Wheezing, breathlessness and coughing may be a problem for you. These symptoms may be related to the cancer if it is affecting your lungs. The symptoms may also be caused by:

• a chest infection
• a build-up of fluid between the two layers that surround the outside of the lungs (pleural effusion)
• fluid building up in the lungs themselves
• anaemia
• radiotherapy to the chest.

Whatever the cause, breathing difficulties can usually be helped.

Treating breathlessness

How breathlessness is treated depends on the cause. Chemotherapy, hormone therapy or radiotherapy may help to shrink the cancer and relieve symptoms, if it is caused by lung cancer. If your airways have become narrowed, your doctor can prescribe drugs to help. These may be given as tablets, inhalers or through a special mask called a nebuliser. Treating a chest infection with antibiotics often improves symptoms.

Pleural effusion A pleural effusion is a build-up of fluid between the membranes around the outside of the lungs and is quite common. The fluid stops your lung from being able to expand fully, leading to breathlessness. It is treated by placing a tube, connected to a drainage bag or bottle, between the two layers of pleura and draining off the fluid. This is done under a local anaesthetic. Sometimes, after the fluid has been drained, powder or an antibiotic or chemotherapy drug is put between the two layers of pleura. This makes the pleura stick together, so that fluid cannot collect between them. This is called a pleurodesis.

Anaemia If your breathlessness is caused by anaemia, treating this with a blood transfusion may help.

Radiotherapy If you have had radiotherapy to your chest, you may cough and feel mildly breathless for several weeks or months after your treatment has ended. This is due to inflammation in your lungs from the radiation and can be treated by a course of steroids. After taking the steroids for several weeks, your dose will gradually be reduced and then stopped when your breathing is better.

Morphine Small doses of morphine can be helpful in controlling breathlessness and slowing your breathing down to a more normal rate. If you are already taking morphine for pain control, the dose can be altered to help with the breathing problem too.

Coping with breathlessness

Positioning If you are breathless you may find some positions more comfortable than others. You may find it more comfortable to sit upright or to lean forward slightly while resting your forearms on the arms of the chair, the table or your knees. It can help to sleep propped up on several pillows or in a recliner chair.

Emotions Feeling breathless can make you feel anxious and start to breathe faster. Some people worry that they could die because feel unable to draw breath, but this isn’t the case. Anxiety and panic make breathlessness worse so learning ways to stay calm and feel in control can be helpful. You can also be prescribed medication that reduces feelings of anxiety to help you with this.

Breathing techniques

Special breathing techniques, known as pursed lip breathing and abdominal (or diaphragmatic) breathing, can help you to control your breathing and to feel less panicky. A physiotherapist or specialist palliative care nurse can teach these techniques.

Pursed lip breathing technique  Pursed lip breathing slows the flow of air as you breathe out. It relieves shortness of breath by helping to open the airways, releasing trapped air, decreasing the effort of breathing and making each breath more effective.

• Breathe in through your nose as you normally would.
• Breathe out through pursed lips for twice as long as you breathe in.
• It may help to count slowly to yourself as you breathe in and again as you breathe out.

How to purse your lips While breathing out keep your lips tightly together except for a small opening in the centre. (As if you were going to whistle). Blow out through this small opening.

It works best if you practice the technique about five times a day until you are comfortable with it. Use the technique during any activity involving effort such as climbing stairs or if you feel yourself becoming anxious and your breathing rate increasing.

Abdominal breathing technique (also called diaphragmatic breathing) Abdominal breathing helps you to breath more deeply using all of the lungs, so your breathing is slower, deeper and more effective. To start with, many people find it easier to learn when lying down. However, it can be done in a sitting or lying position, whichever is more comfortable for you.

• Lie on your back as flat as is comfortable for you. Bend your knees, put a cushion under them if you wish.
• Put one palm on your upper chest and the other over your tummy.
• Breathe in slowly so your tummy moves out against your hand.
• Breathe out slowly (using the pursed lip technique). As you breathe out feel your tummy gently fall back. Your hand on your chest should have little or no movement.

It works best if you practice this technique daily several times in a row.

Other things that may help

Learning relaxation techniques can be helpful.

Feeling breathless is often brought on by effort such as climbing stairs or dressing. Specialist equipment such as stair lifts can help you to minimise activities that may make you feel out of breath. Equipment suppliers are listed in our section on useful organisations.

Airflow from a nearby fan or open window can help to ease the sensation of breathlessness for some people.

Sometimes oxygen therapy is helpful. This may be used in short bursts before and after activity or may be needed all the time. Oxygen can be supplied at home. Your hospital doctor or GP can organise this for you.

Coughing

Coughing helps to clear the airways and so can be helpful, but can also be uncomfortable, embarrassing and affect our ability to sleep, rest and eat.

If you are coughing up green or dark-yellow coloured phlegm (sputum), you may have an infection and will need to have antibiotics. Some people also need chest physiotherapy to help them clear their airways. Sometimes steam inhalations or saline given as a fine spray through a nebuliser are helpful.

If you have a dry irritable cough, your doctor may prescribe a cough mixture to help relieve it.

Occasionally people cough up blood. This may be just a small amount or it may be larger clots. Coughing up blood can be caused by a chest infection, a blood clot in the lung, bleeding from small blood vessels in the lungs or from a tumour in the lungs.

The treatment will depend on the cause, so you may need to have tests to find this. Antibiotics can help treat a chest infection, or your doctor may prescribe a drug called tranexamic acid, which encourages blood to clot and reduces bleeding. Radiotherapy can often be helpful when the cause is a tumour in the lung.

It is always important to let your doctor know if you begin to cough up blood or if this symptom gets worse.

Bladder problems may be caused by cancer pressing on, or blocking, the tube (urethra) through which urine passes out of the bladder. This can lead to incontinence (loss of bladder control) or retention (when urine cannot flow out of the bladder). Rarely, a tumour pressing on the nerves in the spine can cause nerve damage leading to incontinence.

Urinary problems may also occur following some types of surgery to the bladder, prostate, bowel or womb (hysterectomy). These may be due to damage to the valve that controls the flow of urine from the bladder (urinary sphincter) or to nerve damage in the pelvis. These problems are often temporary and so improve over weeks or months. If you experience problems after surgery you may be helped by exercises called pelvic floor exercises or kegel exercises. These exercises help to retrain the muscles involved in bladder control.

After surgery to their prostate, some men have urinary problems due to an overactive bladder. Your doctor can prescribe drugs to help correct this. Most men’s symptoms improve with time. However, rarely, if symptoms don’t improve over several months some men may be offered surgery to improve bladder control.

During and after radiotherapy to the pelvic area you may need to pass urine more often. You may also have some pain when you pass urine. These symptoms can also be caused by a bladder infection, or may become worse if one develops. An infection can be treated with antibiotics prescribed by your doctor.

Our sections about pelvic radiotherapy have information about bladder problems and how to cope with them.

If you are at increased risk of a urinary infection, perhaps because you are having radiotherapy treatment to the pelvic area, you may want to try cranberry extracts. Cranberries contain a substance that can prevent bacteria from sticking to the walls of the bladder. Research has shown that taking daily cranberry extracts may help to prevent urinary infections in some people. It isn’t clear what the best dose is, but high dose capsules may be better than low dose capsules or juice. It is best to avoid cranberry extracts or juice if you take warfarin tablets as they can affect how it works.

It can help to drink enough water to keep your urine a clear, or pale yellow colour, and it may help to avoid drinking too much alcohol or coffee.

Continence problems can occur if you find it difficult to get out of a chair or bed and so can’t get to a toilet quickly. These may be avoided by making sure that help is always available or a commode is close by.

Dealing with incontinence

A wide range of continence aids are available. Your district nurse or a specialist continence nurse can arrange for these to be supplied to you. Pads use materials that draw urine away from the body. They are small and inconspicuous but secure enough to prevent embarrassing accidents. For men there are also sheaths for the penis and dribble pouches

Tips for dealing with urinary problems

• Some drinks, such as tea, coffee, cola drinks and alcohol, cause bladder irritation and may make symptoms worse.
• After any operation that may affect your bladder, build up your physical activities gently. You should usually be able to do all your normal activities within four to six weeks.
• Constipation can make bladder problems worse.
• 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 7000 locked public toilets around the country. RADAR, Incontact or the Continence Foundation can tell you about the scheme.

If you are restricted to bed, incontinence can be more difficult to cope with. In this situation, or if you are having trouble emptying your bladder, a thin flexible plastic tube (catheter) can be inserted into your bladder so that urine is continuously drained away. This can prevent the discomfort that can occur with severe incontinence.

Catheters need to be changed regularly (about once a month or more often). During the day, if you are up and about, a catheter bag can be attached to your leg and hidden under clothes. Otherwise bags and tubes can easily be covered by bedclothes or blankets.

The Continence Foundation can give you advice about managing continence problems.

Itching (pruritus)

Itching is a common symptom and may affect any area of your body. It may affect all of your body or only one particular area. Itching may be due to:

• dry skin
• chemicals released by the cancer (especially some cancers of the blood)
• medication
• jaundice
• kidney problems.

Itching can be difficult to control but there are many medicines that may help. Your doctor can prescribe these for you. Drugs that may be helpful include;

• anti-inflammatory drugs, such as steroids, cimetidine, aspirin and thalidomide
• drugs that affect blood pressure, such as propranolol
• drugs that act on the nervous system, including anaesthetics, antidepressants, anti-epileptic drugs, sedatives and some types of painkillers
• an anti-sickness drug called ondansetron
• antihistamine tablets or lotion.

For some cancers there are specific medicines that can control the itching. Your doctor can discuss these with you.

Dealing with an itchy skin

• If your skin is dry, use a moisturiser such as aqueous cream twice a day. If you store the cream in the fridge it will feel cool and soothing when applied.
• Protect your skin from damage caused by scratching. Keep your nails clean and short, and rub rather than scratch the itchy area.
• Avoid things that may irritate the skin or make the itching worse such as biological washing powders, scented soaps, bubble baths and products containing lanolin.
• Keep cool by wearing light, natural fibres, such as cotton, and keeping the atmosphere around you cool but not too dry. Avoid alcohol and hot spicy foods and drinks.
• If hot or warm water make the itching worse, take cool or lukewarm baths or showers.
• Use other activities to try to distract yourself from the itching. Psychotherapy and relaxation techniques may also help you to cope.
• Sometimes acupuncture or Transcutaneous Electrical Nerve Stimulation (TENS) can reduce itching. The aim of TENS is to stimulate the nerves reaching the brain, and so block out the sensation of itching. Acupuncture and TENS treatments are given at some NHS hospitals.

Pressure sores

These are areas of skin that become damaged or broken. They can occur when the blood supply to an area of skin is interrupted. Often this is caused by prolonged pressure from long periods of sitting or lying in one position. Friction from clothing or bedclothes can also contribute to pressure sores developing. Thin, delicate skin over the joints, such as elbows, knees, hips, heels, and at the base of the spine, is especially prone to pressure sores.

Preventing pressure sores

• If you spend a lot of time sitting or lying in bed, change your position regularly, preferably every half an hour.
• Your district nurse may be able to get a special mattress and pressure-relieving cushions for you. A bed cradle will keep the weight of the bedclothes off your legs.
• Use pillows to support yourself in comfortable positions, and keep the bedclothes loose. We have a section listing organisations that can provide equipment to keep you comfortable.
• Look out for patches of sore or inflamed skin, as these are early signs of pressure sores. Any sore or red areas need special attention. Try to keep your weight off them as much as possible to relieve the pressure on them
• Tell your doctor or a district nurse if you think you have any early signs of a pressure sore. They can give you help and advice to make sure that your skin heals properly and to prevent infection from developing.

Increased sweating

Sweating is one of the ways our body keeps our temperature normal, but sometimes people with cancer can experience episodes of increased sweating. When this is severe it can cause serious discomfort and affect activities like sleeping. There are various reasons for excessive sweating. It can be a symptom of some cancers such as some types of lymphoma, or it can be due to fever caused by infection. Sometimes cancer treatments affect hormone levels in the body causing increased sweating.

Your doctor will be able to advise you on the best treatment depending on the cause. There are also things you can do to help yourself manage sweats.

Helpful tips to cope with sweating

• Wear layers of light clothing that can be taken off or put on easily.
• Keep rooms cool and well-aired.
• Avoid things that may trigger your sweats, eg some people find sweats are made worse by alcohol or hot spicy food.
• Use light bedding.
• Put a large towel on the bed underneath you. This will absorb any sweat and can be removed easily, rather than having to change all the bedclothes.

The causes of night sweats are not fully understood. If your night sweats are caused by the menopause or are a side effect of a hormonal treatment, we have a section on these symptoms, including hot flushes and sweats.

Swollen ankles and legs

Some people with cancer find their ankles and legs get swollen. This can be for several reasons. A common reason is being unable able to move about as much as usual.

Keeping your feet up when sitting down (using a footstool) can help. It is also helpful to gently exercise your legs while you are sitting down. A nurse or physiotherapist can show you some exercises to do. Water tablets (diuretics) may also be prescribed by your doctor to help get rid of the excess fluid. In some situations, your doctor or nurse can give you special pressure stockings to help the circulation in your legs

Swelling may be due to lymphoedema (see below).

If the swelling is only in one leg or ankle and is painful, red and hot, this may be a sign of a blood clot (thrombosis). Blood clots are fairly common in people with cancer, especially those who have cancer of the prostate, breast, ovary or pancreas. Some cancer treatments, such as tamoxifen, stilboestrol and thalidomide, can increase the risk of developing a blood clot. Let your doctor know if you develop symptoms of a possible thrombosis, as treatment needs to be given as soon as possible.

Ascites

Certain types of cancer can cause a build up of fluid in the tummy area (abdomen). This is called ascites and can make the tummy swollen and uncomfortable. Your doctors may treat this by inserting a small tube into the abdomen to drain off the fluid. This is usually done in hospital, under a local anaesthetic. The fluid can be drained as often as necessary. Water tablets (diuretics) can be used to try to stop or slow down fluid build up after ascites has been drained. Sometimes radiotherapy or chemotherapy treatment can prevent the fluid from coming back.

Lymphoedema

The lymph glands are part of the body's natural drainage-system. Fluid may collect in the tissues if some of your lymph glands have been removed or damaged. This might happen following a mastectomy for breast cancer if the lymph glands under the arm have been removed. Fluid may build up in the arm on the affected side and this can be very uncomfortable, especially if the swelling is severe. In a similar way, swelling can occur in the legs if the lymph glands in the groin have been removed.

Massaging fluid away from the area of the swelling using a technique called manual lymphatic drainage can help to reduce it. Manual Lymphatic Drainage should only be carried out by a person who has had specific training in this type of massage. Specially designed elasticated sleeves or stockings can also help to keep the swelling down.

In some hospitals and hospices, lymphoedema specialists can advise you on how to manage your lymphoedema. You can also ask your doctor to refer you to a lymphoedema treatment unit.

This is a burning sensation behind the breastbone and is caused by the backflow of acid from the stomach into the gullet (oesophagus). It can be very painful and can be caused by some foods, some medicines, and tight clothing around the abdomen. It can be made worse by lying flat.

Helpful tips to prevent heartburn

• Avoid chocolate, alcohol, fatty foods, mint, aniseed, dill, fizzy drinks, chewing gum, hard boiled sweets, and large meals.
• Ensure that clothing around your tummy is loose.
• Avoid lying flat, especially after meals.

This is discomfort in the upper part of the abdomen, occurring particularly after meals. It can be caused by:

• having a small stomach capacity
• some medicines such as steroids
• irritation of the stomach or bowel lining, caused by particular drugs, or cancer treatments such as radiotherapy or chemotherapy
• overproduction of stomach acid
• not moving around much
• anxiety
• not eating or drinking much.

Dealing with indigestion

The best way of dealing with indigestion will depend on the cause. If you have a small stomach it is helpful to avoid drinking fluids at mealtimes. It is best to eat small, frequent meals and snacks throughout the day rather than two or three large meals. Irritation of the stomach lining can be relieved by antacid medicines like Asilone®. Your doctor can prescribe these.

Drugs which reduce acid production, such as ranitidine (Zantac®) or omeprazole (Losec®) can relieve indigestion caused by overproduction of stomach acid. Drugs to reduce 'wind' production, such as semeticone (Dentinox®, Ifacol®) or dimethicone, can also be helpful.

If you are not moving around much, metoclopramide (an anti-sickness drug) can help the stomach to empty more quickly.

Hiccups are a sudden contraction, or spasm, of the diaphragm, (the breathing muscle under the lungs). They are a reflex action so aren’t under your control.

Mild hiccups are common. They usually last for only a few minutes and don’t need to be treated. However, if you have hiccups that keep coming back or that last for more than 24 hours, you may need treatment. When hiccups last for a long time it can be distressing and uncomfortable. It can also make eating, drinking and sleeping difficult.

Causes and treatment

Hiccups are often caused by:

• stress or excitement
• a bloated stomach
• a change in the levels of certain chemicals in the blood
• certain medicines to treat cancer such as steroids and some chemotherapy drugs
• some conditions, such as having an enlarged liver, lead to irritation of the diaphragm and this brings hiccups on
• rarely people who have irritation to the brain because of infection or a tumour may develop troublesome hiccups.

Most hiccups go away without treatment. Some people find that home remedies can help them to get rid of hiccups more quickly. They include:

• quickly swallowing two teaspoons of granulated sugar
• swallowing dry bread
• biting on a lemon
• drinking from the wrong (opposite) side of a cup
• holding your breath
• breathing into a paper bag
• pulling your knees up to your chest.

If your hiccups don’t go away after 24 hours or if they keep coming back you should tell your doctor. There are medicines they can prescribe which may help. The best treatment for hiccups depends on the cause.

Treatments that may help if you have a bloated stomach include:

• drinking peppermint water, which relaxes the stomach and gullet helping to release trapped air through belching
• anti 'wind' or antacid medicines (eg Asilone®)
• metoclopramide, an anti-sickness drug, which helps the stomach to empty.

It's best not to take peppermint water and metoclopramide at the same time because they work against each other. Peppermint works by relaxing the stomach muscle but metoclopramide stimulates it so that the stomach empties more quickly.

Other treatments that may help include:

• drugs that relax the muscles – eg baclofen or midazolam
• sedative drugs – eg haloperidol or chlorpromazine
• drugs that act on the central nervous system – eg gabapentin.

If you are started on a drug treatment for hiccups your doctor will usually check with you about three days later to see how well it is working. If the hiccups haven’t gone away the dose may need to be increased or another drug tried.

Jaundice can happen if the bile duct becomes blocked by cancer. The bile duct drains bile from the liver and gall bladder into the bowel. Jaundice can also happen if there is an infection in the liver.

Symptoms of jaundice include:

• yellowing of the skin and the whites of the eyes
• itchy skin
• dark-coloured urine
• pale bowel motions.

Dealing with jaundice

If your jaundice is caused by an infection, antibiotics may help.

If it is caused by a tumour, treatment to remove or shrink the cancer may help.

Your doctors may suggest putting in a stent (a small tube which holds the bile duct open). The stent can be put in using a procedure known as an ERCP (endoscopic retrograde cholangio-pancreatography). A thin flexible tube (an endoscope) is passed down your throat, into your stomach and then into the first part of the small bowel – the duodenum. Once it is in position the doctor can see through the endoscope into the opening of the bile duct. A stent is then put inside the duct to keep it open.

It may also be possible to put a stent into the bile duct using another procedure called  PTC (percutaneous transhepatic cholangiography). This involves inserting a needle through the skin just below the rib cage. A fine guide wire is passed through the liver, into the blockage. The stent is passed along this wire.

Sometimes the stent can become dislodged or blocked. The first sign of this is often the jaundice returning. If this happens the stent can be replaced.

An alternative treatment to relieve the blockage is surgery to bypass the bile duct. The surgeon joins the gall bladder or bile duct to the bowel in an operation called a cholecystoenterostomy.

If it is possible to unblock the bile duct the symptoms should begin to improve. Sometimes, however, it is not possible to do this and symptoms will continue. An itchy skin can often be the most troublesome problem.

Medicines used to treat an itch caused by jaundice include prochlorperazine, colestyramine and antihistamine tablets.