This section describes the major problems that can happen with advanced cancer. You may have some of these problems and symptoms or none of them. The section "Problems grouped by location of cancer," describes problems that are related to specific types of cancer.
 

Broken bones (fractures)
 

When cancer moves into bones, it can make them weak, so that they are more likely to break (fracture). Fractures occur most often in the leg bones near the hip because these bones support most of your weight. Cancer in the bone may cause severe pain for a while before the bone actually breaks. If an x-ray is taken at that time, it may show that the bone is likely to break.
 

Treatment: The best approach is to prevent the fracture. This is done with surgery to put a metal rod through the weak part of the bone. They do this while you are in a deep sleep (under general anesthesia).
 

If the bone has already broken, then something else will be done to support the bone. Usually surgeons put a steel support over the fractured area of the bone.
 

Radiation treatments may also be given to prevent any more damage. Usually about 10 to 15 treatments are needed, although some doctors give the total dose of radiation in only 1 or 2 treatments. The radiation therapy will not make the bone stronger, but it may stop further damage. After radiation surgery may still be needed to prevent a fracture.
 

If bones of the spine (the vertebrae) are fractured, vertebroplasty may be used to support them. In this procedure an acrylic cement is injected into the damaged bones of the spine. The area is numbed first and an imaging scan, like a CT scan, is used to guide the needle to the right place. Vertebroplasty often reduces pain right away and can be done in an outpatient setting.
 

Medicines you take or the cancer itself may make you confused, dizzy, or weak. This can lead to falls and accidents. Falls can cause fractures, especially in bones made weak by the cancer. Talk with your cancer care team about safety equipment you can use at home. Some things that you might find helpful are shower chairs, walkers, and handrails.

Blocked bowel (bowel obstruction)
 

When cancer blocks either the small intestine or large intestine (colon), digested food or stool cannot move through. This is called bowel obstruction. The symptoms include severe cramping, belly (abdomen) pain, and vomiting. The vomit may contain digested food, bile, and sometimes stool. Bowel obstruction occurs most often with abdominal or pelvic cancers.
 

Treatment: It is very hard to solve this problem with surgery, and many patients are too sick to go through surgery. Others have such a poor outlook that surgery may not help much. Most studies have shown that patients with advanced cancer who develop this problem live only a short time. The decision to have surgery should be weighed against the chances of returning to a comfortable life.
 

An operation called a colostomy may help if only the colon is blocked. In this operation the surgeon cuts the colon above the blockage. The cut end is then brought to the outside of the abdomen. Your stool can empty into a bag that is put around the opening.
 

If the bowel is blocked in only one area, a small, stiff tube called a stent may be able to be placed through the blocked area to keep it open. This can be an option for blockages of the colon and the small intestine.
 

Treating only the symptoms is often the best choice for many patients. This is called supportive care. For example, the stomach’s contents can be removed through a tube placed through your nose (called a nasogastric or NG tube) which is attached to a suction device. This often relieves nausea and vomiting. If this helps, the NG tube can be replaced by a tube that goes directly into the stomach through the skin. You would also need to stop eating and to drink only small amounts to relieve thirst. If needed, you can take medicines for pain and nausea as a shot (injection) or as a patch.

Confusion
 

People with cancer that is getting worse often become restless, anxious, depressed, irritable, or angry. The person may look sleepy and not respond to questions one minute, but be wide awake and alert the next. Or they may be loud and agitated but unable to tell you why. They may see and hear things that are not really there, and say things that don't make sense to others. These symptoms should be reported to the doctor, since this kind of confusion can often be treated.
 

Many different things can cause confusion:

• liver disease
• bowel blockage (obstruction)
• bladder blockage
• medicines
• medicine withdrawal
• low blood sugar
• cancer that has spread to the brain
• infection
• pain
• blood chemistry changes, such as too much calcium

Treatment: There are many ways to treat confusion, but the best approach is to find the cause and treat it. A physical exam will be done and x-rays may be taken. Blood tests may be done to look at how well the organs are working and check the blood chemistry. Medicines, especially pain medicines, may be looked at closely and adjusted to see if the confusion changes.

Constipation
 

Constipation is when stool gets hard, dry, and you have trouble passing it out of your body. It can be caused by many of the changes that go along with advanced cancer, such as:

• medicines (especially opioid pain medicines, such as morphine)
• diet changes, including eating and drinking less
• decreased activity
• blood chemistry changes, such as too much calcium or too little potassium

Treatment: Preventive measures are the best way to deal with constipation. Prevention includes

• talking to your health care team about the problem before it becomes severe
• taking laxatives before the problem starts
• drinking enough fluids
• getting plenty of fiber
• mild exercise, like short walks or even chair exercises

If possible, the cause of the constipation should be found and, treatment should be aimed at it. A physical exam, blood tests, or even x-rays may be done, depending on what your doctor suspects may be causing the constipation.
 

A number of drugs and laxatives can be used to treat constipation. Talk to your cancer care team about what might work best in your situation. If you don't respond to treatment, your cancer care team may need to look for other more serious possible causes of constipation, such as pressure on the spinal cord and bowel blockage (obstruction).