Some people with cancer have very few symptoms, while others may experience more. Some symptoms are due to cancer, but others may be caused by its treatment. One symptom may affect another: for example, pain can make it difficult to sleep. Symptoms may come and go over time. You are unlikely to have more than a few of the symptoms mentioned in this section. Often, symptoms can be relieved by medical or non-medical treatments or by a combination of both.

Some of the common symptoms are described here:

Fatigue means feeling exhausted all, or most of the time. It is one of the most common, and sometimes one of the most difficult, problems for people with cancer. It may be due to your treatment, the progress of your disease, or may be a result of other symptoms, such as breathlessness, anaemia (a low red blood cell count) or pain.

Some people find that their tiredness is mild and doesn’t interfere much with their daily life. Other people find that it really disrupts their life.

Some of the more common effects are:

• difficulty doing everyday tasks
• having no energy
• feeling weak
• difficulty thinking or concentrating
• becoming forgetful
• dizziness or light-headedness
• difficulty sleeping
• a lower sex drive
• feeling irritable, emotional and tearful.

There are different ways of treating fatigue depending on the cause, so let your doctor and nurse know how you are feeling. Sometimes treating other symptoms can help you to become less tired. For example, if you are anaemic a blood transfusion may help.

There are also steps that you can take to plan your day, to make it easier to cope and save your energy for doing things that are most important to you. This may mean being more willing to accept help from others, or making simple changes to the way you do things around the home.

Research has found that exercise and keeping active can help to raise energy levels. However, don't feel that you have to exercise, or keep going with your daily schedule if you are too tired. It may help to discuss how you feel with a physiotherapist or an occupational therapist at the hospital. They can suggest simple exercises or ways to help you cope with the tiredness.

Most people with cancer have trouble sleeping at some time during their illness. This may be due to anxiety, fears about the future or by disturbed sleep patterns. You may find that the treatment interferes with your normal sleep patterns, or your sleep may be disturbed because you have to stay in hospital, where it may be noisy. Pain can affect sleep, but it can usually be dealt with by good pain control. Symptoms, such as feeling sick, breathless or having diarrhoea can also affect the amount and quality of your sleep.

If you feel tired and doze during the day, you are likely to find it harder to sleep at night. Getting to sleep may be the problem. If you are depressed you may have difficulty falling asleep, or you may wake early – around 3am or 4am – and find it difficult to get back to sleep. Most sleeping tablets work by helping people fall asleep, so they won’t help if you wake in the early hours of the morning.

What can help

Talking through your worries and concerns may be helpful. Some people find counselling can also help. You can contact the organisations listed in our resources section, or talk to one of our experienced cancer nurses for details about support and counselling services in your area.

If possible, avoid napping in the late afternoon or evening. If you nap frequently during the day and have problems sleeping at night, it may be that you don’t need so much rest. Limit yourself to one rest or sleep each day to see if it helps.

It can be helpful to try to keep yourself busy during the day and, if you can, do a little exercise.

Try to have a regular routine at bedtime and go to bed at the same time each night. Make your bedroom as quiet and comfortable as possible – it may help to remove clocks from the room. Try a warm, milky drink before bed. Have a warm bath with a few drops of lavender or geranium oil to relax you, or sprinkle a couple of drops on your pillow.

If you can't sleep or you wake up early, try to relax and not worry about it. Rather than lying in bed tossing and turning, you could listen to music or the radio, or watch TV or read a book. Wait until you feel tired again and then go back to bed. Listening to tapes or CDs with stories can also be useful for getting to sleep. Most public libraries and bookshops have story audio tapes. You could also try listening to relaxation tapes, which you may be able to get from your local bookshop or library. Alternatively, you can contact the organisations listed in our resources section.

Your body will still benefit from lying quietly in bed, resting, even if you are not asleep.

Although you may feel as if you have been awake all night, you may well have had several hours of good quality sleep. Older people, and those who have not been very physically active during the day, need less sleep at night.

Taking steroid tablets in the evening or at bedtime can interfere with your sleep. You may find it better to take your steroids earlier in the day, unless your doctor advises otherwise. Other stimulants, such as caffeine and nicotine, may also stop you getting to sleep. Sometimes a short course of sleeping pills can help you to get back to a more normal sleeping pattern and get you over a particularly difficult patch. If you have pain, try using long-acting pain killers that last all night.

Many people lose their appetite, and some feel sick as well. These may be symptoms of the cancer or the result of treatment, especially chemotherapy or radiotherapy. You may be put off by even the sight and smell of food, and any worries about your illness may make things worse.

Small, frequent, simple meals are likely to be more tempting than large plates of rich food.

Adding extra calories can help you to keep your weight steady, as it can be difficult to put weight back on once it is lost. If you start to lose weight, your doctor may prescribe a course of steroids or a drug called megestrol acetate (Megace®) to boost your appetite for a while. You can also ask for information and advice from a dietitian at your hospital.

Our section on eating well that has advice on ways of increasing the calories in your food without adding bulk.

Many people gradually start to put weight back on after their treatment has finished, but even so, weight loss can be distressing. If this is so in your case, you could consider taking simple steps to improve your self-esteem, such as buying some new clothes in a smaller size.

If possible, try to get someone else to prepare food so that you do not feel too tired to eat by the time it is ready. During the most difficult times, try some of the high-calorie drinks such as Complan® and Build Up®. You can go back to solid foods when you feel better. A wide range of sweet and savoury food supplements can also be prescribed by your doctor or a dietitian.

We have a section containing some recipes for meals that may be appetising to you.

People who have very advanced cancer may find that they become weak and their body is not able to absorb food very well. In this situation it is best to eat what you want, whenever you feel able to, and not worry too much about 'healthy' eating.

Cancer, or cancer treatment, can sometimes cause nausea (feeling sick) or vomiting (being sick). This can be unpleasant and distressing.

Nausea may be caused by various things including:

• radiotherapy
• chemotherapy
• constipation
• some painkillers
• infection
• pain
• a high level of calcium in the blood (hypercalcaemia)
• irritation of the stomach lining
• blockage of the bowel.

Your doctors will want to find out why you are feeling sick as this helps them to choose the treatment that is most likely to help. Whenever possible, the cause, such as pain or a high calcium level, should be treated.

You may be prescribed an anti-sickness (anti-emetic) drug. These are usually given as tablets, but if you can’t keep tablets down there are other ways to take them. Some anti-sickness drugs can be dissolved under the tongue, others can be given by injection or they can be given as a suppository (into the back passage).

Anti-sickness drugs often work better when taken regularly so that the sickness doesn’t have a chance to come back. Sometimes, it may not be possible to completely control the sickness caused by chemotherapy, but much can be done to reduce it.

Complementary therapies such as relaxation, homeopathy, visualisation and acupuncture can be used to help reduce nausea and vomiting.

Helpful tips for reducing nausea

• If possible have someone else prepare your food.
• Try to eat when you feel less sick.
• Fatty foods, foods with a strong smell, or fried foods make your nausea worse.
• Eat cold or warm food if the smell of hot food makes you feel sick.
• Eat small snacks during the day and chew the food well.
• Have small, regular meals if possible.
• Take plenty of liquids. Drink slowly, taking small sips.
• Try not to drink too much fluid before you eat.
• Sea-bands (acupressure wristbands) can help to reduce nausea – these are available from many chemist shops.
• Ginger can be helpful – try eating ginger biscuits or drinking ginger beer.

Our section on controlling nausea and vomiting contains more information on the causes of nausea and vomiting and ways of managing them.

The effects of cancer or its treatment can lead to mouth problems such as a dry mouth, infection or ulcers. These can affect eating and drinking as well as your ability to talk comfortably. Following a regular mouth care routine can help to prevent or lessen mouth problems.

Mouth care routine

• Brush your teeth every morning and evening using a small, soft–bristled toothbrush and a toothpaste with fluoride.
• Provided it isn’t sore, gently brush your tongue when cleaning your teeth.
• Use water or an alcohol-free mouthwash to rinse your mouth after meals. You can do this more often if needed to keep your mouth fresh. You can make a mouthwash with one teaspoon of salt dissolved in 250ml of fresh water.
• Rinse dentures after meals.
• Remove dentures at night. Clean them with a toothbrush and toothpaste or denture paste. Soak overnight in a denture solution containing sodium hypochlorite, (eg1tsp of Milton® in 400ml water). NB If dentures have metal parts use chlorhexidine solution instead. Rinse dentures well before use.
• If your doctor prescribes a mouthwash for you, use it regularly as prescribed.
• Use dental tape or floss daily (gently).
• Keep your lips moist by using Vaseline, or a flavoured lip balm.

Some people with cancer may have a dry mouth because they produce less saliva, or breathe more through their mouth due to breathlessness. Radiotherapy to the head and neck (and certain drugs) can be another cause. Feeling very anxious can also make your mouth feel dry. A dry mouth can be uncomfortable and change the way your food tastes.

Regular mouthwashes can help to keep your mouth moist, but avoid any that contain alcohol as these can dry the lining of your mouth.

To keep your mouth moist, drink sips of water or sugar-free drinks throughout the day. Smoothing a small amount of vegetable oil on the lining of your mouth can help to keep it moist, especially at night. Keep your lips moist by using Vaseline or a flavoured lip balm. Artificial saliva is available as gels, sprays, pastilles or lozenges, and your doctor can prescribe these for you.

Food hints that may help if you have a dry mouth

• Drink fluids with meals.
• Include plenty of sauces and gravy with meals.
• Avoid chocolate and pastry; they can stick to the roof of your mouth.
• Sugar-free chewing gum can stimulate saliva production.
• Eat foods with a high fluid content such as jelly, pureed fruits, and soft puddings.
• Chewing fresh unsweetened pineapple chunks can help to keep your mouth fresh and moist.
• Avoid dry foods such as biscuits and crackers.

If, because of radiotherapy treatment, you aren’t making enough saliva you have a higher risk of tooth decay, so it is important to take care of your teeth. Your dentist will be able to help you with this and will want you to have regular check-ups.

You may find that your sense of taste changes or that the texture of food seems different. This may be due to the cancer or it can be a temporary change following cancer treatment. You may no longer enjoy certain foods or find that all foods taste the same. You may notice a metallic taste in your mouth after chemotherapy. Sometimes food has no taste at all.

Coping with taste changes

• Eat foods that you enjoy and ignore those that do not appeal to you, but try them again after a few weeks, as your sense of taste may change again.
• Use seasonings, spices and herbs like rosemary, basil and mint to flavour your cooking.
• Try marinating meat in fruit juices or wine, or dress it in strong sauces like sweet and sour or curry.
• Cold meats may taste better garnished with pickle or chutney.
• Sharp-tasting foods like fresh fruit, fruit juices and bitter boiled sweets can be refreshing and leave a pleasant taste in the mouth.
• If you go off the taste of tea or coffee, try lemon or green tea instead, or perhaps an ice-cold fizzy drink like lemonade.
• Some people find that cold foods taste more palatable than hot foods.
• Serve fish, chicken and egg dishes with sauces.

Many chemotherapy drugs, and radiotherapy to the mouth and/or throat can cause a sore mouth or mouth ulcers.

You may also develop a sore mouth if you:

• are not able to eat a nutritious diet
• have a low immunity
• have an infection of the lining of the mouth or throat.

Your doctor may prescribe an antiseptic and painkilling mouthwash for you to use during treatment if it is likely to cause mouth ulcers. You may also be prescribed a protective gel that can help to ease the pain and discomfort of mouth ulcers.

If you are taking antibiotics or steroids, you may develop a fungal infection in your mouth called thrush. This coats your tongue and can make eating unpleasant. Your doctor can prescribe anti-fungal medication to clear this.

If your mouth becomes sore after cancer treatment, have it checked by a doctor for signs of viral infection or thrush. If you have an infection your doctor can prescribe treatment.

Always contact your doctor if your mouth becomes too sore for you to eat or talk. They can prescribe painkillers if necessary.

Helpful hints if you have a sore mouth

• Follow a mouth care routine as far as possible.
• If your toothpaste stings, use a mouthwash instead.
• If you wear dentures you may find it easier to leave them out for a while to prevent chafing your gums. However, if you are having radiotherapy to the jaw area you may be advised to keep your dentures in as much as possible during the day to help maintain the shape of your gums.
• Avoid neat spirits, tobacco, hot spices, garlic, onion, vinegar and salty food as these may irritate your mouth.
• Keep your mouth and food moist. Add gravy and sauces to your food to make swallowing easier.
• Avoid rough textured food, such as toast or crisps, as these can scrape sore areas.
• Try to drink at least one litre (about two pints) of fluid a day (water, tea, weak coffee, and soft drinks such as fruit juices).
• Try drinking through a straw.
• Cold foods and drinks can be soothing to a sore mouth. Try adding crushed ice to drinks and eating ice cream.
• Warm herbal teas may be more soothing than acidic drinks such as orange and grapefruit juice.

Constipation and/or diarrhoea are common problems for people with cancer.

Constipation

This can be caused by many things. When you are not feeling well it is easy to get out of your normal routine. You may not feel like eating, and perhaps you are not getting your usual amount of exercise. Most people taking medium strength or strong painkillers will need to take a laxative prescribed by their doctor to keep their bowels regular.

Constipation can also occur with some chemotherapy and anti-sickness (anti-emetic) drugs, if the level of calcium in the blood is too high, or if the bowel is blocked. Your doctor may need to do tests to find the exact cause of the constipation.

Eating a balanced diet, including fibre-rich foods (such as fresh fruit and vegetables, cereals and wholemeal bread) can help prevent constipation. Drink plenty of fluids and try to get some exercise – even if it is only a short walk a couple of times a day. If you can’t walk by yourself, you could ask a carer, friend or neighbour to come with you.

If you are becoming constipated, try adding fruit to your cereal in the morning or your pudding in the evening. Eating prunes and figs, and having hot lemon drinks can also help. Tell your doctor if your constipation lasts for longer than three or four days, so that they can prescribe a laxative – either to soften the stools so that they can be passed more easily, or to stimulate your bowel to work normally. Some people need to have suppositories or a small enema (a small amount of a special type of fluid introduced into the back passage) to relieve constipation if it is severe.

Helpful tips if you have constipation

• Make sure that you have plenty of fibre (roughage) in your diet. Good sources of fibre include: wholegrain breakfast cereals like Weetabix®, Shredded Wheat®, porridge or muesli; wholemeal bread and flour; brown rice; wholemeal pasta; and fresh fruit and vegetables with skins on.
• Natural remedies for constipation include syrup of figs, apricots, prunes and prune juice.
• Make sure you drink plenty of fluids. Aim to drink at least two litres (3½ pints) a day.
• Gentle exercise will help to keep your bowels moving.
• If the constipation is due to medicines (such as painkillers or anti-sickness drugs) don’t reduce the dose of these medicines. Tell your doctor or nurse so that they can prescribe a laxative or they may increase the dose if you are already taking one.
• Flaxseed (linseed) can help to ease constipation and soften stools. One teaspoon or dessertspoon of the seeds can be taken daily with a glass of water. If you have cancer of the gullet (oesophagus) or bowel, ask your doctor before taking fibre or linseed.

If you have cancer of the bowel, always ask your doctor for advice on dealing with constipation.

Diarrhoea

Diarrhoea may occur due to infection, or a side effect of cancer treatments such as chemotherapy, or radiotherapy to the pelvis. Some medicines can cause diarrhoea, and some types of cancer may prevent food from being absorbed properly from the bowel. Sometimes severe constipation can be mistaken for diarrhoea. When the bowel is blocked by constipation, liquid faeces pass around the solid faeces (sometimes called overflow) so it may seem as though the person has diarrhoea.

Helpful tips if you have diarrhoea

• While you have diarrhoea cut down on your fibre intake from cereals, fruit and vegetables. Eat peeled and cooked fruit and vegetables instead of raw ones.
• Avoid milk and dairy products, such as cheese, until the diarrhoea has stopped.
• Drink plenty of fluids to replace the water lost with the diarrhoea, but not alcohol or coffee. Avoid fizzy drinks, which can cause wind and stomach cramps.
• Eat small, frequent meals made from light foods – white fish, chicken, eggs (well cooked), white bread, pasta or rice.
• Avoid highly spiced or fatty foods.
• Eat your meals slowly.

If the diarrhoea continues for more than two days, tell your doctor, who can investigate the cause, and prescribe some anti-diarrhoea medicines for you.

Antibiotics can kill off helpful bacteria normally found in the bowel; eating live yoghurt can replace them. Check with your doctor or nurse before trying this if you are having chemotherapy.

If you have longer term problems with diarrhoea, knowing you may need to get to a toilet quickly can make trips out to the shops or elsewhere become a source of worry and embarrassment. A public toilet key scheme for people with continence problems allows you to use around 7,000 locked public toilets in the UK. RADAR, Incontact or the Continence Foundation can tell you about the scheme.

Our section on eating well has tips on dealing with constipation and diarrhoea.

Diarrhoea caused by radiotherapy

Diarrhoea is a common, temporary, side effect of radiotherapy to the pelvis, and your doctor will prescribe medicine to help with it. If your diarrhoea is caused by radiotherapy, changing your diet is unlikely to help, and it is important that you take the anti-diarrhoea medicines prescribed by your doctor.

We have a section on coping with side effects of pelvic radiotherapy.

Anxiety is one of the most common emotional responses to cancer. It is a natural reaction. Questions like 'How will I cope?', 'What is going to happen?', 'Will I get better?' and 'Will the treatment work?', will probably go through your mind.

Anxious feelings may be present all of the time, or may come and go. They can also vary in how severe and disruptive they are. Anxiety may show itself as physical symptoms such as:

• breathing too fast
• shaking
• tense muscles
• breathlessness
• dizziness
• palpitations
• sweating
• a dry mouth
• feeling sick
• diarrhoea
• chest pain or discomfort
• a 'lump in the throat'
• pins and needles
• reddening of the face and neck (flushing).

It can be easy to confuse the symptoms of cancer, or cancer treatment, with the symptoms of anxiety. Anxiety and the illness can act together to make the symptoms worse.

Dealing with anxiety

When anxiety levels are high, the symptoms can be difficult to control and may be experienced as a 'panic attack'. Relaxation techniques can help you to get back in control. Take some slow deep breaths and concentrate on what is happening right at that moment, not what you worry may happen.

Your doctor will be able to help you to work out whether your symptoms are related to anxiety and may prescribe medication to help. Understanding the reason for your symptoms can be reassuring, but if you are still very anxious, counselling or psychotherapy can help. Some of the organisations in our resources section offer counselling and psychotherapy.

Feeling depressed can make it difficult to concentrate and get to sleep. It can also make you feel tired and lethargic. Talking about your concerns will help others to help you.

Practical help at home, financial advice if you can’t work, or someone to listen while you talk, can all help to relieve your anxieties and lift your depression. Some GPs offer counselling sessions to give you time to talk over your worries, or they can put you in touch with trained counsellors or psychotherapists. You can also contact the Cancer Counselling Trust.

The physical symptoms anxiety and depression produce may occur for days or weeks after diagnosis, but if they continue for more than three or four weeks, medical treatment may be necessary to relieve them.

Fear can make some symptoms such as breathlessness worse, as can many other emotions including anxiety, depression and tiredness. This does not mean that the symptoms are 'all in the mind'. Symptoms of many physical illnesses, including asthma, heart disease and stomach ulcers are made worse by emotional upset, so it is important to treat the emotional as well as the physical causes of any symptom.

Talking with family, friends, your specialist care team or counsellors can be very helpful. A course of drug treatment may also be helpful, with either an anti-depressant to help your mood or a sedative drug such as diazepam.

Our section on the emotional effects of cancer has helpful tips on dealing with the feelings and emotions that cancer can cause.