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Macmillan and Cancerbackup merged in 2008. Together we provide free, high quality information for people affected by cancer through our publications, website and phone service. Find out more| .
How we produce our information|
Wheezing, breathlessness| and coughing may be a problem for you. These symptoms may be related to the cancer if it is affecting your lungs. The symptoms may also be caused by:
Whatever the cause, breathing difficulties can usually be helped.
How breathlessness is treated depends on the cause. Chemotherapy, hormone therapy or radiotherapy may help to shrink the cancer and relieve symptoms, if it is caused by lung cancer. If your airways have become narrowed, your doctor can prescribe drugs to help. These may be given as tablets, inhalers or through a special mask called a nebuliser. Treating a chest infection with antibiotics often improves symptoms.
Pleural effusion A pleural effusion| is a build-up of fluid between the membranes around the outside of the lungs and is quite common. The fluid stops your lung from being able to expand fully, leading to breathlessness. It is treated by placing a tube, connected to a drainage bag or bottle, between the two layers of pleura and draining off the fluid. This is done under a local anaesthetic. Sometimes, after the fluid has been drained, powder or an antibiotic or chemotherapy drug is put between the two layers of pleura. This makes the pleura stick together, so that fluid cannot collect between them. This is called a pleurodesis.
Anaemia If your breathlessness is caused by anaemia, treating this with a blood transfusion may help.
Radiotherapy If you have had radiotherapy| to your chest, you may cough and feel mildly breathless for several weeks or months after your treatment has ended. This is due to inflammation in your lungs from the radiation and can be treated by a course of steroids. After taking the steroids for several weeks, your dose will gradually be reduced and then stopped when your breathing is better.
Morphine Small doses of morphine can be helpful in controlling breathlessness and slowing your breathing down to a more normal rate. If you are already taking morphine for pain control, the dose can be altered to help with the breathing problem too.
Positioning If you are breathless you may find some positions more comfortable than others. You may find it more comfortable to sit upright or to lean forward slightly while resting your forearms on the arms of the chair, the table or your knees. It can help to sleep propped up on several pillows or in a recliner chair.
Emotions Feeling breathless can make you feel anxious and start to breathe faster. Some people worry that they could die because feel unable to draw breath, but this isn’t the case. Anxiety and panic make breathlessness worse so learning ways to stay calm and feel in control can be helpful. You can also be prescribed medication that reduces feelings of anxiety to help you with this.
Special breathing techniques, known as pursed lip breathing and abdominal (or diaphragmatic) breathing, can help you to control your breathing and to feel less panicky. A physiotherapist or specialist palliative care nurse can teach these techniques.
Pursed lip breathing technique Pursed lip breathing slows the flow of air as you breathe out. It relieves shortness of breath by helping to open the airways, releasing trapped air, decreasing the effort of breathing and making each breath more effective.
How to purse your lips While breathing out keep your lips tightly together except for a small opening in the centre. (As if you were going to whistle). Blow out through this small opening.
It works best if you practice the technique about five times a day until you are comfortable with it. Use the technique during any activity involving effort such as climbing stairs or if you feel yourself becoming anxious and your breathing rate increasing.
Abdominal breathing technique (also called diaphragmatic breathing) Abdominal breathing helps you to breath more deeply using all of the lungs, so your breathing is slower, deeper and more effective. To start with, many people find it easier to learn when lying down. However, it can be done in a sitting or lying position, whichever is more comfortable for you.
It works best if you practice this technique daily several times in a row.
Learning relaxation techniques| can be helpful.
Feeling breathless is often brought on by effort such as climbing stairs or dressing. Specialist equipment such as stair lifts can help you to minimise activities that may make you feel out of breath. Equipment suppliers are listed in our section on useful organisations|.
Airflow from a nearby fan or open window can help to ease the sensation of breathlessness for some people.
Sometimes oxygen therapy is helpful. This may be used in short bursts before and after activity or may be needed all the time. Oxygen can be supplied at home. Your hospital doctor or GP can organise this for you.
Coughing helps to clear the airways and so can be helpful, but can also be uncomfortable, embarrassing and affect our ability to sleep, rest and eat.
If you are coughing up green or dark-yellow coloured phlegm (sputum), you may have an infection and will need to have antibiotics. Some people also need chest 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 relieve it.
Occasionally people cough up blood. This may be just a small amount or it may be larger clots. Coughing up blood can be caused by a chest infection, a blood clot in the lung, 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 this. 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.
It is always important to let your doctor know if you begin to cough up blood or if this symptom gets worse.
Bladder problems may be caused by cancer pressing on, or blocking, the tube (urethra) through which urine passes out of the bladder. This can lead to incontinence (loss of bladder control) or retention (when urine cannot 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 (hysterectomy). These may be due to damage to the valve that controls the flow of urine from the bladder (urinary sphincter) or to nerve damage in the pelvis. These problems are often temporary and so improve over weeks or months. If you experience problems after surgery you may be helped by exercises called pelvic floor exercises or kegel exercises. These exercises help to retrain the muscles involved in bladder control.
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’s symptoms improve with time. However, rarely, 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. 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. An infection can be treated with antibiotics prescribed by your doctor.
Our sections about pelvic radiotherapy| have information about bladder problems and how to cope with them.
If you are at increased risk of a urinary infection, perhaps because you are having radiotherapy treatment to the pelvic area, you may want to try 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 in some people. It isn’t clear what the best dose is, but high dose capsules may be better than low dose capsules or juice. It is best to avoid cranberry extracts or juice if you take warfarin tablets as they can affect how it works.
It can help to drink enough water to keep your urine a clear, or pale yellow colour, and it may help to avoid drinking too much alcohol or coffee.
Continence problems can occur if you find it difficult to get out of a chair or bed and so can’t get to a toilet quickly. These may be avoided by making sure that help is always available or a commode is close by.
A wide range of continence aids are available. Your district nurse or a specialist continence nurse can arrange for these to be supplied to you. Pads use materials that draw urine away from the body. They are small and inconspicuous but secure enough to prevent embarrassing accidents. For men there are also sheaths for the penis and dribble pouches
If you are restricted to bed, incontinence can be more difficult to cope with. In this situation, or if you are having 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 are 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.
The Continence Foundation can give you advice about managing continence problems.
Itching is a common symptom and may affect any area of your body. It may affect all of your body or only one particular area. Itching may be due to:
Itching can be difficult to control but there are many medicines that may help. Your doctor can prescribe these for you. Drugs that may be helpful include;
For some cancers there are specific medicines that can control the itching. Your doctor can discuss these with you.
Dealing with an itchy skin
These are areas of skin that become damaged or broken. They can occur when the blood supply to an area of skin is interrupted. Often this is caused by prolonged pressure from long periods of sitting or lying in one position. Friction from clothing or bedclothes can also contribute to pressure sores developing. Thin, delicate skin over the joints, such as elbows, knees, hips, heels, and at the base of the spine, is especially prone to pressure sores.
Preventing pressure sores
Sweating is one of the ways our body keeps our temperature normal, but sometimes people with cancer can experience episodes of increased sweating. When this is severe it can cause serious discomfort and affect activities like sleeping. There are various reasons for excessive sweating. It can be a symptom of some cancers such as some types of lymphoma, or it can be due to fever caused by infection. Sometimes cancer treatments affect hormone levels in the body causing increased sweating.
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 yourself manage sweats.
Helpful tips to cope with sweating
The causes of night sweats are not fully understood. If your night sweats are caused by the menopause or are a side effect of a hormonal treatment, we have a section on these symptoms|, including hot flushes and sweats.
Some people with cancer find their ankles and legs get swollen. This can be for several reasons. A common reason is being unable able to move about as much as usual.
Keeping your feet up when sitting down (using a footstool) can help. It is also helpful to gently exercise your legs while you are sitting down. A nurse or physiotherapist can show you some exercises to do. Water tablets (diuretics) may also be prescribed by your doctor to help get rid of the excess fluid. In some situations, your doctor or nurse can give you special pressure stockings to help the circulation in your legs
Swelling may be due to lymphoedema (see below).
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). Blood clots are fairly common in people with cancer, especially those who have cancer of the prostate, breast, ovary or pancreas. Some cancer treatments, such as tamoxifen, stilboestrol and thalidomide, can increase the risk of developing a blood clot. Let your doctor know if you develop symptoms of a possible thrombosis, as treatment needs to be given as soon as possible.
Certain types of cancer can cause a build up of fluid in the tummy area (abdomen). This is called ascites| and can make the tummy swollen and uncomfortable. Your doctors may treat this by inserting a small tube into the 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) can be used to try to stop or slow down fluid build up after ascites has been drained. Sometimes radiotherapy or chemotherapy treatment can prevent the fluid from coming back.
The lymph glands are part of the body's natural drainage-system. Fluid may collect in the tissues if some of your lymph glands have been removed or damaged. This might happen following a mastectomy for breast cancer if the lymph glands under the arm have been removed. Fluid may build up in the arm on the affected side and this can be very uncomfortable, especially if the swelling is severe. In a similar way, swelling can occur in the legs if the lymph glands in the groin have been removed.
Massaging fluid away from the area of the swelling using a technique called manual lymphatic drainage can help to reduce it. Manual Lymphatic Drainage should only be carried out by a person who has had specific training in this type of massage. Specially designed elasticated sleeves or stockings can also help to keep the swelling down.
In some hospitals and hospices, lymphoedema specialists can advise you on how to manage your lymphoedema|. You can also ask your doctor to refer you to a lymphoedema treatment unit.
This is a burning sensation behind the breastbone and is caused by the backflow of acid from the stomach into the gullet (oesophagus). It can be very painful and can be caused by some foods, some medicines, and tight clothing around the abdomen. It can be made worse by lying flat.
This is discomfort in the upper part of the abdomen, occurring particularly after meals. It can be caused by:
The best way of dealing with indigestion will depend on the cause. If you have a small stomach it is helpful to avoid drinking fluids at mealtimes. It is best to eat 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®. Your doctor can prescribe these.
Drugs which reduce acid production, such as ranitidine (Zantac®) or omeprazole (Losec®) can relieve indigestion caused by overproduction of stomach acid. Drugs to reduce 'wind' production, such as semeticone (Dentinox®, Ifacol®) or dimethicone, can also be helpful.
If you are not moving around much, metoclopramide (an anti-sickness drug) can help the stomach to empty more quickly.
Hiccups are a sudden contraction, or spasm, of the diaphragm, (the breathing muscle under the lungs). They are a reflex action so aren’t under your control.
Mild hiccups are common. They usually last for only 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 24 hours, 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 are often caused by:
Most hiccups go away without treatment. Some people find that home remedies can help them to get rid of hiccups more quickly. They include:
If your hiccups don’t go away after 24 hours or if they keep coming back you should tell your doctor. There are medicines they can prescribe which may help. The best treatment for hiccups depends on the cause.
Treatments that may help if you have a bloated stomach include:
It's best not to take peppermint water and metoclopramide at the same time because they work against each other. Peppermint works by relaxing the stomach muscle but metoclopramide stimulates it so that the stomach empties more quickly.
Other treatments that may help include:
If you are started on a drug treatment for hiccups your doctor will usually check with you about three days later to see how well it is working. If the hiccups haven’t gone away the dose may need to be increased or another drug tried.
Jaundice can happen if the bile duct becomes blocked by cancer. The bile duct drains bile from the liver and gall bladder into the bowel. Jaundice can also happen if there is an infection in the liver.
Symptoms of jaundice include:
If your jaundice is caused by an infection, antibiotics may help.
If it is caused by a tumour, treatment to remove or shrink the cancer may help.
Your doctors may suggest putting in a stent (a small tube which 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 (an endoscope) is passed down your throat, into your stomach and then into the first part of the small bowel – the duodenum. Once it is 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.
It may also be possible to put a stent into the bile duct using another procedure called PTC (percutaneous transhepatic cholangiography). This involves inserting a needle through the skin just below the rib cage. A fine guide wire is passed through the liver, into the blockage. The stent is passed along this wire.
Sometimes the 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. The surgeon joins the gall bladder or bile duct to the bowel in an operation called a cholecystoenterostomy.
If it is possible to unblock the bile duct the symptoms should begin to improve. Sometimes, however, it is not possible to do this and symptoms will continue. An itchy skin can often be the most troublesome problem.
Medicines used to treat an itch caused by jaundice include prochlorperazine, colestyramine and antihistamine tablets.
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