickness drugs can be dissolved in your mouth, others can be given by injection, or they can be given as a suppository into your back passage. Sometimes anti-sickness medicines are given by constant infusion under the skin (subcutaneously), using a small portable pump called a syringe driver|.
Complementary therapies| such as relaxation and acupuncture can also be used to help reduce nausea and vomiting.
The effects of cancer or its treatment can lead to mouth problems. These can affect eating and drinking as well as your ability to talk comfortably.
Some of the common causes of mouth problems include:
Following a regular mouth care| routine can help prevent or lessen mouth problems:
You might find it helpful to watch our slideshow |with tips for what you can do if you have a sore mouth.
Some people with cancer have a dry mouth|, because they produce less saliva or they breathe more through their mouth due to breathlessness. Oxygen treatment can also cause a dry mouth. Radiotherapy to the head and neck and certain drugs can be another cause. Speak to your doctor if it’s likely that a drug is causing your dry mouth, as a replacement drug may be available. Feeling anxious| can also make your mouth feel dry.
A dry mouth can be uncomfortable and change the way your food tastes.
If you have a dry mouth for a long time you have a higher risk of tooth decay, so it’s important to take care of your teeth. Your dentist will be able to help you with this and will want you to have regular check-ups. Some dentists will visit you at home if you can’t attend the surgery.
You may find that your sense of taste changes|, or that the texture of food seems different. This may be due to the cancer, or it can be a temporary change following cancer treatment. You may no longer enjoy certain foods, or find that all foods taste the same. Some people having chemotherapy notice a metallic taste in their mouth. Others find that food has no taste at all.
If you have radiotherapy| to your mouth and/or throat, the area can become sore| and you may develop mouth ulcers. Many chemotherapy| drugs cause the same problem. You may also develop a sore mouth if you:
If your cancer treatment is likely to cause mouth ulcers, your doctor may prescribe an antiseptic and painkilling mouthwash for you to use during treatment. You may also be prescribed a protective gel that can help ease any pain and discomfort.
If you’re taking antibiotics or steroids, you may develop a fungal infection in your mouth called thrush. This coats your tongue and can make eating unpleasant. Your doctor can prescribe an anti-fungal medicine to clear this. If your mouth or lips become sore after cancer treatment, see your doctor who can check for signs of infection or thrush. If you do have an infection, the doctor can prescribe treatment. If, after taking a course of anti-fungal medicine for thrush, your symptoms haven’t improved, it’s important to go back to your doctor to try a different type of anti-fungal medicine.
Always contact your doctor if mouth pain is making it difficult to eat or talk. They can prescribe painkillers if necessary.
Anxiety is one of the most common emotional| responses to cancer, and it’s a natural reaction. Questions like ‘How will I cope?’, ‘What’s going to happen?’, ‘Will I get better?’ and ‘Will the treatment work?’ may go through your mind.
Anxious feelings may be present all the time, or they may come and go. They can also vary in how severe and disruptive they are. Anxiety may show as physical symptoms such as:
It can be easy to confuse the symptoms of cancer, or cancer treatment|, with the symptoms of anxiety. Being anxious on top of having cancer can also make your symptoms worse.
When anxiety levels are high, the symptoms can be difficult to control and you may feel that you’re having a ‘panic attack’. Learning controlled breathing| and relaxation techniques| can help you manage these attacks.
Your doctor will be able to help you work out whether your symptoms are related to anxiety, and they may prescribe medication to help. Anxiety can also be treated with a sedative drug such as diazepam.
Understanding the reason for your symptoms can be reassuring, but if you’re still very anxious, try talking to your nurse or doctor. For some people, seeing a trained counsellor can help. Some organisations| offer counselling and psychotherapy. These feelings are very common, so don’t be embarrassed to discuss them or check whether your fears and concerns are justified.
Some people become depressed as a result of having cancer or coping with symptoms. Everyone can feel down or anxious at times, but sometimes these feelings don’t go away and can start to affect your everyday life. Common symptoms of depression include:
Depression often comes on gradually. The first step to feeling better is getting appropriate help. If you or your family think that you may be depressed, discuss this with your GP or nurse. They will be able to tell you about the different treatments that can help.
Counselling or talking therapies can help you express your emotions and clarify your feelings about what’s happening in your life. Trained counsellors, clinical psychologists and psychiatrists all deal with talking therapies. For some people they can be as effective as antidepressants or sedatives.
There are different types of talking therapy.
Person-centred therapy aims to help you sort out your feelings and find ways of coping with them through discussion with a trained counsellor. It’s often used to help someone cope with recent events they have found difficult. This therapy is widely available.
Cognitive behavioural therapy (CBT) aims to help you change unhelpful thoughts and behaviours. CBT is available as one-to-one or group therapy. Self-help books and computer programmes are also available.
Psychodynamic (psychoanalytic) psychotherapy deals with immediate problems by encouraging you to look back at your past, to try to discover how your past affects how you are feeling, thinking and behaving now. This tends to be longer-term therapy.
We have a video about how counselling can help people affected by cancer.
Your doctor may prescribe an antidepressant to help lift your mood. Antidepressants are thought to work by affecting certain chemicals within the brain. They work slowly, so you won’t usually notice any improvement in your symptoms for a few weeks. Your doctor may have to try more than one drug to find the one that suits you best.
Constipation| can be a common problem, but many people find it embarrassing to discuss. Loss of appetite, poorly controlled pain and nausea can all lead to constipation. A lack of fibre (roughage) in your diet, low fluid intake and being less mobile can also contribute. Some medicines can cause constipation, particularly the painkillers morphine and codeine. If you’re taking regular painkillers, you may need a laxative to help prevent constipation.
Everyone’s normal bowel pattern is different, but as a general guide you should let your doctor or nurse know if you’ve not had a bowel movement for three days, unless this is usual for you.
Signs of constipation include:
Tips for managing constipation
If you have cancer of the gullet (oesophagus)| or bowel|, ask your doctor before taking fibre or linseed.
There are different types of laxative available. Your doctor or nurse will recommend a specific type of laxative, depending on the cause of the constipation.
Softening laxatives, for example lactulose, encourage more water to be taken up by the bowel, making stools softer and easier to pass along.
Stimulant laxatives, such as Senna®, increase the movement of the bowel wall to help push stools along.
Some laxatives combine a softening laxative with a stimulant laxative (for example Co-danthramer).
Bulk-forming laxatives, for example Fybogel®, increase the volume of stool. This is similar to the role of fibre in your diet. These laxatives can take a few days to work and need to be taken with plenty of fluid to be effective.
If you’re very constipated, or if the laxatives aren’t working, your doctor or nurse may recommend suppositories or an enema. These preparations are inserted into the bowel through the back passage.
If you have cancer of the bowel, always ask your doctor for advice about dealing with constipation.
Diarrhoea may occur as a side effect of cancer treatments such as chemotherapy, or radiotherapy to the pelvis. It may also occur due to infection. Some medicines can cause diarrhoea, and some cancers may prevent food from being absorbed properly from the bowel, causing diarrhoea. Sometimes severe constipation can be mistaken for diarrhoea: when the bowel is blocked by constipation, liquid faeces pass around the solid faeces (sometimes called overflow), so it may seem as though you have diarrhoea.
Diarrhoea is a common temporary side effect of radiotherapy to the pelvis, and your doctor will prescribe medicine to help with it. If you have diarrhoea caused by radiotherapy, changing your diet is unlikely to help, and it’s important that you take the anti-diarrhoea medicines prescribed by your doctor.
Content last reviewed: 1 October 2011
Next planned review: 2013
For answers, support or just a chat, call the Macmillan Support Line free (Monday to Friday, 9am-8pm)
If you have any questions about cancer, need support or just want someone to talk to, ask Macmillan.
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© Macmillan Cancer Support 2013
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