Symptoms depend on where the metastases are located. Gynaecologic cancers, especially ovarian cancer, most commonly spread to the abdominal cavity, liver, lungs, and bones, as well as other organs. The cancer may also recur locally in the pelvic area. Read on for more information about the most common symptoms caused by metastases.
Bowel function disorders
It’s possible for cancer to spread to the abdominal cavity and disrupt bowel function, which may at worst lead to bowel obstruction. Bowel obstruction can also be caused by adhesions formed after having previously had surgery. Symptoms of bowel obstruction include constipation, nausea, vomiting, and stomach pain. Treatment of bowel obstruction may require surgery; if suspecting obstruction, it may be necessary to seek acute medical attention for examinations such as a CT scan. Before surgery, a nasogastric tube will be placed, the patient will be given fluids into a vein, and the treatment team will assess the patient’s eligibility for surgery as well as the risks involved. In the case of advanced cancer, if surgery is not an option, symptoms of bowel obstruction can also be relieved with medication.
Build-up of fluid in the abdomen
Additionally, a build-up of fluid may develop in the abdominal cavity, causing the belly to swell and become bloated. The excess fluid can be removed with a needle or through a tube called a drainage catheter, which rapidly relieves the feeling of pressure.
Symptoms caused by metastases in the lungs and liver
In many cases, individual metastases in the lungs and liver don’t cause any major symptoms. As lung metastases increase in number, they may cause shortness of breath or coughing. Shortness of breath can be treated with medications, radiation therapy (if a tumour is obstructing the bronchi), or by removing excess fluid from around the lungs.
Liver metastases don’t usually cause symptoms until there is a large number of them and liver function starts to suffer. A common symptom experienced at this point is increasing fatigue. Corticosteroid medicines may be helpful.
Symptoms caused by tumours in the pelvic area
If cancer spreads to the pelvic area, it may cause pain and difficulty urinating or problems with passing stools. Sometimes a tumour forms an opening (also called a “fistula”) between organs or through the skin (for example, between the bladder and the bowel, between the bowel and the vagina or through the skin). A tumour can cause tissue damage and nerve compression in the pelvic area, resulting in pain. Symptoms caused by tumours may be relieved with radiation therapy, and sometimes with surgical operations like by creating a stoma (an artificial opening). In the case of severe pain, special techniques such as spinal pain management may be used. This involves inserting a catheter to administer pain medicine and numbing anaesthetics into the space around the spinal cord containing cerebrospinal fluid. This treatment can also take place at home.
Tumours in the pelvic area may interfere with the lymphatic flow, leading to swelling (oedema) in the legs. Oedema can be treated with compression products (socks) or bandages. If tumours in the pelvic area are causing problems such as pain or obstruction in the ureter or lymphatic system, radiation therapy may be used to shrink them. Additionally, a stent can be placed in the ureter by a urologist to try and open up the blockage, or in some cases, a radiologist may place a small tube in the kidney (percutaneous nephrostomy) to allow urine to drain from the kidney.Tumours in the uterus, cervix, vagina, or pelvis may cause bleeding that can sometimes be heavy. In the early stages, bleeding caused by tumours in the vagina, uterus, or the pelvic area can be treated with medicines. In some cases, radiation therapy may be used to control the bleeding. In the case of heavy bleeding, the blood vessels leading to the tumour can be blocked in a procedure (“embolisation”) done by X-ray. In case the bleeding comes back, the procedure can be repeated if necessary.
Symptoms caused by bone metastases
Bone metastases tend to cause pain, especially when moving. Both pain medicines and radiation therapy are effective. Bone metastases may also cause fractures or, if located in the spine, a condition called metastatic spinal cord compression; in these cases, seek acute medical attention. Bone medications are effective in treating bone pain; in addition, a radiologist may administer pain-relieving injections to the sites where the pain is located, if needed.
Psychological strain
Having an illness puts strain on the mind too. Living with a long-term illness includes both good and bad moments. It’s good to talk to the care team about how you’re coping mentally. Depression and anxiety can be managed by talking as well as with medication. Peer support may also be helpful. Support from a psychiatric nurse is always available, and a psychiatrist can be consulted if needed. In addition, hospital chaplains are happy to provide talk support and to serve as support during difficult times when dealing with the illness, regardless of the patient’s religious beliefs.
