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Nausea and Vomiting (PDQ®)

Patient Version
Last Modified: 12/01/2011

Chronic Nausea and Vomiting in Advanced Cancer

Key Points for This Section


Nausea and vomiting in advanced cancer has many causes.

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

Treatment of nausea and vomiting in advanced cancer includes ways to keep bowel habits regular.

In patients with advanced cancer, constipation is one of the most common causes of nausea. To prevent constipation, it is important that a regular bowel routine be followed, even if the patient isn't eating. Laxatives that soften the stool or stimulate the bowel may help prevent constipation, especially if the patient is being treated with opioids for cancer pain. Patients with advanced cancer usually cannot handle high-fiber diets or laxatives with psyllium or cellulose that need to be taken with a lot of fluids.

Enemas and rectal suppositories are used for short-term, severe episodes of constipation. Patients who have a loss of bowel function because of nerve damage (such as a tumor pressing on the spinal cord) may need suppositories for regular bowel emptying. Enemas and rectal suppositories should not be used in patients who have damage to the bowel wall. (See the Constipation 1 section in the PDQ summary on Gastrointestinal Complications 2 and the Side Effects of Opioids 3 section in the PDQ summary on Pain 4.)

Nausea and vomiting are sometimes caused by a blocked bowel.

Patients who have advanced cancer may have a blocked bowel caused by a tumor. If the bowel is partly blocked, the doctor may put a nasogastric tube through the nose and esophagus into the stomach to make a temporary passage. If the bowel is completely blocked, the doctor may insert a gastrostomy tube through the wall of the abdomen directly into the stomach to relieve the build-up of fluid and air. Also, medicines and liquids can be given directly into the stomach through the tube.

Sometimes, the doctor may create an ileostomy or colostomy by bringing part of the small intestine or colon through the abdominal wall to form an opening on the outside of the body. For certain colorectal blockages, an expandable metal tube called a stent may be put in, to open the blocked area.

Medicines may also be used to treat nausea and vomiting and relieve pain.



Glossary Terms

abdomen (AB-doh-men)
The area of the body that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs.
abdominal (ab-DAH-mih-nul)
Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs.
antidepressant (AN-tee-dee-PREH-sunt)
A drug used to treat depression.
blood (blud)
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.
bowel (BOW-ul)
The long, tube-shaped organ in the abdomen that completes the process of digestion. The bowel has two parts, the small bowel and the large bowel. Also called intestine.
bowel function (BOW-ul FUNK-shun)
The way the intestines work in terms of how often there are bowel movements, the ability to control when to have a bowel movement, and whether the stools are hard and dry as in constipation or watery as in diarrhea.
calcium (KAL-see-um)
A mineral needed for healthy teeth, bones, and other body tissues. It is the most common mineral in the body. A deposit of calcium in body tissues, such as breast tissue, may be a sign of disease.
cancer (KAN-ser)
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.
cellulose (SEL-yoo-lose)
A building block of plant cells and fiber. Cellulose cannot be digested by people, and is used to add bulk to the diet.
chronic (KRAH-nik)
A disease or condition that persists or progresses over a long period of time.
colon (KOH-lun)
The longest part of the large intestine, which is a tube-like organ connected to the small intestine at one end and the anus at the other. The colon removes water and some nutrients and electrolytes from partially digested food. The remaining material, solid waste called stool, moves through the colon to the rectum and leaves the body through the anus.
colorectal (KOH-loh-REK-tul)
Having to do with the colon or the rectum.
colostomy (koh-LOS-toh-mee)
An opening into the colon from the outside of the body. A colostomy provides a new path for waste material to leave the body after part of the colon has been removed.
constipation (KON-stih-PAY-shun)
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.
dehydration (dee-hy-DRAY-shun)
A condition caused by the loss of too much water from the body. Severe diarrhea or vomiting can cause dehydration.
diet (DY-et)
The things a person eats and drinks.
enema (EH-neh-muh)
The injection of a liquid through the anus into the large bowel.
esophagus (ee-SAH-fuh-gus)
The muscular tube through which food passes from the throat to the stomach.
fiber (FY-ber)
In food, fiber is the part of fruits, vegetables, legumes, and whole grains that cannot be digested. The fiber in food may help prevent cancer. In the body, fiber refers to tissue made of long threadlike cells, such as muscle fiber or nerve fiber.
fluid (FLOO-id)
A substance that flows smoothly and takes the shape of its container. Liquids and gases are fluids.
gastrostomy tube (gas-TROS-toh-mee toob)
A tube inserted through the wall of the abdomen directly into the stomach. It allows air and fluid to leave the stomach and can be used to give drugs and liquids, including liquid food, to the patient. Giving food through a gastrostomy tube is a type of enteral nutrition. Also called PEG tube and percutaneous endoscopic tube.
ileostomy (IL-ee-OS-toh-mee)
An opening into the ileum, part of the small intestine, from the outside of the body. An ileostomy provides a new path for waste material to leave the body after part of the intestine has been removed.
infection (in-FEK-shun)
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.
laxative (LAK-suh-tiv)
A substance that promotes bowel movements.
medicine (MEH-dih-sin)
Refers to the practices and procedures used for the prevention, treatment, or relief of symptoms of a diseases or abnormal conditions. This term may also refer to a legal drug used for the same purpose.
nasogastric tube (NAY-zoh-GAS-trik toob)
A tube that is inserted through the nose, down the throat and esophagus, and into the stomach. It can be used to give drugs, liquids, and liquid food, or used to remove substances from the stomach. Giving food through a nasogastric tube is a type of enteral nutrition. Also called gastric feeding tube and NG tube.
nerve (nerv)
A bundle of fibers that receives and sends messages between the body and the brain. The messages are sent by chemical and electrical changes in the cells that make up the nerves.
opioid (OH-pee-OYD)
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.
PDQ
PDQ is an online database developed and maintained by the National Cancer Institute. Designed to make the most current, credible, and accurate cancer information available to health professionals and the public, PDQ contains peer-reviewed summaries on cancer treatment, screening, prevention, genetics, complementary and alternative medicine, and supportive care; a registry of cancer clinical trials from around the world; and directories of physicians, professionals who provide genetics services, and organizations that provide cancer care. Most of this information, and more specific information about PDQ, can be found on the NCI's Web site at http://www.cancer.gov/cancertopics/pdq. Also called Physician Data Query.
psyllium (SIH-lee-um)
A plant with seeds that are used as a mild laxative. The outer layer of the seeds swells when wet. This increases the size of stool and helps it pass more easily through the intestines (lower part of the digestive tract). Psyllium is a type of bulk laxative.
quality of life (KWAH-lih-tee ... life)
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.
rectal (REK-tul)
By or having to do with the rectum. The rectum is the last several inches of the large intestine closest to the anus.
side effect (side eh-FEKT)
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.
small intestine (... in-TES-tin)
The part of the digestive tract that is located between the stomach and the large intestine.
spinal cord (SPY-nul kord)
A column of nerve tissue that runs from the base of the skull down the back. It is surrounded by three protective membranes, and is enclosed within the vertebrae (back bones). The spinal cord and the brain make up the central nervous system, and spinal cord nerves carry most messages between the brain and the rest of the body.
stent (stent)
A device placed in a body structure (such as a blood vessel or the gastrointestinal tract) to keep the structure open.
stomach (STUH-muk)
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.
stool (stool)
The material in a bowel movement. Stool is made up of undigested food, bacteria, mucus, and cells from the lining of the intestines. Also called feces.
tumor (TOO-mer)
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.
ulceration (UL-seh-RAY-shun)
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.

Table of Links

1http://www.cancer.gov/cancertopics/pdq/supportivecare/gastrointestinalcomplicat
ions/Patient/Page3#Section_9
2http://www.cancer.gov/cancertopics/pdq/supportivecare/gastrointestinalcomplicat
ions/Patient
3http://www.cancer.gov/cancertopics/pdq/supportivecare/pain/Patient/Page4#Sectio
n_27
4http://www.cancer.gov/cancertopics/pdq/supportivecare/pain/Patient