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Cardiopulmonary Syndromes (PDQ®)

Patient Version

Dyspnea During Advanced Cancer

Many conditions can cause dyspnea.

Dyspnea is the feeling of difficult or uncomfortable breathing or of not getting enough air. It also may be called shortness of breath, breathlessness, or air hunger. In cancer patients, causes of dyspnea include the following:

A diagnosis of the cause of dyspnea helps to plan treatment.

Diagnostic tests and procedures include the following:

  • Physical exam and history: An exam of the body to check general signs of health, including checking for signs or symptoms of dyspnea, such as breathing fast or using the neck or chest muscles to breathe. A history of your health habits and past illnesses and treatments will also be taken. Your doctor will also ask about when the dyspnea occurs, what it feels like, other signs or symptoms that happen at the same time as the dyspnea, and anything that makes it better or worse.
  • Functional assessment: An exam to check for how the dyspnea affects your ability to perform activities of daily living such as eating, bathing, or climbing stairs. This exam may include a 6-minute walk test (6MWT) to measure how far you can walk on a flat, hard surface in 6 minutes.
  • Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
    Chest x-ray; drawing shows the patient standing with her back to the x-ray machine. X-rays are used to take pictures of organs and bones of the chest. X-rays pass through the patient onto film.
    X-ray of the chest. X-rays are used to take pictures of organs and bones of the chest. X-rays pass through the patient onto film.
  • CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
  • Complete blood count: A procedure in which a sample of blood is taken and checked for the following:
  • Oxygen saturation test: A procedure to check for the amount of oxygen being carried by the red blood cells. A lower than normal amount of oxygen may be a sign of lung disease or other health problems. One method uses a device clipped to the finger. The device senses the amount of oxygen in the blood flowing through the small blood vessels in the finger. Another method uses a sample of blood taken from an artery, usually in the wrist, that is tested for the amount of oxygen.
  • Maximum inspiratory pressure (MIP) test: The MIP is the highest pressure that can be reached in the lungs when you take a deep breath. When you breathe through a device called a manometer, the device measures the pressure. The information is sent to a computer. The pressure level shows how strong the breathing muscles are.

It may be possible to treat the cause of dyspnea.

Treatment may include the following:

  • Radiation therapy: Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. External radiation therapy uses a machine outside the body to send radiation toward the cancer.
  • Chemotherapy: Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.
  • Laser therapy for tumors inside large airways: Use of a laser beam (a narrow beam of intense light) as a knife to remove the tumor.
  • Cauterization of tumors inside large airways: Use of a hot instrument, an electric current, or a caustic substance to destroy the tumor.
  • Procedures to remove fluid that has built up around the lungs (malignant pleural effusion), around the heart (malignant pericardial effusion), or in the abdominal cavity (ascites). (See the sections on controlling the signs and symptoms of malignant pleural effusion and malignant pericardial effusion for more information.)
  • Stent placement: Surgery to place a stent (thin tube) in an airway to keep it open. This may be done if a large airway is blocked by a tumor that is pressing on it from the outside.
  • Medicine:
  • Blood transfusions for anemia.

Treatment of dyspnea depends on the cause of it.

The treatment of dyspnea depends on its cause, as follows:

If the dyspnea is caused by:Then the treatment may be:
Tumor blocking the large or small airways in the chest or lungRadiation therapy.
 Chemotherapy, for tumors that usually respond quickly to this treatment.
 Laser surgery to remove the tumor.
 Cauterization of tumors.
  
Pleural effusionRemoval of the extra fluid around the lung using a needle or chest drain.
  
Pericardial effusionRemoval of the extra fluid around the heart using a needle.
  
AscitesRemoval of the extra fluid in the abdominal cavity using a needle.
  
Carcinomatous lymphangitisSteroid therapy.
 Chemotherapy, for tumors that usually respond quickly to this treatment.
  
Superior vena cava syndrome Chemotherapy, for tumors that usually respond quickly to this treatment.
 Radiation therapy.
 Surgery to place a stent in the superior vena cava to keep it open.
  
Chest infectionsAntibiotics.
 Breathing treatments.
  
Blood clotsAnticoagulants.
  
Bronchospasms or chronic obstructive pulmonary diseaseBronchodilators.
 Inhaled steroids.
  
Heart failureDiuretics and other heart medicines.
  
AnemiaBlood transfusion

Treatment may be to control the signs and symptoms of dyspnea.

Treatment to control the signs and symptoms of dyspnea may include the following:

  • Oxygen therapy: Patients who cannot get enough oxygen from the air may be given extra oxygen to inhale from a tank. Devices that increase the amount of oxygen already in the air may also be prescribed.
  • Medicines: Opioids, such as morphine, may lessen physical and mental distress and exhaustion and the feeling that the patient cannot take in enough air. Other drugs may be used to treat dyspnea that is related to panic disorder or severe anxiety.
  • Supportive care:
  • Updated: September 16, 2014