Treating symptoms of metastatic bowel cancer

Metastatic bowel cancer is cancer that started in either the back passage (rectum) or large bowel (colon) and has spread to another part of the body. It is also called advanced cancer.

You might have metastatic cancer when you are first diagnosed. Or the cancer might have come back after previous treatment.

Symptoms of metastatic bowel cancer can be hard to cope with. But doctors and nurses can offer support and treatment to help you.

There are treatments available that can help to shrink the cancer and relieve symptoms. These include:

• chemotherapy
• radiotherapy
• targeted and immunotherapy drugs

Other treatments such as stents can treat specific symptoms such as a blockage in the bowel.

Symptoms

You might have one or more of the symptoms we list below.

Loss of appetite

You might not feel like eating and may lose weight. If you find you have a loss of appetite, some of the following suggestions might help.

Tips:

• Eating several small meals and snacks throughout the day can be easier to manage.

• Ask your doctor to recommend high calorie drinks to sip if you are worried about losing weight.

• Eat whatever you feel like eating rather than what you think you should eat.

• Eat plenty of calories when you can to make up for times when you don’t feel like eating.

• Drink plenty of fluids even if you can't eat.

• Don't fill your stomach with a large amount of liquid before eating.

• Try to eat high calorie foods to keep your weight up.

Tiredness and feeling unwell

Tiredness (fatigue) is a common symptom of advanced cancer. You may feel that you lack energy, and this can be overwhelming. 

Let your doctor or nurse know if you’re very tired, as they can prescribe medicine to help or other treatments to help. For example, a blood transfusion can give you more energy if you’re tired due to anaemia (low red blood cell levels).

Resting

It’s important to rest a few times throughout the day. Resting regularly can help you feel less tired and more able to cope. You don't have to sleep during these times. Just sitting or lying down will help. 

Exercise

Exercising can be hard when you feel very tired. But, research shows that daily light to moderate exercise can give you more energy. You can try a short walk if you can manage it. Gentle exercises in bed or standing up can help if you can’t move around easily. 

Your hospital physiotherapist might be able to help you plan an exercise programme that suits your needs.  

Sleeping

You might feel more tired if you have trouble sleeping at night. It can help to change a few things about when and where you sleep.

Swollen tummy (ascites)

You might have a swollen tummy (abdomen) if your cancer has spread to the liver. The swelling is due to a build up of fluid called ascites. It can make your clothes feel tighter. Your tummy might feel bloated. You might also find it difficult to sit comfortably or to move around.  

Your doctor can drain off the fluid by putting a small, flexible tube into the abdomen. This helps you to feel more comfortable.

Pain

If you have pain, there are painkillers available. Pain can usually be well controlled. With good pain control, most people should be able to be free of pain when they are lying or sitting. The first step is to tell your doctor or nurse that you have pain so that they can find the right painkillers for you.

Cancer treatment can be used to try and control and shrink the cancer to help with symptoms. For example, an enlarged liver may cause pain in your right side or shoulder. The pain can be reduced by surgery, radiotherapy, chemotherapy or targeted and immunotherapy drugs that shrink the cancer.

Bowel problems

Cancer can cause bowel problems such as diarrhoea or constipation. Cancer treatments or medicines can also cause them. For example, painkillers commonly cause constipation.  

Talk to your doctor or nurse if you have bowel problems. They can help by giving you medicine. And they can refer you to a dietitian for advice on what to eat or drink. 

Sickness

Treatment for sickness depends on what is causing it. Some painkillers or cancer treatments can cause sickness. You might also feel sick if you are constipated.

Talking this over with a doctor or nurse is a good idea. Then, you can get the treatment you need.

Some people find that ginger is a good natural remedy for sickness. Try eating stem ginger or crystallised ginger if you like it. Or drinking boiled water with a small piece of fresh ginger in it. Some people find sipping fizzy ginger drinks can help. 

Difficulty sleeping

Even when you feel tired, you may find it hard to sleep. There are different reasons for this, including anxiety and having a lot on your mind. You may want to ask your doctor for sleeping pills. These can help break a poor sleep pattern and get you back into a better routine.

You can also try the following for insomnia:

• warm milk drinks before bed
• cognitive and behavioural therapy (CBT) techniques for insomnia
• sleep apps such as Sleepio
• a warm bath in the evening
• a relaxing body massage to relieve muscle tension
• a little more exercise during the day, if you can manage it

A blockage in the bowel

Sometimes cancer can grow so that it completely blocks the bowel. This is called a bowel obstruction. The waste from the food you have digested can't get past the blockage. This causes quite a few symptoms such as:

• feeling bloated and full

• vomiting large amounts

• feeling sick

• constipation

• being unable to pass wind

• pain

There are treatments available to make you feel more comfortable.

Other symptoms from cancer that has spread

You might have other symptoms, depending on where the cancer has spread to.

Help with controlling symptoms

Your doctor or specialist nurse (key worker) can:

• give you medicines
• help you to get the equipment that you need
• suggest other ways of controlling your symptoms
• refer you to a symptom control team (a palliative care team)

Symptom control team

There are symptom control teams in most cancer units. They can help you to stay as well as possible for as long as possible. They are also in hospices and many general hospitals.

Most symptom control teams have home care services so they can visit you at home.