Anticipatory Nausea and Vomiting
Acute Nausea and Vomiting
Delayed Nausea and Vomiting
        Nausea and Vomiting in Advanced Cancer
        Radiation Therapy and Nausea and Vomiting

Nausea is controlled by a part of the central nervous system that controls involuntary bodily functions. Vomiting is a reflex controlled by a vomiting center in the brain. Vomiting can be stimulated by various triggers, such as smell, taste, anxiety, pain, motion, poor blood flow, irritation, or changes in the body caused by inflammation.

The most common causes of nausea and vomiting are:

• Chemotherapy drugs.
• Radiation therapy directed at the gastrointestinal (GI) tract, liver, or brain.

Nausea and vomiting are more likely to occur if the patient:

• Experienced severe episodes of nausea and vomiting after past chemotherapy sessions.
• Is female.
• Is younger than 50 years.
• Has a fluid and/or electrolyte imbalance (hypercalcemia, dehydration, or an excess of fluid in the body's tissues).
• Has a tumor in the GI tract, liver, or brain.
• Has constipation.
• Is receiving certain drugs.
• Has an infection or blood poisoning.
• Has kidney disease.
• Experiences anxiety.

Anticipatory nausea and vomiting occur after the patient has undergone several cancer treatments. It occurs in response to triggers, such as odors in the therapy room. For example, a person who begins chemotherapy and smells an alcohol swab at the same time, may later experience nausea and vomiting at the smell of alcohol alone. Patients usually do not experience nausea and/or vomiting before or during chemotherapy until after they have received several courses of treatment. The following factors may help predict which patients are more likely to experience anticipatory nausea and vomiting:

• Being younger than 50 years.
• Being female.
• The severity of nausea and vomiting after the last chemotherapy session.
• Feeling warm or hot after the last chemotherapy session.
• A history of motion sickness.
• Feeling dizzy or lightheaded after chemotherapy.
• Sweating after the last chemotherapy session.
• Experiencing weakness after the last chemotherapy session.
• Having a high level of anxiety.
• The type of chemotherapy (some are more likely to cause nausea and vomiting).
• Having morning sickness during pregnancy.

Chemotherapy is the most common treatment-related cause of nausea and vomiting. The drug, dose, schedule of administration, route, and factors that are unique to the patient all determine how often nausea occurs and how severe it will be. Usually, these symptoms can be prevented or controlled.

Acute nausea and vomiting are more likely to occur in patients who:

• Have experienced nausea and vomiting after previous chemotherapy sessions.
• Are female.
• Drink little or no alcohol.
• Are young.

Delayed nausea and vomiting occurs more than 24 hours after chemotherapy. It is more likely to occur in patients who:

• Are receiving high-dose chemotherapy regimens.
• Have experienced acute nausea and vomiting with chemotherapy.
• Are female.
• Drink little or no alcohol.
• Are young.

Drugs to prevent nausea and vomiting may be given alone or in combinations to patients who are receiving chemotherapy.

Patients who have advanced cancer commonly experience chronic nausea and vomiting, which can significantly impair quality of life. Nausea and vomiting related to advanced cancer may be caused by the following:

• Use of opioids, antidepressants, and other pain medications.
• Constipation (a common side effect of opioid use).
• Brain and colon tumors.
• Abnormal levels of certain substances in the blood.
• Dehydration.
• Stomach ulcers.

Radiation therapy may also cause nausea and vomiting, especially in patients who are undergoing radiation to the GI tract (particularly the small intestine and stomach) or brain. The risk for nausea and vomiting increases as the dose of radiation and area being irradiated increase. Nausea and vomiting associated with radiation therapy usually occurs one-half hour to several hours after treatment. Symptoms may improve on days the patient does not undergo radiation therapy.

Glossary Terms

Not normal. An abnormal lesion or growth may be cancer, premalignant (likely to become cancer), or benign (not cancer).

Symptoms or signs that begin and worsen quickly; not chronic.

Cancer that has spread to other places in the body and usually cannot be cured or controlled with treatment.

A chemical substance found in beer, wine, and liquor. Alcohol is also found in some medicines, mouthwashes, essential oils (scented liquid taken from plants), and household products.

A drug used to treat depression.

Feelings of fear, dread, and uneasiness that may occur as a reaction to stress. A person with anxiety may sweat, feel restless and tense, and have a rapid heart beat. Extreme anxiety that happens often over time may be a sign of an anxiety disorder.

A tissue with red blood cells, white blood cells, platelets, and other substances suspended in fluid called plasma. Blood takes oxygen and nutrients to the tissues, and carries away wastes.

Disease caused by the spread of bacteria and their toxins in the bloodstream. Also called septicemia and toxemia.

The growth of abnormal cells in the tissues of the brain. Brain tumors can be benign (not cancer) or malignant (cancer).

A term for diseases in which abnormal cells divide without control and can invade nearby tissues. Cancer cells can also spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is a cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is a cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is a cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood. Lymphoma and multiple myeloma are cancers that begin in the cells of the immune system. Central nervous system cancers are cancers that begin in the tissues of the brain and spinal cord. Also called malignancy.

The brain and spinal cord. Also called CNS.

Treatment with drugs that kill cancer cells.

A disease or condition that persists or progresses over a long period of time.

Cancer that forms in the tissues of the colon (the longest part of the large intestine). Most colon cancers are adenocarcinomas (cancers that begin in cells that make and release mucus and other fluids).

A condition in which stool becomes hard, dry, and difficult to pass, and bowel movements don’t happen very often. Other symptoms may include painful bowel movements, and feeling bloated, uncomfortable, and sluggish.

A condition caused by the loss of too much water from the body. Severe diarrhea or vomiting can cause dehydration.

The amount of medicine taken, or radiation given, at one time.

Any substance, other than food, that is used to prevent, diagnose, treat or relieve symptoms of a disease or abnormal condition. Also refers to a substance that alters mood or body function, or that can be habit-forming or addictive, especially a narcotic.

A substance that breaks up into ions (particles with electrical charges) when it is dissolved in water or body fluids. Some examples of ions are sodium, potassium, calcium, chloride, and phosphate. These ions help move nutrients into cells, help move waste out of cells, and help nerves, muscles, the heart, and the brain work the way they should.

A substance that flows smoothly and takes the shape of its container. Liquids and gases are fluids.

The stomach and intestines. The gastrointestinal tract is part of the digestive system, which also includes the salivary glands, mouth, esophagus, liver, pancreas, gallbladder, and rectum.

An intensive drug treatment to kill cancer cells, but that also destroys the bone marrow and can cause other severe side effects. High-dose chemotherapy is usually followed by bone marrow or stem cell transplantation to rebuild the bone marrow.

Higher than normal levels of calcium in the blood. Some types of cancer increase the risk of hypercalcemia.

Invasion and multiplication of germs in the body. Infections can occur in any part of the body and can spread throughout the body. The germs may be bacteria, viruses, yeast, or fungi. They can cause a fever and other problems, depending on where the infection occurs. When the body’s natural defense system is strong, it can often fight the germs and prevent infection. Some cancer treatments can weaken the natural defense system.

Redness, swelling, pain, and/or a feeling of heat in an area of the body. This is a protective reaction to injury, disease, or irritation of the tissues.

An action that is not made by choice. In the body, involuntary actions (such as blushing) occur automatically, and cannot be controlled by choice.

Treated with radiation.

One of a pair of organs in the abdomen. Kidneys remove waste from the blood (as urine), produce erythropoietin (a substance that stimulates red blood cell production), and play a role in blood pressure regulation.

A large organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile.

A feeling of sickness or discomfort in the stomach that may come with an urge to vomit. Nausea is a side effect of some types of cancer therapy.

A substance used to treat moderate to severe pain. Opioids are like opiates, such as morphine and codeine, but are not made from opium. Opioids bind to opioid receptors in the central nervous system. Opioids used to be called narcotics. An opioid is a type of alkaloid.

In medicine, action taken to decrease the chance of getting a disease or condition. For example, cancer prevention includes avoiding risk factors (such as smoking, obesity, lack of exercise, and radiation exposure) and increasing protective factors (such as getting regular physical activity, staying at a healthy weight, and having a healthy diet).

The overall enjoyment of life. Many clinical trials assess the effects of cancer and its treatment on the quality of life. These studies measure aspects of an individual’s sense of well-being and ability to carry out various activities.

Energy released in the form of particle or electromagnetic waves. Common sources of radiation include radon gas, cosmic rays from outer space, medical x-rays, and energy given off by a radioisotope (unstable form of a chemical element that releases radiation as it breaks down and becomes more stable).

The use of high-energy radiation from x-rays, gamma rays, neutrons, protons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Also called irradiation and radiotherapy.

A treatment plan that specifies the dosage, the schedule, and the duration of treatment.

In clinical trials, the step-by-step plan for how patients are to be treated; for example, the drug or type of radiation therapy that is to be given, the method by which it is to be given, the amount of time between courses, and the total length of treatment.

A problem that occurs when treatment affects healthy tissues or organs. Some common side effects of cancer treatment are fatigue, pain, nausea, vomiting, decreased blood cell counts, hair loss, and mouth sores.

The part of the digestive tract that is located between the stomach and the large intestine.

An organ that is part of the digestive system. The stomach helps digest food by mixing it with digestive juices and churning it into a thin liquid.

An indication that a person has a condition or disease. Some examples of symptoms are headache, fever, fatigue, nausea, vomiting, and pain.

Treatment.

A group or layer of cells that work together to perform a specific function.

An abnormal mass of tissue that results when cells divide more than they should or do not die when they should. Tumors may be benign (not cancer), or malignant (cancer). Also called neoplasm.

The formation of a break on the skin or on the surface of an organ. An ulcer forms when the surface cells die and are cast off. Ulcers may be associated with cancer and other diseases.

To eject some or all of the contents of the stomach through the mouth.