Control of less common cancer symptoms
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Some people with cancer have problems with breathlessness and coughing.
How breathlessness is treated depends on its cause. Sometimes there can be more than one cause, and each one may need different treatment.
These are some of the causes of breathlessness:
Cancer involving the lung - This can be a primary cancer, such as lung cancer, or a secondary cancer that has spread to the lung from another organ. Surgery, radiotherapy, chemotherapy or hormonal therapy may help to remove or shrink the cancer and relieve breathlessness.
A chest infection - Appropriate antibiotics can be used to treat this.
Pleural effusion - This is a build-up of fluid between the two layers of the pleura (the membranes that cover the lungs). It can cause pain and breathlessness. It’s treated by placing a small tube between the two layers and draining off the fluid into a drainage bag or bottle. After the fluid has been drained, it may be possible to seal the two layers of the pleura and stop pleural effusions happening again. This is called a pleurodesis.
Pulmonary oedema - This is when fluid builds up in the lungs themselves. Treatment for pulmonary oedema will depend on the cause.
Anaemia - This is having a low level of red blood cells in your blood. It can make you very tired and breathless. Your doctors may recommend that you have a blood transfusion to treat it.
Radiotherapy to the chest - This can cause inflammation of the lung (pnuemonitis), which can lead to a cough and breathlessness. This is usually a short-term side effect and can be treated with a course of steroids.
Medicines for breathlessness
The painkiller morphine can be used to treat breathlessness. It can be given in tablet or liquid form, or by injection under the skin (subcutaneous injection). Drugs that help you relax can also help relieve the anxiety and panic that breathlessness can cause. If swallowing medicines is difficult, painkillers, sedatives and other drugs can be given by constant infusion under the skin (subcutaneously) using a syringe driver.
Drugs called bronchodilators widen the air passages, increasing airflow. These can be given as tablets or as a fine spray that’s breathed in (inhaler). They can also be given through a mask called a nebuliser.
This is where oxygen is given using a face mask, or through small tubes that sit under the nostrils (nasal cannula). Using a fan or sitting by an open window may give you the same benefit. Oxygen therapy is only suitable for some people who are breathless. Your doctor will let you know if oxygen therapy is suitable for you, and if you need oxygen at home they can arrange this for you.
Tips for managing breathlessness at home:
Sit down to carry out everyday tasks like washing, dressing and preparing food.
Cool air blowing directly onto or across your face can help you breathe more easily. Try sitting by an open window or using a small handheld fan.
Arrange your kitchen with frequently used items stored at waist-height, rather than having to bend or stretch to reach cupboards and shelves.
Wear loose-fitting clothes, especially around your waist and chest. Sit down when dressing and bring your feet up to put on socks, tights and shoes, as bending can make you breathless. Slip-on shoes are easier to get on and off than shoes with laces.
Using a telephone extension cord, or a cordless or mobile phone, will mean that 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 shout or get up, especially at night.
Breathlessness can cause you to breathe with your upper chest and shoulders in a rapid and shallow way. This can use up a lot of energy and tire you out. Learning a technique called controlled breathing can help you to relax and breathe gently and more effectively using your lower chest and tummy muscles. A physiotherapist or specialist nurse can teach you these techniques.
Being breathless can cause you to feel anxious, frustrated and panicky. These emotions can cause rapid, shallow breathing, which can make you even more breathless. Understanding your emotional responses to breathlessness and learning to control them can help you manage your condition. Relaxation techniques can help you control anxiety and improve breathlessness.
Coughing can be helpful because it helps to clear our airways, but it can also be uncomfortable, embarrassing and affect our ability to sleep, rest and eat.
If you’re coughing up green or dark yellow phlegm (sputum), you may have an infection and need to take antibiotics. Some people need physiotherapy to help them clear their airways. Sometimes steam inhalations or saline given as a fine spray through a nebuliser are helpful.
If you have a dry irritable cough, your doctor may prescribe a cough mixture to help. If your cough is persistent then painkillers like codeine or morphine can be helpful.
Occasionally people cough up blood. It’s important to let your doctor know if you begin to cough up blood or if this symptom gets worse. It can be caused by a chest infection, by a blood clot in the lung, by bleeding from small blood vessels in the lungs or from a tumour in the lungs. The treatment will depend on the cause, so you may need to have tests to find out what that is. Antibiotics can help treat a chest infection, or your doctor may prescribe a drug called tranexamic acid, which encourages blood to clot and reduces bleeding. Radiotherapy can often be helpful when the cause is a tumour in the lung.
Bladder problems may be caused by a cancer pressing on or blocking the tube that urine passes through out of the bladder (urethra). This can lead to incontinence (loss of bladder control) or retention (when urine can’t flow out of the bladder). Rarely, a tumour pressing on the nerves in the spine can cause nerve damage, leading to incontinence.
Urinary problems may also occur following some types of surgery to the bladder, prostate, bowel or womb. These problems may be caused by damage to the valve that controls the flow of urine from the bladder (urinary sphincter), or caused by nerve damage in the pelvis. These problems are often temporary and improve over weeks or months. If you have urinary problems after surgery, it may help to do exercises called pelvic floor or Kegel exercises. These help to retrain the muscles involved in bladder control. A continence nurse can tell you about these, or you can read more on the Bladder and Bowel Foundation website.
After surgery to their prostate, some men have urinary problems due to an overactive bladder. Your doctor can prescribe drugs to help correct this. Most men find that their symptoms improve with time. Rarely however, if symptoms don’t improve over several months, some men may be offered surgery to improve bladder control.
During and after radiotherapy to the pelvic area, you may need to pass urine more often than usual. You may also have some pain when you pass urine. These symptoms can also be caused by a bladder infection, or may become worse if one develops. Let your nurse or doctor know if you develop any pain when passing urine or if your urine is cloudy or smelly. A urine sample can be tested, and any infection can be treated with antibiotics.
If you’re at increased risk of a urinary infection, perhaps because you’re having radiotherapy to the pelvic area, you may want to try taking cranberry extracts. Cranberries contain a substance that can prevent bacteria from sticking to the walls of the bladder. Research has shown that taking daily cranberry extracts may help to prevent urinary infections for some people. However, it isn’t clear what the best dose is or whether cranberry extract capsules are better than cranberry juice. Cranberry extracts aren’t helpful for people who have a catheter, and if you take warfarin tablets it‘s important to avoid them, as they can affect how warfarin works.
If you have bladder problems, it can help to drink enough water to keep your urine a clear or pale yellow colour. It may also help to avoid drinking too much alcohol or drinks that contain caffeine, such as coffee, tea and cola.
Continence problems can occur if you find it difficult to get out of a chair or bed so can’t get to a toilet quickly. Try to have your bed as close to a toilet as possible, or have a commode, bed pan or urine bottle close by.
Dealing with incontinence
A wide range of continence aids is available. Your district nurse or a specialist continence nurse can arrange supplies for you. You may need to pay for these products, as what’s available on the NHS varies in different parts of the country.
Pads use materials that draw urine away from the body. They are small and easily hidden, but secure enough to prevent leakage. For men, there are also sheaths for the penis and dribble pouches.
Tips for dealing with urinary problems
Some drinks, such as tea, coffee, cola and alcohol, cause bladder irritation and may make symptoms worse.
After any operation that may affect your bladder, build up your physical activities gently. You should usually be able to do all your normal activities within 4-6 weeks.
Constipation can make bladder problems worse.
Knowing you may need to get to a toilet quickly can make going out a source of worry and embarrassment. The National Key Scheme (NKS), for people with continence problems, allows you to use around 9,000 locked public toilets in the UK. Radar or the Bladder and Bowel Foundation can tell you about the scheme.
If you’re restricted to bed, incontinence can be more difficult to cope with. In this situation, or if you have trouble emptying your bladder, a thin flexible plastic tube (catheter) can be inserted into your bladder so that urine is continuously drained away. This can prevent the discomfort that can occur with severe incontinence. Catheters need to be changed regularly - about once a month or more often. During the day, if you’re up and about, a catheter bag can be attached to your leg and hidden under clothes. Otherwise, bags and tubes can easily be covered by bedclothes or blankets.
Your doctor can refer you to a specialist continence adviser. The Bladder and Bowel Foundation can also give you advice about managing continence problems.
Skin problems - itching, pressure sores and sweating
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Itching is a common symptom of cancer and can affect any area of your body. It may affect all of your body or only one particular area.
Itching may be due to:
chemicals released by the cancer (especially some cancers of the blood)
medication (particularly the painkillers morphine and diamorphine)
kidney and liver problems.
Dealing with itchy skin
If your skin is dry use a simple moisturiser, such as aqueous cream, twice a day. A combination of aqueous cream and menthol can be helpful. If you store the cream in the fridge it will feel cool and soothing when applied.
If hot or warm water makes the itching worse, take cool or lukewarm baths or showers. Try adding an emollient (moisturising solution) such as Oilatum® to bath water, and use aqueous cream instead of soap. A little baking soda added to plain bath water can also help. After bathing, apply emollients or aqueous cream while your skin is still damp.
Protect your skin from the damage caused by scratching. Keep your nails clean and short, and rub rather than scratch the itchy area.
Avoid things that may irritate the skin or make itching worse, such as biological washing powders, scented soaps, bubble baths and products containing lanolin.
Keep cool by wearing light, natural fibres such as cotton, and by keeping the atmosphere around you cool but not too dry. Avoid alcohol and hot spicy foods and drinks.
Use other activities to try to distract you from the itching. Counselling and relaxation techniques may help you cope.
Sometimes acupuncture or transcutaneous electrical nerve stimulation (TENS) can reduce itching. The aim of TENS is to stimulate the nerves reaching the brain, and so block out the sensation of itching. Acupuncture and TENS treatments are given at some NHS hospitals.
Itching can be difficult to control, but there are medicines that may help. Your doctor will try to find the cause of the itch. If a particular medicine is the cause, an alternative drug may be prescribed. For some cancers there are specific medicines that can control itching. Your doctor can discuss these with you.
Some drugs that may be helpful include:
antihistamine tablets or lotion
a short course of steroid cream or tablets
anti-inflammatory drugs, cimetidine, aspirin and thalidomide
drugs that affect blood pressure, such as propranolol
drugs that act on the nervous system, including anaesthetics, antidepressants, anti-epileptic drugs, sedatives and some types of painkiller
an anti-sickness drug called ondansetron.
A pressure sore (also called a bedsore or pressure ulcer) is damage that occurs to the skin and the tissue underneath. It can be caused by the weight of the body pressing down on the skin. Friction from clothing or skin being dragged when you’re moved by others can also cause sores.
If your mobility has been restricted by your cancer or its treatment, you’re at a higher risk of developing a pressure sore. You’re also at a higher risk if you’ve lost a lot of weight or aren’t managing to eat and drink well. Some drugs can also increase your risk, including chemotherapy drugs, steroids and anti-inflammatory drugs.
Inspect your skin, particularly bony areas like elbows and ankles. For areas that are difficult to see, like shoulder blades or the base of your spine, use a mirror or ask a friend to help. Look out for reddened or dark patches on these areas, or any blisters or breaks in the skin. Let your nurse know about them straight away.
Preventing pressure sores
If you spend a lot of time sitting or lying in bed, change your position regularly - preferably every half an hour. Wear loose, cotton bedclothes and use pillows to support yourself in comfortable positions.
When possible, standing up for a short time or taking a short walk is the best way to relieve pressure. A physiotherapist can supply you with a walking aid to help with this, if needed.
Your district nurse will be able to assess whether you need a pressure-relieving mattress or cushion and arrange these for you. It’s still important to change position regularly when using these. A bed cradle can help keep the weight of bedclothes off your legs and feet.
Tell your doctor or a district nurse if you think you have early signs of a pressure sore. They can give you help and advice to make sure that your skin heals properly and to prevent infection from developing. There are also organisations that can provide equipment to keep you comfortable.
Treat dry skin using the tips given above.
Sweating is one of the ways our body keeps our temperature normal, but some people with cancer can have episodes of increased sweating. When this is severe it can be very uncomfortable and affect activities like sleeping. There are different causes, including the cancer itself and certain medicines. Your doctor will be able to advise you on the best treatment, depending on the cause. There are also things you can do to help:
Wear layers of light cotton clothing that can be taken off or put on easily.
Keep rooms cool and well-aired - a fan can be helpful.
Keep a sponge or flannel and some cool water by your bed for night sweats.
Use light cotton bedding and put a large cotton towel on the bed underneath you. This will absorb any sweat and can be removed easily, rather than having to change all the bedclothes.
Avoid things that may trigger sweats, for example some people find sweats are made worse by alcohol or spicy food.
Your body loses fluid through sweating, so try to drink a bit more to prevent dehydration.
Some people will have night sweats caused by the menopause or as a side effect of hormonal treatment.
If your sweating is due to the cancer itself, there are drugs that can be used to treat it, such as steroids, amitriptyline, midazolam and cimetidine.
Swollen ankles and legs
Sometimes fluid can build up in the ankles and legs, which can cause swelling.
There can be several reasons for this, including being unable to move about as much as usual. Using a footstool to keep your feet up when sitting down can help. It’s also helpful to gently exercise your legs while you’re sitting. A nurse or physiotherapist can show you some exercises to do. Water tablets (diuretics) may also be prescribed by your doctor to help reduce the swelling. In some situations, your doctor or nurse can supply pressure stockings to help the circulation in your legs.
If the swelling is only in one leg or ankle and is painful, red and hot, this may be a sign of a blood clot (thrombosis). People with cancer have a higher risk of getting a blood clot. Some cancer treatments can also increase your risk. Let your doctor know if you develop any of these symptoms, as treatment needs to be given as soon as possible.
Lymphoedema is swelling caused by a build-up of a fluid called lymph in the body tissues. It usually affects an arm or a leg, but can affect other parts of the body. It can happen if lymph nodes (sometimes called glands) have been removed by surgery or damaged by radiotherapy, or if a cancer is blocking them. Lymph nodes are part of the lymphatic system, which is part of the body’s immune system that helps us fight infections and other illnesses. If lymphoedema is diagnosed, you’ll usually be referred to a lymphoedema specialist for a full assessment.
Lymphoedema specialists are usually based in hospitals, hospices or specialist lymphoedema centres. They can offer advice on self-care and treatments, including:
skincare to prevent injury and infection
positioning the limb and movement to help drain fluid
compressing the limb or area using compression garments such as sleeves, stockings, special bras or compression bandages
exercises and keeping active to improve the flow of lymph
self-massage or specialised massage called manual lymphatic drainage (MLD) to help move fluid that’s built up.
Some types of cancer can cause a build-up of fluid in the tummy (abdomen). This is called ascites. The abdomen becomes swollen and distended, which can be uncomfortable or painful. Other symptoms include a tightness across the abdomen, unexplained weight gain, feeling breathless, feeling sick (nausea) and a reduced appetite.
Your doctors may treat ascites by inserting a small tube into your abdomen to drain off the fluid. This is usually done in hospital under a local anaesthetic. The fluid can be drained as often as necessary. Water tablets (diuretics) may be used to try to stop or slow down fluid build-up. Sometimes radiotherapy or chemotherapy treatment can prevent the fluid from coming back.
High temperature (fever)
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Fever is a common symptom of infection. If you’ve had chemotherapy within the last two weeks, the number of white cells in your blood may be temporarily reduced (neutropenia). White blood cells fight infection, so this could be the cause of your fever. If your temperature goes above 38°C (100.4°F), contact your doctor or hospital straight away. Fever caused by an infection should be treated using antibiotics.
High temperatures can be relieved with paracetamol, aspirin or an anti-inflammatory drug, for example ibuprofen. Your doctor or nurse will advise which is best for you. For tips on coping with sweating, see above.
Heartburn is a burning sensation behind the breastbone that can be very painful. It’s caused by the backflow of acid from the stomach into the gullet (oesophagus). Heartburn can be caused by certain foods and medicines. It can be made worse by lying flat or wearing tight clothing around the waist.
Tips to prevent heartburn
Avoid large meals, chocolate, alcohol, fatty foods, fizzy drinks, chewing gum, hard-boiled sweets, mint, aniseed and dill.
Wear loose clothing around your waist.
Try not to lie flat on your back, especially after meals.
Drug treatments can also help relieve troublesome heartburn. Your GP can prescribe these for you.
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This is discomfort in the upper part of the tummy (abdomen), occurring particularly after meals. It can be caused by:
having a small stomach capacity
irritation of the stomach or bowel lining caused by some drugs (such as steroids), or by some cancer treatments (such as radiotherapy or chemotherapy)
overproduction of stomach acid
not moving around much
not eating or drinking much.
Dealing with indigestion
The best way of dealing with indigestion depends on its cause.
If you have a small stomach, it can help to avoid drinking fluids at mealtimes. Try having small, frequent meals and snacks throughout the day, rather than two or three large meals.
Irritation of the stomach lining can be relieved by antacid medicines like Asilone®.
Drugs that reduce acid production, such as ranitidine (Zantac®) or omeprazole (Losec®), can relieve indigestion caused by the overproduction of stomach acid.
A drug called semeticone (Dentinox®, Infacol®) can reduce indigestion caused by wind.
An anti-sickness drug called metoclopramide can help with indigestion by causing the stomach to empty more quickly. This also helps to relieve nausea.
Your doctor will be able to prescribe the most suitable drug(s) for you, depending on the cause of your indigestion.
Hiccups are a sudden contraction or spasm of the diaphragm (the breathing muscle under the lungs). They’re a reflex action, so they aren’t under your control.
Mild hiccups are common. They usually only last for a few minutes and don’t need to be treated. However, if you have hiccups that keep coming back or that last for more than two days, you may need treatment. When hiccups last for a long time it can be distressing and uncomfortable. It can also make eating, drinking and sleeping difficult.
Hiccups can be caused by:
a bloated stomach
a change in the levels of certain chemicals in the blood
certain medicines, such as steroids, painkillers and some chemotherapy drugs
irritation to the diaphragm, caused by conditions such as an enlarged liver
irritation to the brain caused by a tumour - although this is rare.
Treatment for hiccups
Some people find that home remedies can help them get rid of hiccups more quickly. These include:
sipping iced water or swallowing crushed ice
holding your breath
breathing into a paper bag
pulling your knees up to your chest.
Other traditional remedies include drinking from the wrong (opposite) side of a cup, swallowing dry bread, quickly swallowing two teaspoons of granulated sugar or biting on a lemon.
If your hiccups don’t go away after a couple of days or if they keep coming back, you should tell your doctor. There are medicines they can prescribe that may help. The best treatment for hiccups depends on the cause.
Treatments that may help if you have a bloated stomach include:
drinking peppermint water, which relaxes the stomach and gullet, helping to release trapped air through burping
anti-wind or antacid medicines (for example Asilone®)
some anti-sickness medicines, for example metoclopramide and domperidone.
You shouldn’t take peppermint water and metoclopramide at the same time, because they work against each other. Peppermint relaxes the stomach muscle, but metoclopramide stimulates it so that the stomach empties more quickly.
Other treatments that may help get rid of hiccups include:
drugs that relax the muscles, such as baclofen or midazolam (in persistent hiccups, midazolam can be given by syringe driver)
sedative drugs, for example haloperidol
steroids, which are used to treat hiccups caused by an enlarged liver or pressure on a nerve
drugs that act on the central nervous system (CNS), for example gabapentin.
If you’re started on a drug treatment for hiccups, your doctor will usually check with you about three days later to see how well it‘s working. If the hiccups haven’t gone away the dose may need to be increased, or you may need to try another drug.
Persistent hiccups may occasionally be treated by a nerve block. This is a procedure used by specialists who work in pain clinics.
Jaundice can occur if your bile duct becomes blocked by cancer. The bile duct drains bile from the liver and gall bladder into the bowel. You can also become jaundiced if there’s an infection in your liver.
Symptoms of jaundice include:
yellowing of the skin and the whites of the eyes
pale bowel motions
Dealing with jaundice
If jaundice is caused by an infection, antibiotics may help. If it’s caused by a tumour, treatment to remove or shrink the cancer may be recommended.
Your doctors may suggest putting in a stent – a small tube that holds the bile duct open. The stent can be put in using a procedure known as an ERCP (endoscopic retrograde cholangio-pancreatography). A thin, flexible tube called an endoscope is passed down your throat into your stomach and then into the first part of the small bowel - the duodenum. Once it’s in position, the doctor can see through the endoscope into the opening of the bile duct. A stent is then put inside the duct to keep it open.
Sometimes another procedure called PTC (percutaneous transhepatic cholangiography) may be used to place a stent into the bile duct. It involves inserting a needle through the skin just below the ribcage. A fine guide wire is passed through the liver, into the blockage. The stent is passed along this wire.
Sometimes a stent can become dislodged or blocked. The first sign of this is often the jaundice returning. If this happens, the stent can be replaced.
An alternative treatment to relieve the blockage is surgery to bypass the bile duct. Surgery is only suitable for some people. The surgeon joins the gall bladder or bile duct to the bowel in an operation called a cholecystoenterostomy.
If it’s possible to unblock the bile duct, your symptoms should begin to improve. Sometimes, however, it’s not possible to do this and symptoms will continue.
Itchy skin can often be the most troublesome symptom of jaundice. Medicines used to treat an itch caused by jaundice include prochlorperazine, colestyramine and antihistamine tablets.