NUR3500 Chap.6 Advanced Cancer: Symptoms and Emergencies
Advanced Cancer: Symptoms and Emergencies
Reading the intake
Advanced cancer arrives with a paper trail, and the first skill is reading it for what will change the plan. A referral should give the main diagnosis and the reason for referral, any red flags in the psychosocial or existential domains, the prognosis as the referrer understands it, the medication list, the caregiver situation and whether any planning has taken place.
In a community service the sequence that follows is practical: review what is recorded, make a first telephone contact with the family, take a handover, and then decide who visits and when.
The decision is made on need rather than on a scored triage, because what most often makes a visit urgent is a carer who cannot cope tonight.
What differs between tumour groups
Pain in more than one site, fatigue, poor appetite and weight loss are common to most people with advanced cancer. What differs is the complication that will dominate the last months.
Head and neck tumours impair eating, speech and breathing, alter appearance and carry a risk of bleeding and airway obstruction. Oesophageal disease produces progressive swallowing difficulty and may fistulate into the airway. Gastric disease obstructs the outlet and bleeds. Liver disease decompensates into ascites, encephalopathy and variceal bleeding.
Pancreatic disease brings severe pain, jaundice with itch, exocrine insufficiency and wasting. Colorectal disease obstructs, bleeds and produces neuropathic pelvic pain.
Matching the antiemetic to the mechanism
Nausea is where reflex prescribing is most visible. The useful question is which pathway is driving it. A serotonin receptor antagonist suits nausea provoked by chemotherapy or radiation.
A dopamine receptor antagonist suits nausea mediated through the chemoreceptor trigger zone, including opioid induced and metabolic nausea. A pro-motility dopamine antagonist suits gastric stasis or partial obstruction and is avoided in complete obstruction. A benzodiazepine helps anticipatory nausea but is weak alone. A corticosteroid is used for raised intracranial pressure or refractory nausea.
Constant nausea is dosed regularly rather than only when it returns.
Emergencies are defined by their preparation
A palliative emergency is not defined by how fast you run but by the fact that the outcome depends on what was arranged beforehand.
Catastrophic bleeding is heralded by minor bleeding from a wound, mouth or tracheostomy, visible pulsation and new restlessness, in someone with an irradiated neck or a tumour near a major vessel; preparation means identifying the risk, reviewing anticoagulants, discussing it sensitively, and keeping dark towels and standby sedation in the house. Airway obstruction needs suction, tube care and a written plan.
Malignant bowel obstruction needs partial and complete to be told apart, because the drug choice differs. A seizure in liver failure needs the family taught what to expect and medication available at home.
What no antiemetic reaches
The losses in advanced cancer are rarely physical alone.
Self esteem, relationships, role, income and function all go, and spiritual suffering appears as hopelessness, loneliness, meaninglessness, death anxiety and a sense of being punished. Families are coping with the diagnosis and prognosis, with fear and uncertainty, with loss, with treatment side effects, with anticipatory grief and sometimes with a wish to hasten death.
When a physical symptom will not settle despite rational escalation, this is where to look next.
What this chapter covers
- 01
Reading the referral and setting a visit priority
- 02
Complications by primary tumour site
- 03
Choosing an antiemetic by mechanism
- 04
Four emergencies and their advance preparation
- 05
Psychological, spiritual and family dimensions
A pain that does not respond to escalation
- 2Explain why the failure to respond is information rather than a dosing problem.
- 3Re-characterise the pain and say what that changes.
- 3Give the actions in the other three domains.
Key terms
- Catastrophic bleeding
- A sudden major haemorrhage from a tumour eroding a large vessel, heralded by minor bleeding, visible pulsation or new restlessness.
- Gastric outlet obstruction
- Blockage at the stomach outlet causing vomiting and inability to eat, managed by decompression, bypass, stenting or symptom control.
- Malignant bowel obstruction
- Obstruction of the bowel by tumour or peritoneal disease, presenting with colicky pain, distension, vomiting and obstipation.
- Chemoreceptor trigger zone
- The brain region that detects circulating toxins and drugs and triggers nausea, targeted by dopamine receptor antagonists.
- Fungating wound
- A tumour that has broken through the skin, causing pain, exudate, odour and bleeding, and often social withdrawal.
- Anticipatory grief
- Grief experienced by a patient or family before the death, often mistaken for depression or denial.
Advanced Cancer: Symptoms and Emergencies FAQ
Why does the same nausea need different drugs in different patients?
Because the pathway differs. Nausea driven by circulating drugs or metabolic upset responds to a dopamine antagonist, nausea from chemotherapy or radiation to a serotonin antagonist, and nausea from gastric stasis to a pro-motility agent that must be avoided once obstruction is complete.
What does preparing for a catastrophic bleed actually involve?
Identifying who is at risk, reviewing drugs that increase bleeding, holding a sensitive discussion with the patient, family and out of hours services, and leaving dark towels and standby sedation in the home. During the event the intervention is staying with the person rather than performing a procedure.
How do I tell partial from complete bowel obstruction at the bedside?
Partial obstruction still allows some passage of faeces or flatus, whereas complete obstruction does not. The distinction matters because a pro-motility antiemetic and an antispasmodic are chosen differently depending on whether the aim is to reduce spasm or to quieten the gut.
Exam move
Build a table of five primary sites against the complication that dominates each, then add the single nursing response you would give first. Separately, write the four emergencies with their warning signs, and rehearse the bleeding sequence as four steps in order.
Working through Advanced Cancer: Symptoms and Emergencies in NUR3500? Sia is AskSia’s AI Nursing tutor — ask any NUR3500 Advanced Cancer: Symptoms and Emergencies question and get a clear, step-by-step explanation grounded in how NUR3500 is taught and assessed. Read this chapter free, then take your hardest questions to Sia.
