Cancer of Unknown Primary
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Cancer of Unknown Primary
Managing symptoms and side effects
Symptoms and side effects vary from person to person – you may have none, a few or many. This section describes the most common symptoms and side effects experienced during treatment for CUP. You may have others not mentioned here. Talk to your treatment team about ways to manage any symptoms and side effects you have.
Many people with cancer worry that they will be in pain. Not everyone will have pain, and those who do may find the pain comes and goes. Pain is affected by the location of the cancer and its size. Ways to relieve pain include:
- pain medicines, such as paracetamol, ibuprofen and other non-steroidal anti-inflammatory drugs, and opioids (e.g. oxycodone, morphine)
- medicines that are normally used for other conditions, such as antidepressants and anticonvulsants (known as adjuvant analgesics)
- procedures to block pain signals (e.g. nerve blocks or spinal injections)
- therapies, such as massage, meditation, relaxation, hypnotherapy, exercise and physical therapy
- psychological therapies that can change the way you think about and respond to pain
- cancer treatments used palliatively.
Often a combination of methods is needed and it may take time to find the right pain relief for you. If one method doesn’t work, you can try something else.
Using cancer treatments to control pain
Chemotherapy, radiation therapy and surgery are common cancer treatments. They can sometimes be used palliatively to reduce pain by helping to remove its cause.
Radiation therapy – This treatment can be used to relieve many types of pain. The most common form of radiation therapy for pain is external beam radiation therapy. If cancer has spread to many places in the bone and is causing pain, you may have another form of radiation therapy.
Cancer drug therapies – In some cases, chemotherapy, hormone therapy, targeted therapy and immunotherapy can shrink a tumour that is pressing on nerves or organs and causing pain.
Surgery – Some people have an operation to remove part or all of a tumour. Surgery can also be used to treat a serious condition such as a bowel blockage (obstruction) that is causing pain, or to reduce the size of a cancer and improve how well chemotherapy and radiation therapy work.
Pain management experts – Your GP or oncologist may be able to suggest effective medicine, but if you are still uncomfortable, ask to see a palliative care specialist. Good pain control is one of the major ways a specialist palliative care team can help. How and where the pain is felt, and how it affects your life, may change. Regular check-ups with pain management experts can help keep the pain under control.
For many people, feeling tired and lacking energy (fatigue) can be the most difficult symptom to manage. It can be very frustrating if other people don’t understand how you’re feeling.
Fatigue can be caused by a range of things, such as:
- the cancer itself or cancer treatments
- low levels of red blood cells (anaemia) or high levels of calcium in the blood (hypercalcaemia)
- drugs such as pain medicines, antidepressants and sedatives
- loss of weight and muscle tone
- anxiety or depression
- lack of sleep
- poorly managed pain.
Tips for managing fatigue
- Pace yourself. Spread your activities throughout the day with rest periods in between.
- Try to do gentle exercise. Research shows this reduces tiredness and preserves muscle strength. Even walking to the letterbox or getting up for meals can help.
- Speak to an occupational therapist about ways to conserve energy.
- Have a short nap of no more than 30 minutes during the day. This can refresh you without making it hard to sleep well at night.
- Talk to your doctor if you often feel anxious or sad, or if you are having trouble sleeping at night.
Feeling sick in the stomach (nauseated) is an unpleasant symptom that may be caused by the cancer itself. Nausea can also be a side effect of some types of chemotherapy, but anti-nausea medicines can often prevent or manage this.
Other causes of nausea include:
- treatment with radiation therapy
- stress or anxiety
- too much or too little of a mineral in the blood (e.g. calcium)
- drugs used to control other symptoms (e.g. morphine for pain)
- the kidneys not working properly
- a bowel blockage (obstruction) or constipation
- increased pressure around the brain as a result of cancer in the brain or cancer affecting the flow of fluid around the brain and spinal cord.
Tips for easing nausea
- Eat small meals as often as you can.
- Eat cold foods, such as sandwiches, stewed fruit, salads or jelly.
- Have food or drink that contains ginger, such as ginger ale, ginger tea or ginger cake.
- Talk to your doctor or nurse about anti-nausea drugs or treatments that can help relieve constipation.
- Try to reduce stress by using meditation or relaxation techniques.
- Avoid strong odours and cooking smells.
Not feeling like eating is a common problem faced by people with CUP. This may be caused by the cancer itself or side effects of treatment. You may not enjoy the way food tastes or smells, or you may be worried about the diagnosis and treatment. You might also not want to eat much if you are feeling sick (nauseated) or have a sore mouth or oral thrush infection. These problems can often be managed, so let your treatment team know.
You may go through periods of having no appetite. These may last a few days or weeks, or be ongoing. During these periods, it may help to have liquid meal substitutes. These are high-kilojoule drinks containing some of the major nutrients needed by your body. Drinking these may help keep your energy levels up during periods when your appetite is poor.
Tips for when you don’t feel like eating
- Have small meals and snacks frequently throughout the day.
- Use small dishes so food isn’t “lost” on the plate (e.g. serve soup in a cup).
- Use lemon juice, fresh herbs, ginger, garlic or honey to add more interesting flavours to food.
- Sip fluids throughout the day. Add ice-cream, yoghurt or fruit to drinks to increase the kilojoules.
- Choose full-fat foods over low-fat, light or diet versions.
- If you have a sore mouth, eat soft food, such as scrambled eggs or stewed fruit.
- Ask your dietitian or doctor to recommend the right nutritional supplement for you to help slow weight loss and maintain your muscle strength.
Some people with CUP experience shortness of breath. Causes include:
- fluid surrounding the lungs (pleural effusion)
- an infection in the lungs
- a blood clot in the lungs (pulmonary embolism)
- pressure from the cancer itself or from a swollen abdomen
- anaemia (low levels of red blood cells).
Treatment will depend on the cause. You may need fluid drained from the chest (pleural tap) or medicine for an infection or other lung problem. A low-dose opioid medicine is sometimes prescribed.
Feeling short of breath may make you feel anxious, which can make the breathlessness worse. Your doctor or a psychologist can help you find ways to manage any anxiety.
Tips to help your breathing
- Use a battery-operated handheld fan or open a window to increase airflow near your face.
- Sit up straight to ease your breathing or lean forward on a table with an arm crossed over a pillow. Try sleeping in a more upright position.
- Try relaxation or breathing techniques to see if they help. A physiotherapist or psychologist can teach you these techniques. You can also try listening to recorded meditation or relaxation exercises.
- Ask someone else to breathe in time with you so you can focus on slowing your breath to their pace.
This information is reviewed by
This information was last updated September 2022 by the following expert content reviewers: Prof Chris Karapetis, Network Clinical Director (Cancer Services), Southern Adelaide Local Health Network, Head, Department of Medical Oncology, and Director, Clinical Research in Medical Oncology, Flinders Medical Centre and Flinders University, SA; Dr Amey Aurangabadkar, Radiologist, Illawarra Radiology Group, NSW; Clare Brophy, Consumer; Prof Katherine Clark, Clinical Director of Palliative Care, NSLHD Supportive and Palliative Care Network, Northern Sydney Cancer Centre, Royal North Shore Hospital, NSW; Prof Wendy Cooper, Senior Staff Specialist, Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, NSW; A/Prof Richard Gallagher, Head and Neck Surgeon, Director of Cancer Services and Head and Neck Cancer Services, St Vincent’s Health Network, NSW; Dr Chloe Georgiou, Oncology Research Fellow, Australian Rare Cancer Portal, and Oncology Trials Fellow, Bendigo Health Cancer Centre, VIC; Dr Susan Harden, Radiation Oncologist, Peter MacCallum Cancer Centre, VIC; Justin Hargreaves, Medical Oncology Nurse Practitioner, Bendigo Health Cancer Centre, VIC; Dr Laura Kirsten, Principal Clinical Psychologist, Nepean Cancer Care Centre, NSW; Prof Linda Mileshkin, Medical Oncologist, Peter MacCallum Cancer Centre, VIC; Caitriona Nienaber, 13 11 20 Consultant, Cancer Council WA.