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Nausea and Vomiting (PDQ®): Supportive care - Health Professional Information [NCI] - Nausea, Vomiting (Emesis), Constipation, and Bowel Obstruction in Advanced Cancer


Nausea and vomiting (N&V) are common symptoms in patients with advanced cancer, occurring in approximately 21% to 68% of these patients.[1,2] The underlying pathophysiology and treatment differs somewhat from nausea related to radiation treatment or chemotherapy. Chronic nausea can significantly impair a patient's quality of life.

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Note: Information about physical adjustment to treatment, problems with physical and cognitive development, and life after cancer treatment will be added to this summary in the future. The goal of supportive care is to improve the quality of life for young cancer patients and their families. Most children with cancer can be cured. However, cancer treatment for young patients can cause unwanted side effects and other problems during and after treatment. Early treatment of cancer symptoms...

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Pathophysiology and Causes

Chronic nausea in the advanced cancer setting is often multifactorial in origin.[1,2,3] Medications, including some that are frequently prescribed in this setting-such as opioids, nonsteroidal anti-inflammatory drugs, and selective serotonin reuptake inhibitor antidepressants-may be responsible.

In the case of opioids, nausea frequently resolves spontaneously a few days after initiation of treatment. In some cases, however, it may persist. Nausea resulting from the accumulation of active opioid metabolites (morphine-6-glucuronide) has been described,[4] and patients with impaired renal function may be at increased risk. Opioids invariably produce constipation if prophylactic measures are not taken (namely, the use of a regular laxative regimen), and constipation is one of the most common causes of nausea in patients with advanced cancer.[5,6,7,8]

Opioid-induced gastrointestinal (GI) motility problems may compound the problem of diminished GI motility that many patients experience as part of the anorexia-cachexia syndrome of advanced cancer. The autonomic dysfunction that often accompanies this syndrome results in decreased GI motility, early satiety, and chronic nausea.[9,10,11] Other causes of chronic nausea in these patients include the following:[12]

Nausea, like many other symptoms, may have psychological undercurrents that either exacerbate or induce chronic nausea.


A comprehensive history that includes determining the frequency and effectiveness of bowel movements and laxative therapy is essential. Concurrent medications are reviewed, and the frequency and nature of N&V is documented. Examination will assess for bowel obstruction, fecal impaction, dehydration, and raised intracranial pressure. History and physical examination are poor at determining the extent of constipation.[5] A plain flat-plate x-ray of the abdomen can be very useful to this end.[13] Surgical x-ray views of the abdomen may be helpful if a bowel obstruction is suspected. Investigations to determine blood levels of electrolytes, calcium, and renal parameters may also be helpful.

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