Common symptoms of patients with advanced cancer

(1) infection: advanced cancer patients subjected to various treatments, the body's defense mechanisms are subject to certain injuries, especially in the radiotherapy and chemotherapy, they are susceptible to pathogen infection and death, therefore, prevention and treatment of infections patients with advanced essential.

Routine use of antibiotics to control infection in the absence of the bacterial culture and sensitivity test before the regular selection of carbenicillin and gentamicin combined with the treatment of bacterial infections, amphotericin B is the most common fungal drugs. For patients with advanced cancer, the use of antibiotics, primarily to relieve pain and improve quality of life. Treatment of urinary tract infection can get rid of urinary frequency, urgency, dysuria headache for; treatment of bronchitis and pneumonia can reduce coughing, and respiratory secretions, and relieve breathing difficulties.

(2), gastrointestinal symptoms

Nausea and vomiting: is the common symptoms of advanced cancer patients, often more distressing than the cancer pain. Nausea and vomiting can be side effects of treatment; also be a violation of digestive or nervous system cancer caused; it may be anxiety and other psychological effects. Should in general be different reasons for the symptomatic treatment of patients.

Loss of appetite: may be associated with general malaise or depression, tension and anxiety and gastrointestinal candidiasis, constipation and so on, are also caused by the tumor itself, the patient lack of interest in food, or even mention the food to nausea. Families and medical staff should help patients find ways to stimulate the appetite: the food, such as attention to color, smell, taste and shape, smaller meals, drinking small aperitif before a meal or drink, someone to accompany meals. The most effective drugs are corticosteroids.

Constipation: a common painkiller morphine side effects: reduced activity in patients with advanced cancer, eating less and is too fine and the lack of reasons for the formation of cellulose is constipation; mental stress will increase the constipation. Approach is to eat more fiber-rich fruits, vegetables and other foods, more importantly, to prevent the occurrence of constipation in the use of morphine analgesics should be used laxatives at the same time, the commonly used laxative, stool softener and stimulate peristalsis drugs: Senna, magnesium hydroxide, liquid paraffin, magnesium sulfate and lactic acid fructose; gradually increase the dose; when patients rectum full of stool and laxative invalid, can be used enema suppository, enema or stool with your fingers to pull out .

Diarrhea : chemotherapy, radiotherapy or the lower abdomen caused by intestinal surgery, malabsorption can cause diarrhea, bacterial infection, fat absorption difficulties, special food allergies , mental and psychological factors are likely to be caused by diarrhea causes. Mild diarrhea to be adjusted to alleviate the food; prolonged diarrhea can be secret agents or other intestinal sedatives; cancer caused by diarrhea, possible colostomy or radiotherapy or laser treatment; can be used for severe cases of narcotic drugs including morphine compound treatment; chronic diarrhea patients required nutritional supplements and potassium.

Hiccup: often due to stomach, esophageal and liver cancer caused by stimulation of the diaphragm. Temporarily control the symptoms of inhalation of carbon dioxide; chlorpromazine, stability, and metoclopramide may alleviate the symptoms; corticosteroids may help reduce the pressure on the diaphragm, furosemide sulfur nitramine sometimes effective. Intractable hiccups possible phrenic nerve transection.

(3) respiratory symptoms

Breathing difficulties: patients with advanced cancer is more difficult to deal with one of the symptoms should be treated according to different reasons: as bronchodilator agents to treat breathing difficulties caused by bronchial spasm; due to breathing difficulties caused the lung infection can be sensitive to the antibiotics used ; poor cardiac function may be caused by difficulty in breathing control of heart failure with diuretics to prevent the occurrence of pulmonary edema control; superior vena cava obstruction can cause breathing difficulties and dexamethasone every 12? / FONT> 16 mg, and make emergency radiotherapy. Guide the patient to maintain normal breathing movements are important than any treatment, severe breathing difficulties could easily lead to fear, but fear itself increased breathing difficulties, patients should be allowed to express their fears and to give appropriate guidance and sedative drugs. ,

Some patients is due to extensive pulmonary involvement, secondary transfer, or lymphangitic carcinoma induced respiratory difficulties. At this point, mainly due to breathing difficulties caused by excessive respiratory movement, rather than changes in blood gas levels, therefore, oxygen does not improve symptoms, but will increase the anxiety, small doses of morphine should be given to agents such as morphine solution 2.5 per hour ? / FONT> 5 mg or 10 mg of morphine sulfate tablets each time, 2 times a day to reduce the central sensitivity of abnormal blood gas levels, reduce unnecessary breathing exercises, but also to relieve anxiety. Sometimes given small doses of phenothiazines or steroid drugs are also effective.

Since pulmonary sclerosing (such as lymphatic metastasis) may be given breathing difficulties caused by 0.25%? / FONT> 0.5% Xi Bika more effective for inhalation solution, and to improve the ventilation function. General use of electric nebulizer, easy calm in the alveolar liquid. It should also provide a quiet environment for patients, keep sitting or semi-supine position is also conducive to improving the respiratory status of patients.

Respiratory tract infections: beam sense of advanced cancer patients is mainly due to respiratory airway obstruction, in addition to immune dysfunction, bed, excessive use of sedatives and aspiration (secondary to dysfunction of the pharynx and esophagus, or obstruction) and so on. Pathogenic microorganisms from the oral flora often, such as Streptococcus, anaerobes, and Gram-negative bacteria. Antibiotic treatment of choice to control sensitive. However, in patients with advanced cancer, because the initial use of numerous antibiotics, plus the defense function in patients with lower body, antibiotics are often difficult to work.

Trimethoprim ethyl noise (TMP)? / FONT> SMZ against Gram-positive aerobes (eg, pneumococcus), Gram-negative aerobes (eg, Haemophilus), and Card's lungs caused by pneumonia and effective capsule. Fungal infections (such as Candida, Cryptococcus, Aspergillus, and algae Jundeng coccidioidomycosis) is more common in patients with advanced, but blood cultures are often negative, amphotericin B remains the drug of choice, ketoconazole, there are certain effect. No specific drug therapy viral infection, to try high-dose interferon and immunoglobulins. Cough, could use of narcotic drugs such as codeine cough 30? / FONT> 60 mg 4 times a day, if still can not control, use of morphine 5? / FONT> 10 mg every 4 hours 1 .

Respiratory secretions: often a large number of end-stage pulmonary secretions of patients, auscultation can be heard and the "death sound." Anticholinergic drugs such as scopolamine 0.4? / FONT> 0.6 mg, im, every 4 hours 1 to reduce respiratory secretions, or a small amount of diacetylmorphine and effective. When not cough out phlegm, change in body position when using the suction device or suction.

(4) urinary symptoms

Urinary tract infection: any part of a urinary tract obstruction in patients may need long-term indwelling catheter in patients with urinary tract infections are common. All patients with a Foley's catheter will eventually appear asymptomatic bacteriuria, asymptomatic bacteriuria usually do not need antibiotic treatment, but urinary tract irritation or systemic symptoms should be sensitive antibiotics, the preferred compound SMZ and ampicillin.

Frequent urination and urinary incontinence : A urinary tract infection, pelvic surgery or extreme weakness of the patients should take specific treatment. If incontinence occurs at night, patients can wake up at night, or diuretic use of diuretics in the morning only, or the use of condoms. Night frequency of use of some drugs may improve symptoms. Patients with severe urinary frequency and urinary incontinence catheter should be retained, and bladder irrigation at regular intervals to prevent urinary tract infections.

(5), neuropsychiatric symptoms

Insomnia: insomnia generally pain, depression, anxiety, sweating, or side effects caused by treatment. Before treatment, patients should ask about sleep, specific reasons for insomnia. Commonly used hypnotics are: stability and 5? / FONT> 10 mg or nitrazepam 5? / FONT> 10 mg, amitriptyline 25? / FONT> 125 mg, Dayton clothing, or other sedative antidepressants. Chlorpromazine 25? / FONT> 50 mg in the evening to use can strengthen the role of other hypnotic agents. Patients are difficult to sleep, sleeping pills and other traditional stability is better, and those who wake up repeatedly at night, you need to deal with depression and drugs, such as amitriptyline.

Mental disorder: the family often gives patients greater pain, health care workers dealing with dying patients is a problem. Common cause is drug-induced: such as acid acridine and other sedative drugs often cause hallucinations; opioid analgesics can cause paranoia; corticosteroids can cause mild mania. The other reason comes from the disease itself, patients with brain metastases, there may be no other neurological symptoms of mental disorder; In addition, uremia , hypercalcemia, low blood sugar and so can cause insanity. Caused by drugs, withdrawal symptoms can subside, emergency situations may give droperidol SBR 10? / FONT> 20 mg, intramuscular injection, and then each dose 5? / FONT> 10 mg. If you need to enhance sedation, immediately added with chlorpromazine 50? / FONT> 100 mg, then 25? / FONT> 50 mg, divided doses.

Paralysis (hemiplegia or paraplegia): It is a common complication in patients with advanced cancer, conventional symptomatic treatment. Health care workers and family members of patients through psychological suggestion to encourage active movement, passive movement and turn over to help patients to prevent the occurrence of limb contracture, and bedsores.

Organic brain syndrome: these patients should provide a stable, quiet environment, daily life arrangements and avoid mental disorder and disorientation. For severe anxiety, paranoia, or irritability can be used in patients with sedative medication. Health care workers and family members of patients should always remind and suggest, to avoid noise interference, there is a light at night is best.

(6), systemic complications

Skin symptoms: itching, and patients with end-stage pressure sores are the two major complications. If the itch from dry skin, use water to increase agent, to reduce symptoms such as skin cream; if there is local infection (such as scabies ), should be to treat the infection; drug-induced, should be discontinued; critically ill patients can be partially deposited with 1% Hydrocortisone pine; itching caused by an allergy, you should use anti-tissue amine drugs.

Keep the skin clean, dry, constantly changing position to avoid prolonged pressure on the local skin. Half of patients with water-filled bed air mattress to prevent bedsores from occurring, but also with 5% safflower alcohol massage the site prone to pressure sores, once a day. Once bedsores occur, should be kept clean, regular dressing.

Herpes Zoster : Shingles usually occurs in the chest or back, the trigeminal nerve are often involved, mostly for a few days after the pain of Health, which is characterized by unilateral vesicular rash consisting of zonal distribution. Shingles more common in patients with lymphoma or how to Guinness who may also occur in other immunocompromised cancer patients, often visceral involvement. Neuralgia after herpes particularly common in patients go further, 25%? / FONT> 50% of patients over the age of 50 and 3 / 4 occur in patients over 70 years neuralgia; in these patients, 50% of patients pain will last more than a year. Corticosteroid drugs can reduce the incidence of postherpetic neuralgia. Antidepressants and other ancillary drugs can relieve symptoms, if necessary, and the morphine analgesic use.

Pathological fracture : bone metastases associated with advanced cancer patients prone to pathologic fracture. These patients should be gentle when moving and turning, sometimes with a splint.



(7) sexual dysfunction

Advanced cancer patients, sex was not taboo, because the consequences of treatment (eg, colostomy, genital stenosis, pelvic or perineum and breast surgery, etc.), pain and other symptoms of advanced, physical weakness and lack of knowledge so affect sexual function to varying degrees. Health care workers should take the initiative, enthusiasm, a measured manner to patients and their families to provide medical advice. Patients can exchange views with their spouses, adjust the expression to meet the requirement. Spouses should also actively cooperate with, understanding and care of patients, so that it can happily spend your life in the final stage. Common symptoms of patients with advanced cancer control