Physical symptoms of advanced cancer
People with advanced cancer often experience troubling physical problems. Physical symptoms usually depend on the specific type of cancer a person has and where it has spread.
Be sure to talk to the healthcare team about any of these symptoms. They can’t always be completely controlled, but there is usually something that can be done to bring some comfort and relief.
People with advanced cancer usually get very thin. This may be because they find it hard to eat or drink or they may lose their appetite, even for foods they used to enjoy. This leads to poor nutrition and weight loss.
Eventually, a person with advanced cancer will have a significant loss of muscle mass or muscle wasting (cachexia), which makes them extremely thin. Closer to the end of life, the body’s systems normally slow down and they may not be able to digest food and water.
Friends and family find it very upsetting to watch a loved one lose weight, especially when the person with cancer simply doesn’t want to eat. It may help to understand that if a person has a significant loss of appetite or has lost a lot of weight, eating more will not increase their energy or make their life longer.
Sometimes a person with advanced cancer isn’t able to drink enough fluid because they can’t swallow or don’t feel like drinking. This can lead to dehydration.
If someone can’t drink enough fluid, extra fluids can be given through a vein (intravenous replacement) or into the tissue just under the skin (hypodermoclysis). This can help improve symptoms of dehydration, such as confusion, nausea or restlessness (in certain cases).
It’s important to talk about giving extra fluids to a person with advanced cancer. The decision to give extra fluids in a palliative situation depends on many factors:
- the person’s symptoms and overall condition
- the possible benefits and risks of hydration
- whether or not it will improve quality of life
- the person’s and family’s wishes
Fatigue is very common in people with advanced cancer. They often tire easily and have less energy. People may be drowsy and less alert and active. Fatigue can significantly affect mood, appetite and overall quality of life. It’s important to take advantage of the times when a person isn’t feeling as tired for important activities, visiting or conversations.
Many people with advanced cancer can have problems with chronic nausea and vomiting. Nausea and vomiting may be caused by pain-relieving drugs, constipation, cancer growth, blockage of the bowel or because digestion slows down. Nausea is often worse when a person is tired or anxious.
People with advanced cancer may have a dry mouth or sore mouth and throat. These problems can be caused by breathing through the mouth (rather than the nose), drinking less and some types of treatment. If the immune system is weakened because of treatment or advanced disease, people are at risk of developing mouth infections. Good mouth care can help ease or reduce mouth problems.
Constipation is common in people with advanced cancer. It can be caused by pain-relieving drugs like opioids, eating and drinking less or being less active.
Some people with advanced cancer may have trouble breathing or feel short of breath. This can be very frightening. Shortness of breath can be caused by:
- the cancer
- a buildup of fluid in the lungs (pleural effusion)
- a buildup of fluid around the heart (pericardial effusion)
- lung infections (pneumonia)
The following may help someone with advanced cancer breathe easier:
- lying on the side or having pillows under the head and behind the back
- oxygen therapy
- using a humidifier or a fan in the room
- relaxation and breathing exercises
People with advanced cancer may have skin problems, such as dryness, itching or redness over the joints. Skin may become thin and very fragile. These problems can be caused by drinking less fluid, eating less and weight loss.
The following tips may help with skin problems:
- Bathe with warm water and a non-drying cleanser.
- Gently pat the skin completely dry with soft towels or cloths.
- Massage a gentle, non-perfumed moisturizer into the skin.
- Avoid rubbing reddened areas or where skin is thin.
- Special bandages may be needed on fragile skin on the joints to prevent tearing or splitting of the skin.
Pressure sores can develop if someone stays in one position too long. They are most often found on areas where the joints are close to the skin (hips, ankles, heels and elbows). If left too long, these sores can break open or become infected.
Following these tips may help prevent and relieve pressure sores:
- turning frequently in bed
- using pillows under joints to help relieve pressure
- protecting pressure areas with foam pads, sheepskins or special mattresses
- making sure that sheets and bedding are not wet, wrinkled or irritating to the skin
- keeping the skin clean and dry and checking skin daily for any changes
You’re not alone if pain is one of your biggest fears. People with advanced cancer have different causes or types of pain, such as bone and nerve pain. It’s hard to avoid pain entirely with advanced cancer, but most pain can be managed. When your pain is well controlled, your quality of life is better.
Pain may be less of a problem as death approaches because the person is not moving around as much. Drugs to treat pain can be used even if a person is unconscious. These drugs help keep the person with cancer comfortable. Signs of pain in someone who is unconscious are frowning, grimacing or tension in the skin in the forehead. Groaning and moaning may also be signs of pain, but it’s common for people who are dying to make these noises. Sudden, severe pain that can’t be treated is rare in the last hours before death.