Anticipatory Nausea and Vomiting
Acute/Delayed Nausea and Vomiting
Nausea and Vomiting Related to Constipation and Bowel Obstruction in Advanced Cancer
        Malignant Bowel Obstruction
Alternative Therapies for Nausea and Vomiting

Anticipatory Nausea and Vomiting

Treatment of anticipatory nausea and vomiting is more likely to be successful when symptoms are recognized and treated early. Although antinausea drugs do not seem to be effective, the following may reduce symptoms:

• Guided imagery.



• Hypnosis.



• Relaxation.



• Behavioral modification techniques.



• Distraction (such as playing video games).

Acute and delayed nausea and vomiting are most commonly treated with antinausea drugs. Some drugs last only a short time in the body, and need to be given more often; others last a long time and are given less frequently. Blood levels of the drug(s) must be kept constant to control nausea and vomiting effectively.

The following drugs are commonly given alone or in combinations to treat nausea and vomiting:

• prochlorperazine



• droperidol, haloperidol



• metoclopramide



• ondansetron, granisetron, dolasetron, palonosetron



• aprepitant



• dexamethasone, methylprednisolone



• dronabinol



• lorazepam, midazolam, alprazolam



• olanzapine

In patients with advanced cancer, constipation is one of the most common causes of nausea. To prevent constipation and decrease the risk for nausea and vomiting, it is important that a regular bowel routine be followed, even if the patient isn't eating. High- fiber diets and bulk-forming laxatives with psyllium or cellulose require large amounts of fluid, however, and are not well tolerated by patients with advanced cancer. Laxatives that soften the stool or stimulate the bowel may be prescribed to prevent constipation, especially if the patient is being treated with opioids for cancer pain. The use of enemas and rectal suppositories is limited to short-term, severe episodes of constipation. Patients who have a loss of bowel function because of nerve damage (such as a tumor pressing on the spinal cord) may require suppositories for regular bowel emptying. Enemas and rectal suppositories should not be used in patients who have damage to the bowel wall. (Refer to the Constipation ¹ section in the PDQ summary on Gastrointestinal Complications ² and the Side Effects of Opioids ³ section in the PDQ summary on Pain ⁴.) Severe constipation may result in bowel obstruction.

Patients who have advanced cancer may develop a bowel obstruction that cannot be removed with surgery. The doctor may insert a nasogastric tube through the nose and esophagus into the stomach to temporarily relieve a partial obstruction. If the obstruction completely blocks the bowel, the doctor may insert a gastrostomy tube through the wall of the abdomen directly into the stomach to relieve fluid and air build-up. A gastrostomy tube also allows medications and liquids to be given directly into the stomach by pouring them down the tube. Sometimes, the doctor may create an ileostomy or colostomy by bringing part of the small intestine or colon through the abdominal wall to form an opening; or an expandable metal tube called a stent may be inserted into the bowel to open the blocked area. Injections or infusions of medications may be prescribed to relieve pain and/or nausea and vomiting.

Nausea and vomiting may be controlled without using drugs. The following may be helpful in relieving symptoms, especially for anticipatory nausea and vomiting, and may improve the effectiveness of antinausea drugs.

• Nutrition (refer to the PDQ summary on Nutrition in Cancer Care ⁵ for more information).
• Hypnosis.
• Acupuncture (refer to the PDQ summary on Acupuncture ⁶ for more information).
• Acupressure.
• Guided imagery.

Glossary Terms

The area of the body that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs.

Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs.

The application of pressure or localized massage to specific sites on the body to control symptoms such as pain or nausea. It is a type of complementary and alternative medicine.

The technique of inserting thin needles through the skin at specific points on the body to control pain and other symptoms. It is a type of complementary and alternative medicine.

Symptoms or signs that begin and worsen quickly; not chronic.

Cancer that has spread to other places in the body and usually cannot be cured or controlled with treatment.

A drug used to treat anxiety disorders and panic attacks. It is being studied in the treatment of nausea and vomiting caused by some cancer treatments. It is a type of benzodiazepine. Also called Xanax.

A drug used to prevent and control the nausea and vomiting caused by chemotherapy. It is used together with other anti-vomiting medicines. It belongs to the family of drugs called antiemetic agents. Also called Emend.

A technique used to help people change the way they react to certain triggers in the environment that cause a negative reaction. In cancer treatment, behavior modification may be used to help patients who have become nauseous during previous cancer treatments cope with nausea they feel when they enter the therapy room to begin a new round of treatment.

A tissue with red blood cells, white blood cells, platelets, and other substances suspended in fluid called plasma. Blood takes oxygen and nutrients to the tissues, and carries away wastes.

The long, tube-shaped organ in the abdomen that completes the process of digestion. The bowel has two parts, the small bowel and the large bowel. Also called intestine.

The way the intestines work in terms of how often there are bowel movements, the ability to control when to have a bowel movement, and whether the stools are hard and dry as in constipation or watery as in diarrhea.

A term for diseases in which abnormal cells divide without control and can invade nearby tissues. Cancer cells can also spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood. Lymphoma and multiple myeloma are cancers that begin in the cells of the immune system. Central nervous system cancers are cancers that begin in the tissues of the brain and spinal cord.

A building block of plant cells and fiber. Cellulose cannot be digested by people, and is used to add bulk to the diet.

The longest part of the large intestine, which is a tube-like organ connected to the small intestine at one end and the anus at the other. The colon removes water and some nutrients and electrolytes from partially digested food. The remaining material, solid waste called stool, moves through the colon to the rectum and leaves the body through the anus.

An opening into the colon from the outside of the body. A colostomy provides a new path for waste material to leave the body after part of the colon has been removed.

A condition in which stool becomes hard, dry, and difficult to pass, and bowel movements don’t happen very often. Other symptoms may include painful bowel movements, and feeling bloated, uncomfortable, and sluggish.

A synthetic steroid (similar to steroid hormones produced naturally in the adrenal gland). Dexamethasone is used to treat leukemia and lymphoma and may be used to treat some of the problems caused by other cancers and their treatment.

The things a person eats and drinks.

In medicine, a pain relief method that takes the patient's attention away from the pain.

The active ingredient in a drug used to treat nausea and vomiting caused by cancer treatment. Dolasetron is a type of serotonin receptor antagonist and a type of antiemetic.

A synthetic pill form of delta-9-tetrahydrocannabinol (THC), an active ingredient in marijuana that is used to treat nausea and vomiting associated with cancer chemotherapy.

A drug used to prevent nausea and vomiting in patients who receive anesthesia before surgery. It is also used to treat anxiety. Droperidol is a type of antiemetic, adjunct anesthesia, and antipsychotic.

Any substance, other than food, that is used to prevent, diagnose, treat or relieve symptoms of a disease or abnormal condition. Also refers to a substance that alters mood or body function, or that can be habit-forming or addictive, especially a narcotic.

The injection of a liquid through the anus into the large bowel.

The muscular tube through which food passes from the throat to the stomach.

In food, fiber is the part of fruits, vegetables, legumes, and whole grains that cannot be digested. The fiber in food may help prevent cancer. In the body, fiber refers to tissue made of long threadlike cells, such as muscle fiber or nerve fiber.

A substance that flows smoothly and takes the shape of its container. Liquids and gases are fluids.

A tube inserted through the wall of the abdomen directly into the stomach. It allows air and fluid to leave the stomach and can be used to give drugs and liquids, including liquid food, to the patient.

The active ingredient in a drug used to treat nausea and vomiting caused by cancer treatment. Granisetron is a type of serotonin receptor antagonist and a type of antiemetic.

A drug used to treat certain mental and neurological disorders. It is also being studied in the treatment of nausea and vomiting caused by some cancer treatments. It is a type of antiemetic and a type of antipsychotic. Also called Haldol.

A trance-like state in which a person becomes more aware and focused and is more open to suggestion.

An opening into the ileum, part of the small intestine, from the outside of the body. An ileostomy provides a new path for waste material to leave the body after part of the intestine has been removed.

A technique in which the person focuses on positive images in his or her mind.

A method of putting fluids, including drugs, into the bloodstream. Also called intravenous infusion.

Use of a syringe and needle to push fluids or drugs into the body; often called a "shot."

A substance that promotes bowel movements.

A drug that is used to treat anxiety and certain seizure disorders (such as epilepsy), and to prevent nausea and vomiting caused by chemotherapy. It belongs to the families of drugs called antiemetics and benzodiazepines.

A legal drug that is used to prevent, treat, or relieve symptoms of a disease or abnormal condition.

A corticosteroid hormone replacement.

A drug that increases the motility (movements and contractions) of the stomach and upper intestine. It is used to treat certain stomach problems and nausea and vomiting caused by chemotherapy. It is a type of antiemetic and a type of motility agent. Also called Reglan.

A drug used to treat anxiety and tension and to relax muscles. It is also being studied in the treatment of nausea and vomiting caused by some cancer treatments. It is a type of benzodiazepine. Also called midazolam hydrochloride and Versed.

Describes the passage from the nose to the stomach. For example, a nasogastric tube is inserted through the nose, down the throat and esophagus, and into the stomach.

A feeling of sickness or discomfort in the stomach that may come with an urge to vomit. Nausea is a side effect of some types of cancer therapy.

A bundle of fibers that receives and sends messages between the body and the brain. The messages are sent by chemical and electrical changes in the cells that make up the nerves.

The taking in and use of food and other nourishing material by the body. Nutrition is a 3-part process. First, food or drink is consumed. Second, the body breaks down the food or drink into nutrients. Third, the nutrients travel through the bloodstream to different parts of the body where they are used as "fuel" and for many other purposes. To give the body proper nutrition, a person has to eat and drink enough of the foods that contain key nutrients.

Blockage of a passageway.

A drug used to treat certain mental disorders. It is also being studied in the treatment of nausea and vomiting caused by some cancer treatments. It is a type of antipsychotic and a type of monoamine antagonist. Also called Zyprexa and Zyprexa Zydis.

The active ingredient in a drug used to treat nausea and vomiting caused by cancer treatment. Ondansetron is a type of serotonin receptor antagonist and a type of antiemetic.

A substance used to treat moderate to severe pain. Opioids are like opiates, such as morphine and codeine, but are not made from opium. Opioids bind to opioid receptors in the central nervous system. Opioids used to be called narcotics. An opioid is a type of alkaloid.

A drug used to treat nausea and vomiting caused by cancer treatment. It is a type of serotonin receptor antagonist and a type of antiemetic. Also called Aloxi.

PDQ is an online database developed and maintained by the National Cancer Institute. Designed to make the most current, credible, and accurate cancer information available to health professionals and the public, PDQ contains peer-reviewed summaries on cancer treatment, screening, prevention, genetics, complementary and alternative medicine, and supportive care; a registry of cancer clinical trials from around the world; and directories of physicians, professionals who provide genetics services, and organizations that provide cancer care. Most of this information, and more specific information about PDQ, can be found on the NCI's Web site at http://www.cancer.gov/cancertopics/pdq. Also called Physician Data Query.

A drug used to prevent or reduce nausea and vomiting. It belongs to the family of drugs called antiemetics.

A plant with seeds that are used as a mild laxative. The outer layer of the seeds swells when wet. This increases the size of stool and helps it pass more easily through the intestines (lower part of the digestive tract). Psyllium is a type of bulk laxative.

By or having to do with the rectum. The rectum is the last several inches of the large intestine closest to the anus.

A method used to reduce tension and anxiety, and control pain.

The part of the digestive tract that is located between the stomach and the large intestine.

A column of nerve tissue that runs from the base of the skull down the back. It is surrounded by three protective membranes, and is enclosed within the vertebrae (back bones). The spinal cord and the brain make up the central nervous system, and spinal cord nerves carry most messages between the brain and the rest of the body.

A device placed in a body structure (such as a blood vessel or the gastrointestinal tract) to keep the structure open.

An organ that is part of the digestive system. The stomach helps digest food by mixing it with digestive juices and churning it into a thin liquid.

The material in a bowel movement. Stool is made up of food that was not digested, bacteria, mucus, and cells from the intestines. Also called feces.

A form of medicine contained in a small piece of solid material, such as cocoa butter or glycerin, that melts at body temperature. A suppository is inserted into the rectum, vagina, or urethra and the medicine is absorbed into the bloodstream.

A procedure to remove or repair a part of the body or to find out whether disease is present. An operation.

An indication that a person has a condition or disease. Some examples of symptoms are headache, fever, fatigue, nausea, vomiting, and pain.

An abnormal mass of tissue that results when cells divide more than they should or do not die when they should. Tumors may be benign (not cancer), or malignant (cancer). Also called neoplasm.

To eject some or all of the contents of the stomach through the mouth.