Introduction
Overview
Assessment

Patient Self-Report Physical Exam Assessment of the Outcomes of Pain Management

Management with Drugs

Basic Principles of Cancer Pain Management Acetaminophen and NSAIDs Opioids         Types of Opioids         Guidelines for Giving Opioids         Side Effects of Opioids Drugs Used with Pain Medications

Physical and Psychosocial Interventions

Physical Interventions Thinking and Behavioral Interventions

Anticancer Interventions

Radiation Therapy Radiofrequency Ablation Surgery

Invasive Interventions

Nerve Blocks Neurologic Interventions Management of Procedural Pain

Treating Older Patients
Get More Information From NCI
Changes to This Summary (02/17/2009)
Questions or Comments About This Summary
About PDQ

Introduction

This patient summary on pain is adapted from the summary written for health professionals by cancer experts. This and other credible information about cancer treatment, screening, prevention, supportive care, and ongoing clinical trials is available from the National Cancer Institute. Pain associated with cancer can be controlled in most patients but is frequently undertreated. This brief summary describes the management of cancer pain with the use of medication, physical methods, and psychological intervention.

Overview

Cancer pain can be managed effectively in most patients with cancer or with a history of cancer. Although cancer pain cannot always be relieved completely, therapy can lessen pain in most patients. Pain management improves the patient's quality of life throughout all stages of the disease.

Flexibility is important in managing cancer pain. As patients vary in diagnosis, stage of disease, responses to pain and treatments, and personal likes and dislikes, management of cancer pain must be individualized. Patients, their families, and their health care providers must work together closely to manage a patient's pain effectively.

Assessment

To treat pain, it must be measured. The patient and the doctor should measure pain levels at regular intervals after starting cancer treatment, at each new report of pain, and after starting any type of treatment for pain. The cause of the pain must be identified and treated promptly.

To help the health care provider determine the type and extent of the pain, cancer patients can describe the location and intensity of their pain, any aggravating or relieving factors, and their goals for pain control. The family/caregiver may be asked to report for a patient who has a communication problem involving speech, language, or a thinking impairment. The health care provider should help the patient describe the following:

• Pain: The patient describes the pain, when it started, how long it lasts, and whether it is worse during certain times of the day or night.



• Location: The patient shows exactly where the pain is on his or her body or on a drawing of a body and where the pain goes if it travels.



• Pattern: The patient describes if there have been changes in where the pain is, when the pain occurs, and how long it lasts, or if there is new pain.



• Intensity or severity: The patient keeps a diary of the degree or severity of pain.



• Aggravating and relieving factors: The patient identifies factors that increase or decrease the pain. The patient also identifies symptoms that are most troublesome, since they are not always the most serious or severe.



• Personal response to pain: Feelings of fear, confusion, or hopelessness about cancer, its prognosis, and the causes of pain can affect how a patient responds to and describes the pain. For example, a patient who thinks pain is caused by cancer spreading may report more severe pain or more disability from the pain.



• Behavioral response to pain: The health care provider and/or caregivers note behaviors that may suggest pain in patients who have communication problems.



• Goals for pain control: With the health care provider, the patient decides how much pain he or she can tolerate and how much improvement he or she may achieve. The patient uses a daily pain diary to increase awareness of pain, gain a sense of control of the pain, and receive guidance from health care providers on ways to manage the pain.

The assessment will include an exam of the body to check general signs of health or anything that seems unusual, and to look for signs that the cancer has grown or spread. A history of the patient’s health habits and past illnesses and treatments will also be taken. A neurological exam will be done. This is a series of questions and tests to check the brain, spinal cord, and nerve function. The exam checks the patient's mental status, ability to move and walk normally, and how well the muscles, senses, and reflexes work.

The results of pain management should be measured by monitoring for a decrease in the severity of pain and improvement in thinking ability, emotional well-being, and social functioning. The results of taking pain medication should also be monitored. Drug addiction is rare in cancer patients. Developing a higher tolerance for a drug and becoming physically dependent on the drug for pain relief does not mean that the patient is addicted. Patients should take pain medication as prescribed by the doctor. Patients who have a history of drug abuse may tolerate higher doses of medication to control pain.

Management with Drugs

Basic Principles of Cancer Pain Management

The World Health Organization developed a 3-step approach for pain management based on the severity of the pain:

• For mild to moderate pain, the doctor may prescribe a Step 1 pain medication such as aspirin, acetaminophen, or a nonsteroidal anti-inflammatory drug (NSAID). Patients should be monitored for side effects, especially those caused by NSAIDs, such as kidney, heart and blood vessel, or stomach and intestinal problems.



• When pain lasts or increases, the doctor may change the prescription to a Step 2 or Step 3 pain medication. Most patients with cancer -related pain will need a Step 2 or Step 3 medication. The doctor may skip Step 1 medications if the patient initially has moderate to severe pain.



• At each step, the doctor may prescribe additional drugs or treatments (for example, radiation therapy).



• The patient should take doses regularly, "by mouth, by the clock" (at scheduled times), to maintain a constant level of the drug in the body; this will help prevent recurrence of pain. If the patient is unable to swallow, the drugs are given by other routes (for example, by infusion or injection).



• The doctor may prescribe additional doses of drug that can be taken as needed for pain that occurs between scheduled doses of drug.



• The doctor will adjust the pain medication regimen for each patient's individual circumstances and physical condition.

NSAIDs are effective for relief of mild pain. They may be given with opioids for the relief of moderate to severe pain. Acetaminophen also relieves pain, although it does not have the anti-inflammatory effect that aspirin and NSAIDs do. Patients, especially older patients, who are taking acetaminophen or NSAIDs should be closely monitored for side effects. Aspirin should not be given to children to treat pain.

Opioids are very effective for the relief of moderate to severe pain. Many patients with cancer pain, however, become tolerant to opioids during long-term therapy. Therefore, increasing doses may be needed to continue to relieve pain. A patient's tolerance of an opioid or physical dependence on it is not the same as addiction (psychological dependence). Mistaken concerns about addiction can result in undertreating pain.

There are several types of opioids. Morphine is the most commonly used opioid in cancer pain management. Other commonly used opioids include hydromorphone, oxycodone, methadone, fentanyl, and tramadol. The availability of several different opioids allows the doctor flexibility in prescribing a medication regimen that will meet individual patient needs.

Most patients with cancer pain will need to receive pain medication on a fixed schedule to manage the pain and prevent it from getting worse. The doctor will prescribe a dose of the opioid medication that can be taken as needed along with the regular fixed-schedule opioid to control pain that occurs between the scheduled doses. The amount of time between doses depends on which opioid the doctor prescribes. The correct dose is the amount of opioid that controls pain with the fewest side effects. The goal is to achieve a good balance between pain relief and side effects by gradually adjusting the dose. If opioid tolerance does occur, it can be overcome by increasing the dose or changing to another opioid, especially if higher doses are needed.

Occasionally, doses may need to be decreased or stopped. This may occur when patients become pain free because of cancer treatments such as nerve blocks or radiation therapy. The doctor may also decrease the dose when the patient experiences opioid-related sedation along with good pain control.

Medications for pain may be given in several ways. When the patient has a working stomach and intestines, the preferred method is by mouth, since medications given orally are convenient and usually inexpensive. When patients cannot take medications by mouth, other less invasive methods may be used, such as rectally or through medication patches placed on the skin. Intravenous methods are used only when simpler, less demanding, and less costly methods are inappropriate, ineffective, or unacceptable to the patient. Patient-controlled analgesia (PCA) pumps may be used to determine the opioid dose when starting opioid therapy. Once the pain is controlled, the doctor may prescribe regular opioid doses based on the amount the patient required when using the PCA pump. Intraspinal administration of opioids combined with a local anesthetic may be helpful for some patients who have uncontrollable pain.

Patients should be watched closely for side effects of opioids. The most common side effects of opioids include nausea, sleepiness, and constipation. The doctor should discuss the side effects with patients before starting opioid treatment. Sleepiness and nausea are usually experienced when opioid treatment is started and tend to improve within a few days. Other side effects of opioid treatment include vomiting, difficulty in thinking clearly, problems with breathing, gradual overdose, and problems with sexual function.

Opioids slow down the muscle contractions and movement in the stomach and intestines resulting in hard stools. The key to effective prevention of constipation is to be sure the patient receives plenty of fluids to keep the stool soft. Unless there are problems such as a blocked bowel or diarrhea, patients will usually be given a regimen to follow to prevent constipation and information on how to manage bowel health while taking opioids.

Patients should talk to their doctor about side effects that become too bothersome or severe. Because there are differences between individual patients in the degree to which opioids may cause side effects, severe or continuing problems should be reported to the doctor. The doctor may decrease the dose of the opioid, switch to a different opioid, or switch the way the opioid is given (for example intravenous or injection rather than by mouth) to attempt to decrease the side effects. (Refer to the PDQ summaries on Gastrointestinal Complications ¹, Nausea and Vomiting ², Nutrition in Cancer Care ³, and Sexuality and Reproductive Issues ⁴ for more information about coping with these side effects.)

Other drugs may be given at the same time as the pain medication. This is done to increase the effectiveness of the pain medication, treat symptoms, and relieve specific types of pain. These drugs include antidepressants, anticonvulsants, local anesthetics, corticosteroids, bisphosphonates, and stimulants. There are great differences in how patients respond to these drugs. Side effects are common and should be reported to the doctor.

The use of bisphosphonates may cause severe and sometimes disabling pain in the bones, joints, and/or muscles. This pain may develop after these drugs are used for days, months, or years, as compared with the fever, chills, and discomfort that may occur when intravenous bisphosphonates are first given. If severe muscle or bone pain develops, bisphosphonate therapy may need to be stopped.

The use of bisphosphonates is also linked to the risk of bisphosphonate-associated osteonecrosis (BON). See the PDQ summary on Oral Complications of Chemotherapy and Head/Neck Radiation ⁵ for more information on BON.

Physical and Psychosocial Interventions

Noninvasive physical and psychological methods can be used along with drugs and other treatments to manage pain during all phases of cancer treatment. The effectiveness of the pain interventions depends on the patient's participation in treatment and his or her ability to tell the health care provider which methods work best to relieve pain.

Weakness, muscle wasting, and muscle/bone pain may be treated with heat (a hot pack or heating pad); cold (flexible ice packs); massage, pressure, and vibration (to improve relaxation); exercise (to strengthen weak muscles, loosen stiff joints, help restore coordination and balance, and strengthen the heart); changing the position of the patient; restricting the movement of painful areas or broken bones; stimulation; controlled low-voltage electrical stimulation; or acupuncture. See the PDQ summary on Acupuncture ⁶ for more information.

Thinking and behavior interventions are also important in treating pain. These interventions help give patients a sense of control and help them develop coping skills to deal with the disease and its symptoms. Beginning these interventions early in the course of the disease is useful so that patients can learn and practice the skills while they have enough strength and energy. Several methods should be tried, and one or more should be used regularly.

• Relaxation and imagery: Simple relaxation techniques may be used for episodes of brief pain (for example, during cancer treatment procedures). Brief, simple techniques are suitable for periods when the patient's ability to concentrate is limited by severe pain, high anxiety, or fatigue. (See Relaxation exercises below.)



• Hypnosis: Hypnotic techniques may be used to encourage relaxation and may be combined with other thinking/behavior methods. Hypnosis is effective in relieving pain in people who are able to concentrate and use imagery and who are willing to practice the technique.



• Redirecting thinking: Focusing attention on triggers other than pain or negative emotions that come with pain may involve distractions that are internal (for example, counting, praying, or saying things like "I can cope") or external (for example, music, television, talking, listening to someone read, or looking at something specific). Patients can also learn to monitor and evaluate negative thoughts and replace them with more positive thoughts and images.



• Patient education: Health care providers can give patients and their families information and instructions about pain and pain management and assure them that most pain can be controlled effectively. Health care providers should also discuss the major barriers that interfere with effective pain management.



• Psychological support: Short-term psychological therapy helps some patients. Patients who develop clinical depression or adjustment disorder may see a psychiatrist for diagnosis.



• Support groups and religious counseling: Support groups help many patients. Religious counseling may also help by providing spiritual care and social support.

The following relaxation exercises may be helpful in relieving pain.

Exercise 1. Slow rhythmic breathing for relaxation *

1. Breathe in slowly and deeply, keeping your stomach and shoulders relaxed.
2. As you breathe out slowly, feel yourself beginning to relax; feel the tension leaving your body.
3. Breathe in and out slowly and regularly at a comfortable rate. Let the breath come all the way down to your stomach, as it completely relaxes.
4. To help you focus on your breathing and to breathe slowly and rhythmically: Breathe in as you say silently to yourself, "in, two, three." OR Each time you breathe out, say silently to yourself a word such as "peace" or "relax."
5. Do steps 1 through 4 only once or repeat steps 3 and 4 for up to 20 minutes.
6. End with a slow deep breath. As you breathe out say to yourself, "I feel alert and relaxed."

Exercise 2. Simple touch, massage, or warmth for relaxation *

• Touch and massage are traditional methods of helping others relax. Some examples are:
  • Brief touch or massage, such as hand holding or briefly touching or rubbing a person's shoulders.
  • Soaking feet in a basin of warm water or wrapping the feet in a warm, wet towel.
  • Massage (3 to 10 minutes) of the whole body or just the back, feet, or hands. If the patient is modest or cannot move or turn easily in bed, consider massage of the hands and feet.
  • Use a warm lubricant. A small bowl of hand lotion may be warmed in the microwave oven or a bottle of lotion may be warmed in a sink of hot water for about 10 minutes.
  • Massage for relaxation is usually done with smooth, long, slow strokes. Try several degrees of pressure along with different types of massage, such as kneading and stroking, to determine which is preferred.

Especially for the elderly person, a back rub that effectively produces relaxation may consist of no more than 3 minutes of slow, rhythmic stroking (about 60 strokes per minute) on both sides of the spine, from the crown of the head to the lower back. Continuous hand contact is maintained by starting one hand down the back as the other hand stops at the lower back and is raised. Set aside a regular time for the massage. This gives the patient something pleasant to anticipate.

Exercise 3. Peaceful past experiences *

• Something may have happened to you a while ago that brought you peace or comfort. You may be able to draw on that experience to bring you peace or comfort now. Think about these questions:
  • Can you remember any situation, even when you were a child, when you felt calm, peaceful, secure, hopeful, or comfortable?
  • Have you ever daydreamed about something peaceful? What were you thinking?
  • Do you get a dreamy feeling when you listen to music? Do you have any favorite music?
  • Do you have any favorite poetry that you find uplifting or reassuring?
  • Have you ever been active religiously? Do you have favorite readings, hymns, or prayers? Even if you haven't heard or thought of them for many years, childhood religious experiences may still be very soothing.

Additional points: Some of the things that may comfort you, such as your favorite music or a prayer, can probably be recorded for you. Then you can listen to the tape whenever you wish. Or, if your memory is strong, you may simply close your eyes and recall the events or words.

Exercise 4. Active listening to recorded music *

1. Obtain the following:
   • A cassette player or tape recorder. (Small, battery-operated ones are more convenient.)
   • Earphones or a headset. (Helps focus the attention better than a speaker a few feet away, and avoids disturbing others.)
   • A cassette of music you like. (Most people prefer fast, lively music, but some select relaxing music. Other options are comedy routines, sporting events, old radio shows, or stories.)
2. Mark time to the music; for example, tap out the rhythm with your finger or nod your head. This helps you concentrate on the music rather than on your discomfort.
3. Keep your eyes open and focus on a fixed spot or object. If you wish to close your eyes, picture something about the music.
4. Listen to the music at a comfortable volume. If the discomfort increases, try increasing the volume; decrease the volume when the discomfort decreases.
5. If this is not effective enough, try adding or changing one or more of the following: massage your body in rhythm to the music; try other music; or mark time to the music in more than one manner, such as tapping your foot and finger at the same time.

Additional points: Many patients have found this technique to be helpful. It tends to be very popular, probably because the equipment is usually readily available and is a part of daily life. Other advantages are that it is easy to learn and not physically or mentally demanding. If you are very tired, you may simply listen to the music and omit marking time or focusing on a spot.

* [Note: Adapted and reprinted with permission from McCaffery M, Beebe A: Pain: Clinical Manual for Nursing Practice. St. Louis, Mo: CV Mosby: 1989.]

Anticancer Interventions

Radiation therapy, radiofrequency ablation, and surgery may be used for pain relief rather than as treatment for primary cancer. Certain chemotherapy drugs may also be used to manage cancer -related pain.

Local or whole-body radiation therapy may increase the effectiveness of pain medication and other noninvasive therapies by directly affecting the cause of the pain (for example, by reducing tumor size). A single injection of a radioactive agent may relieve pain when cancer spreads extensively to the bones. Radiation therapy also helps reduce pain-related interference with walking and other functions in patients who have cancer that has spread to the bones. It is possible for pain to come back after radiation therapy, though more studies about this need to be done.

Radiofrequency ablation uses a needle electrode to heat tumors and destroy them. This minimally invasive procedure may provide significant pain relief in patients who have cancer that has spread to the bones.

Surgery may be used to remove part or all of a tumor to reduce pain directly, relieve symptoms of obstruction or compression, and improve outcome, even increasing long-term survival.

Invasive Interventions

Less invasive methods should be used for relieving pain before trying invasive treatment. Some patients, however, may need invasive therapy.

A nerve block is the injection of either a local anesthetic or a drug that inactivates nerves to control otherwise uncontrollable pain. Nerve blocks can be used to determine the source of pain, to treat painful conditions that respond to nerve blocks, to predict how the pain will respond to long-term treatments, and to prevent pain following procedures.

Surgery can be performed to implant devices that deliver drugs or electrically stimulate the nerves. In rare cases, surgery may be done to destroy a nerve or nerves that are part of the pain pathway.

Many diagnostic and treatment procedures are painful. Pain related to procedures may be treated before it occurs. Local anesthetics and short-acting opioids can be used to manage procedure-related pain, if enough time is allowed for the drug to work. Anti- anxiety drugs and sedatives may be used to reduce anxiety or to sedate the patient. Treatments such as imagery or relaxation are useful in managing procedure-related pain and anxiety.

Patients usually tolerate procedures better when they know what to expect. Having a relative or friend stay with the patient during the procedure may help reduce anxiety.

Patients and family members should receive written instructions for managing the pain at home. They should receive information regarding whom to contact for questions related to pain management.

Treating Older Patients

Older patients are at risk for under-treatment of pain because their sensitivity to pain may be underestimated, they may be expected to tolerate pain well, and misconceptions may exist about their ability to benefit from opioids. Issues in assessing and treating cancer pain in older patients include the following:

• Multiple chronic diseases and sources of pain: Age and complicated medication regimens put older patients at increased risk for interactions between drugs and between drugs and the chronic diseases.



• Visual, hearing, movement, and thinking impairments may require simpler tests and more frequent monitoring to determine the extent of pain in the older patient.



• Nonsteroidal anti-inflammatory drug (NSAID) side effects, such as stomach and kidney toxicity, thinking problems, constipation, and headaches, are more likely to occur in older patients.



• Opioid effectiveness: Older patients may be more sensitive to the pain-relieving and central nervous system effects of opioids resulting in longer periods of pain relief.



• Patient-controlled analgesia must be used cautiously in older patients, since drugs are slower to leave the body and older patients are more sensitive to the side effects.



• Other methods of administration, such as rectal administration, may not be useful in older patients since they may be physically unable to insert the medication.



• Pain control after surgery requires frequent direct contact with health care providers to monitor pain management.



• Reassessment of pain management and required changes should be made whenever the older patient moves (for example, from hospital to home or nursing home).

Get More Information From NCI

Call 1-800-4-CANCER

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There are also many other places to get materials and information about cancer treatment and services. Hospitals in your area may have information about local and regional agencies that have information on finances, getting to and from treatment, receiving care at home, and dealing with problems related to cancer treatment.

Find Publications

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Changes to This Summary (02/17/2009)

The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.

Changes were made to this summary to match those made to the health professional version.

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About PDQ

PDQ is a comprehensive cancer database available on NCI's Web site.

PDQ is the National Cancer Institute's (NCI's) comprehensive cancer information database. Most of the information contained in PDQ is available online at NCI's Web site ⁸. PDQ is provided as a service of the NCI. The NCI is part of the National Institutes of Health, the federal government's focal point for biomedical research.

PDQ contains cancer information summaries.

The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries are available in two versions. The health professional versions provide detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions provide current and accurate cancer information.

The PDQ cancer information summaries are developed by cancer experts and reviewed regularly.

Editorial Boards made up of experts in oncology and related specialties are responsible for writing and maintaining the cancer information summaries. The summaries are reviewed regularly and changes are made as new information becomes available. The date on each summary ("Date Last Modified") indicates the time of the most recent change.

PDQ also contains information on clinical trials.

A clinical trial is a study to answer a scientific question, such as whether one method of treating symptoms is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. Some patients have symptoms caused by cancer treatment or by the cancer itself. During supportive care clinical trials, information is collected about how well new ways to treat symptoms of cancer work. The trials also study side effects of treatment and problems that come up during or after treatment. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients who have symptoms related to cancer treatment may want to think about taking part in a clinical trial.

Listings of clinical trials are included in PDQ and are available online at NCI's Web site ¹¹. Descriptions of the trials are available in health professional and patient versions. Many cancer doctors who take part in clinical trials are also listed in PDQ. For more information, call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.

Glossary Terms

A drug that reduces pain and fever (but not inflammation). It belongs to the family of drugs called analgesics.

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.

Uncontrollable craving, seeking, and use of a substance such as a drug or alcohol.

In medicine, the act of giving a treatment, such as a drug, to a patient. It can also refer to the way it is given, the dose, or how often it is given.

A drug or other substance that causes a loss of feeling or awareness. Local anesthetics cause a loss of feeling in one small area of the body. Regional anesthetics cause a loss of feeling in a part of the body, such as an arm or leg. General anesthetics cause a loss of feeling and a complete loss of awareness that feels like a very deep sleep.

Having to do with reducing inflammation.

A drug or other substance used to prevent or stop seizures or convulsions. Also called antiepileptic.

A drug used to treat depression.

Feelings of fear, dread, and uneasiness that may occur as a reaction to stress. A person with anxiety may sweat, feel restless and tense, and have a rapid heart beat. Extreme anxiety that happens often over time may be a sign of an anxiety disorder.

A drug that reduces pain, fever, inflammation, and blood clotting. Aspirin belongs to the family of drugs called nonsteroidal anti-inflammatory agents. It is also being studied in cancer prevention.

In healthcare, a process used to learn about a patient’s condition. This may include a complete medical history, medical tests, a physical exam, a test of learning skills, tests to find out if the patient is able to carry out the tasks of daily living, a mental health evaluation, and a review of social support and community resources available to the patient.

Something that blocks, prevents, separates, or limits.

A drug or substance used to treat hypercalcemia (abnormally high blood calcium) and bone pain caused by some types of cancer. Forms of bisphosphonates are also used to treat osteoporosis and for bone imaging. Bisphosphonates inhibit a type of bone cell that breaks down bone. Also called diphosphonate.

The necrosis (death) of bone tissue caused by treatment with a bisphosphonate (a drug or substance used to treat osteoporosis, bone pain caused by some types of cancer, and high blood calcium). It commonly occurs in the jaw bones. There may be pain, swelling and infection in the areas of necrosis. Also called BON.

A tube through which the blood circulates in the body. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins.

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.

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.

The brain and spinal cord. Also called CNS.

Treatment with drugs that kill cancer cells.

A disease or condition that persists or progresses over a long period of time.

Having to do with the examination and treatment of patients.

A type of research study that tests how well new medical approaches work in people. These studies test new methods of screening, prevention, diagnosis, or treatment of a disease. Also called clinical study.

A mental state in which one is not thinking clearly.

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.

To adjust to new situations and overcome problems.

The methods a person uses to deal with stressful situations. These may help a person face a situation, take action, and be flexible and persistent in solving problems.

Any steroid hormone made in the adrenal cortex (the outer part of the adrenal gland). They are also made in the laboratory. Corticosteroids have many different effects in the body, and are used to treat many different conditions. They may be used as hormone replacement, to suppress the immune system, and to treat some side effects of cancer and its treatment. Corticosteroids are also used to treat certain lymphomas and lymphoid leukemias.

The process by which a professional counselor helps a person cope with mental or emotional distress, and understand and solve personal problems.

A mental condition marked by ongoing feelings of sadness, despair, loss of energy, and difficulty dealing with normal daily life. Other symptoms of depression include feelings of worthlessness and hopelessness, loss of pleasure in activities, changes in eating or sleeping habits, and thoughts of death or suicide. Depression can affect anyone, and can be successfully treated. Depression affects 15-25% of cancer patients.

The process of identifying a disease, such as cancer, from its signs and symptoms.

A specific test or series of steps done to help diagnose a disease or condition. Mammograms and colonscopies are examples of diagnostic procedures.

Frequent and watery bowel movements.

In medicine, a disturbance of normal functioning of the mind or body. Disorders may be caused by genetic factors, disease, or trauma.

The amount of medicine taken, or radiation given, at one time.

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 use of illegal drugs or the use of prescription or over-the-counter drugs for purposes other than those for which they are meant to be used, or in large amounts. Drug abuse may lead to social, physical, emotional, and job-related problems.

A condition that occurs when the body gets used to a medicine so that either more medicine is needed or different medicine is needed.

In medicine, a device such as a small metal plate or needle that carries electricity from an instrument to a patient for treatment or surgery. Electrodes can also carry electrical signals from muscles, brain, heart, skin, or other body parts to recording devices to help diagnose certain conditions.

A condition marked by extreme tiredness and inability to function due lack of energy. Fatigue may be acute or chronic.

A drug used to treat severe cancer pain in that occurs even though the patient is already taking opioids. It is also used during anesthesia for surgery. Fentanyl citrate binds to opioid receptors in the central nervous system. It is a type of analgesic agent and a type of opioid.

An increase in body temperature above normal (98.6 degrees F), usually caused by disease.

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

A drug used to relieve pain.

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

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

A loss of part or all of a physical or mental ability, such as the ability to see, walk, or learn.

A substance or object that is put in the body as a prosthesis, or for treatment or diagnosis.

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."

In medicine, a treatment or action taken to prevent or treat disease, or improve health in other ways.

Having to do with the intestines.

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

Within the spine (backbone).

Into or within a vein. Intravenous usually refers to a way of giving a drug or other substance through a needle or tube inserted into a vein. Also called IV.

A medical procedure that invades (enters) the body, usually by cutting or puncturing the skin or by inserting instruments into the body.

In medicine, the place where two or more bones are connected. Examples include the shoulder, elbow, knee, and jaw.

One of a pair of organs in the abdomen. Kidneys remove waste from the blood (as urine), produce erythropoietin (a substance that stimulates red blood cell production), and play a role in blood pressure regulation.

Treatment that affects cells in the tumor and the area close to it.

An oily or slippery substance.

A treatment in which the soft tissues of the body are kneaded, rubbed, tapped, and stroked. Massage therapy may help people relax, relieve stress and pain, lower blood pressure, and improve circulation. It is being studied in the treatment of cancer symptoms such as lack of energy, pain, swelling, and depression.

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

A drug used to treat moderate to severe pain that does not respond to other types of pain medicine. It is also used to help people who are addicted to opioid drugs such as heroin. Methadone hydrochloride binds to opioid receptors in the central nervous system. It is a type of analgesic agent and a type of opioid.

In medicine, to regularly watch and check a person or condition to see if there is any change. Also refers to a device that records and/or displays patient data, such as for an electrocardiogram (EKG).

A drug used to treat moderate to severe pain. It binds to opioid receptors in the central nervous system and some other tissues. Morphine sulfate is made from opium. It is a type of opiate and a type of analgesic agent.

A weakening, shrinking, and loss of muscle caused by disease or lack of use. Muscle wasting decreases strength and the ability to move.

The National Cancer Institute, part of the National Institutes of Health of the United States Department of Health and Human Services, is the Federal Government's principal agency for cancer research. The National Cancer Institute conducts, coordinates, and funds cancer research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer. Access the National Cancer Institute Web site at http://www.cancer.gov. Also called NCI.

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.

A procedure in which medicine is injected directly into or around a nerve or into the spine to block pain.

A series of questions and tests to check brain, spinal cord, and nerve function. The exam checks a person’s mental status, coordination, ability to walk, and how well the muscles, sensory systems, and deep tendon reflexes work.

In medicine, it describes a procedure that does not require inserting an instrument through the skin or into a body opening. In cancer, it describes disease that has not spread outside the tissue in which it began.

A drug that decreases fever, swelling, pain, and redness. Also called NSAID.

A place that gives care to people who have physical or mental disabilities and need help with activities of daily living (such as taking a bath, getting dressed, and going to the bathroom) but do not need to be in the hospital.

Blockage of a passageway.

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.

By or having to do with the mouth.

A specific result or effect that can be measured. Examples of outcomes include decreased pain, reduced tumor size, and improvement of disease.

A drug used to treat moderate to severe pain. It is made from morphine and binds to opioid receptors in the central nervous system. Oxycodone hydrochloride is a type of analgesic agent and a type of opiate.

A method of pain relief in which the patient controls the amount of pain medicine that is used. When pain relief is needed, the person can receive a preset dose of pain medicine by pressing a button on a computerized pump that is connected to a small tube in the body. Also called PCA.

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 condition in which a person takes a drug over time, and unpleasant physical symptoms occur if the drug is suddenly stopped or taken in smaller doses.

A doctor's order for medicine or another intervention.

In medicine, action taken to decrease the chance of getting a disease or condition. For example, cancer prevention includes avoiding risk factors (such as smoking, obesity, lack of exercise, and radiation exposure) and increasing protective factors (such as getting regular physical activity, staying at a healthy weight, and having a healthy diet).

The original tumor.

The likely outcome or course of a disease; the chance of recovery or recurrence.

A medical doctor who specializes in the prevention, diagnosis, and treatment of mental, emotional, and behavioral disorders.

Having to do with how the mind works and how thoughts and feelings affect behavior.

A device that is used to give a controlled amount of a liquid at a specific rate. For example, pumps are used to give drugs (such as chemotherapy or pain medicine) or nutrients.

The overall enjoyment of life. Many clinical trials assess the effects of cancer and its treatment on the quality of life. These studies measure aspects of an individual’s sense of well-being and ability to carry out various activities.

The use of high-energy radiation from x-rays, gamma rays, neutrons, protons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Also called irradiation and radiotherapy.

Giving off radiation.

A procedure that uses radio waves to heat and destroy abnormal cells. The radio waves travel through electrodes (small devices that carry electricity). Radiofrequency ablation may be used to treat cancer and other conditions.

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

A treatment plan that specifies the dosage, the schedule, and the duration of treatment.

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

Checking for disease when there are no symptoms. Since screening may find diseases at an early stage, there may be a better chance of curing the disease. Examples of cancer screening tests are the mammogram (breast), colonoscopy (colon), Pap smear (cervix), and PSA blood level and digital rectal exam (prostate). Screening can also include checking for a person’s risk of developing an inherited disease by doing a genetic test.

A drug or substance used to calm a person down, relieve anxiety, or help a person sleep.

A problem that occurs when treatment affects healthy tissues or organs. Some common side effects of cancer treatment are fatigue, pain, nausea, vomiting, decreased blood cell counts, hair loss, and mouth sores.

A network of family, friends, neighbors, and community members that is available in times of need to give psychological, physical, and financial help.

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.

The bones, muscles, tendons, and other tissues that reach from the base of the skull to the tailbone. The spine encloses the spinal cord and the fluid surrounding the spinal cord. Also called backbone, spinal column, and vertebral column.

Having to do with deep, often religious, feelings and beliefs, including a person’s sense of peace, purpose, connection to others, and beliefs about the meaning of life.

The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer, and whether the cancer has spread from the original site to other parts of the body.

In medicine, a family of drugs used to treat depression, attention-deficit disorder (a common disorder in which children are inattentive, impulsive, and/or over-active), and narcolepsy (a sleep disorder that causes uncontrollable sleepiness). Stimulants increase brain activity, alertness, attention, and energy. They also raise blood pressure and increase heart rate and breathing rate.

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 group of people with similar disease who meet to discuss how better to cope with their disease and treatment.

Care given to improve the quality of life of patients who have a serious or life-threatening disease. The goal of supportive care is to prevent or treat as early as possible the symptoms of a disease, side effects caused by treatment of a disease, and psychological, social, and spiritual problems related to a disease or its treatment. Also called comfort care, palliative care, and symptom management.

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.

Treatment.

Radiation therapy to the entire body. It is usually followed by bone marrow or peripheral stem cell transplantation.

The extent to which something is poisonous or harmful.

In medicine, a specific event that starts a process or that causes a particular outcome. For example, chemotherapy, painful treatments, or the smells, sounds, and sights that go with them may trigger anxiety and fear in a patient who has cancer. In allergies, exposure to mold, pollen or dust may trigger sneezing, watery eyes, and coughing.

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.

A part of the United Nations that deals with major health issues around the world. The World Health Organization sets standards for disease control, health care, and medicines; conducts education and research programs; and publishes scientific papers and reports. A major goal is to improve access to health care for people in developing countries and in groups who do not get good health care. The headquarters are located in Geneva, Switzerland. Also called WHO.