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  • Managing the symptoms and side effects of cancer of unknown primary


    The most common symptoms and side effects will vary from person to personyou may have none or only a few, or you may experience others not mentioned here. Most symptoms and side effects can be relieved and some can even be prevented.


    Many people with CUP worry that they will be in pain. Not everyone will experience pain and those who do may find their pain comes and goes. Pain depends on the location of the cancer and its size. If you do experience pain it can usually be controlled.

    There are many ways to relieve pain, including:

    • pain medicines such as non-steroidal anti-inflammatory drugs (NSAIDs), paracetamol and opioids
    • an injection of pain-relieving drugs into the spinal canal (epidural or spinal block)
    • relaxation therapies, such as massage, meditation or hypnotherapy
    • treating the cause of the pain with chemotherapy, radiotherapy or surgery.

    You may need to use more than one of these pain-relieving methods. It may take time to find the right pain control measure for you. If one method doesn’t work, you can try something else.

    Good pain control is one of the major contributions that a specialist palliative care team can make for someone whose pain is difficult to manage.

    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. It’s better to take your pain medicine regularly, rather than waiting for the pain to occur.

    For more information about pain, call Cancer Council 13 11 20 or you can download the booklet Overcoming cancer pain.


    For many people, extreme and constant tiredness (fatigue) can be a major problem. It can be very distressing for the person experiencing it and for those around them. Some people say their tiredness is harder to manage than their pain or nausea.

    Tiredness can be caused by a range of things such as:

    • the cancer itself
    • cancer treatment such as chemotherapy or radiotherapy
    • poor nutrition causing loss of weight and muscle tone
    • anxiety
    • lack of sleep
    • drugs such as pain medicines, antidepressants and sedatives
    • anaemia (low levels of red blood cells)
    • infection.

    Tips to manage fatigue

    • Talk about the fatigue with your friends, relatives and carers to help them understand how you feel.
    • Plan to do things at the time of day when your tiredness is least severe.
    • Try to do gentle exercises. Research shows this reduces tiredness, helps preserve muscle strength and gives a sense of normality. Even activities such as walking to the letterbox or getting up for meals can help.
    • A short nap of no more than 30 minutes during the day can refresh you without making it hard for you to sleep at night.

    Call Cancer Council 13 11 20 for more information about coping with fatigue. 

    Lack of appetite

    Lack of appetite is a common problem faced by people with CUP. Some people don’t feel like eating because of stress from the diagnosis and treatment. The treatment may also change the way food tastes or smells. You might also not want to eat much if you are feeling sick (nauseated) or have a sore mouth, but these problems can often be treated, so let your treatment team know.

    You may go through periods of having no appetite. These may last a few days or weeks, or the lack of appetite could be ongoing. You may be unable to eat the way you used to. If you are trying to overcome a lack of appetite, eat when you feel like it and what you feel like. For example, you may find it easier to have your main meal at lunch. Follow your cravings and eat more of your favourite foods.

    Tips to manage lack of appetite

    • Have small meals and snacks frequently.
    • Use small dishes so food isn’t ‘lost’ on the plate, e.g. serve soup in a cup or dessert in a wineglass.
    • Choose full-fat foods over low-fat, light or diet versions.
    • Use lemon juice and salt to add flavour to bland food.
    • Sip fluids throughout the day. Add eggs, ice-cream or fruit to drinks to increase kilojoules.
    • If you have a sore mouth, eat moist food, such as scrambled eggs or stewed fruit.
    • Ask your dietitian if you can use nutrition supplements to help slow weight loss and maintain muscle strength. 

    For more information about lack of appetite, call Cancer Council 13 11 20 or you can download the booklet Nutrition and cancer.


    Feeling sick in the stomach (nauseated) is an unpleasant symptom that may be caused by the cancer itself. Other causes include:

    • treatment with chemotherapy or radiotherapy
    • stress or anxiety
    • an imbalance of minerals in the blood e.g. calcium
    • drugs that control other symptoms e.g. morphine for pain
    • the kidneys not working properly
    • oral thrush infection, sometimes related to chemotherapy
    • a bowel blockage (obstruction)
    • increased pressure around the brain as a result of cancer in the brain or cancer affecting the fluid around the spinal cord.

    You don’t have to put up with nausea. Your doctor or nurse can sugguest treatments such as anti-nausea drugs and dietary changes.

    Tips to manage nausea

    • eat small meals as often as you can
    • eat cold foods, such as sandwiches, salads, stewed fruit or jelly
    • have food or drink with ginger e.g. ginger ale, ginger tea or ginger cake
    • avoid strong odours and cooking smells
    • take anti-nausea medication regularly and before taking pain medication
    • use stress-reduction techniques such as meditation or relaxation.


    Some people with CUP experience breathlessness. You may find the feeling of being breathless frightening. Feeling anxious can make breathlessness worse. Some of the causes of shortness of breath include:

    • fluid surrounding the lungs (pleural effusion)
    • an infection in the lungs
    • the cancer itself
    • anaemia (low levels of red blood cells)
    • pressure from a swollen abdomen
    • chronic breathing disorders, such as asthma or emphysema.

    Treatment will depend on what is causing the breathlessness. You may need fluid drained from the chest (pleural tap) or medicine for an infection or other lung problem. A low-dose opioid medication (also used for strong pain) is sometimes prescribed.

    Tips to ease breathlessness

    • Sit up to ease your breathing or lean forward resting on a table. You might want to try sleeping in a more upright position.
    • Relaxation or breathing techniques may help. A physiotherapist can teach you these, or you could listen to a meditation or relaxation CD.
    • Use a fan or open a window to get a draught of air moving near your face.
    • Try breathing in time with someone else and focus on slowing your breath.

    For more information about breathlessness, call Cancer Council 13 11 20 or visit Lung Foundation Australia for further patient support.

    This website page was last reviewed and updated in February 2018.

    Information reviewed by: A/Prof Linda Mileshkin, Medical Oncologist, Peter MacCallum Cancer Centre, VIC; Dr Sarwan Bishnoi, Medical Oncologist, Adelaide Cancer Centre, SA; Dave Clark, Consumer; Dr Jan Maree Davis, Area Director, Palliative Care Service, Calvary Health Care and St George Hospital, NSW; Linda Tompsitt, Cancer Nurse 13 11 20, Cancer Council WA; Catherine Trevaskis, Gastrointestinal Cancer Specialist Nurse, The Canberra Hospital, ACT.




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