From the Guidelines
Cancer causes nausea through the release of substances that trigger the brain's vomiting center, physical obstruction of the digestive tract, and activation of the chemoreceptor trigger zone by chemotherapy and radiation therapy. The mechanisms of nausea in cancer patients are complex and multifactorial, involving various pathways and receptors, including serotonin (5-hydroxytryptamine-3 [5-HT3]), dopamine, corticosteroid, and neurokinin-1 receptors 1. Cancer treatments, such as chemotherapy and radiation therapy, are major contributors to nausea, with approximately 70% to 80% of cancer patients on chemotherapy experiencing nausea and/or vomiting 1.
Causes of Nausea in Cancer Patients
- The cancer itself can release substances that trigger the brain's vomiting center, particularly in cancers affecting the digestive system, brain, or liver
- Tumors can physically obstruct parts of the digestive tract, leading to nausea and vomiting
- Cancer treatments, such as chemotherapy and radiation therapy, can activate the chemoreceptor trigger zone in the brain and irritate tissues, stimulating nausea
- Pain and anxiety associated with cancer can further worsen nausea symptoms
Management of Nausea in Cancer Patients
- Medications like ondansetron (Zofran), granisetron, or palonosetron are commonly prescribed before and after treatments to prevent nausea, typically at doses of 4-8mg for ondansetron every 8-12 hours 1
- For persistent nausea, a combination approach may be used, including dexamethasone, NK1 receptor antagonists like aprepitant, or cannabinoids 1
- Staying hydrated, eating smaller meals, avoiding strong odors, and using ginger supplements may help manage symptoms alongside prescribed medications
- The use of antiemetic agents, such as 5-HT3 receptor antagonists, corticosteroids, and aprepitant, is recommended for the prevention of chemotherapy-induced nausea and vomiting 1
From the Research
Cancer and Nausea
- Cancer can cause nausea due to various factors, including chemotherapy-induced nausea and vomiting (CINV) 2, 3, 4.
- CINV is a common adverse effect of chemotherapy that can impact quality of life and treatment outcomes 3.
- The exact mechanism of how cancer causes nausea is not fully understood, but it is thought to be related to the release of inflammatory cytokines and other chemical signals in the body 5.
Chemotherapy-Induced Nausea and Vomiting (CINV)
- CINV can be classified into different types, including acute and delayed CINV 3.
- Delayed CINV occurs 24-120 hours after chemotherapy and is often poorly controlled 2.
- Various medications are available to prevent and treat CINV, including 5-HT3 receptor antagonists, NK1 receptor antagonists, and corticosteroids 3.
- Olanzapine has been shown to be effective in treating breakthrough CINV in patients receiving highly emetogenic chemotherapy 4.
Inflammatory Cytokines and Cancer
- Inflammation plays a complex role in cancer progression, and chemotherapy can induce inflammatory cytokine production in tumor cells 5.
- The release of inflammatory cytokines can contribute to the development of nausea and other symptoms in cancer patients 5.
- Further research is needed to understand the relationship between inflammatory cytokines, cancer, and nausea 5.