ABSTRACT
The brain and the mind affect and are affected by the systemic symptoms of advanced malignancy. Nausea is one of the most frequent and an unpleasant symptom associated with advanced malignancy and is often undertreated. The clinical characteristics of nausea and vomiting suggest the most likely intervention. Stretching and irritation of the gut wall by tumour or gastroparesis can cause nausea, precipitated and aggravated by nutritional sensory stimuli. Clinically differentiating depression and fatigue is difficult. The affective and cognitive symptoms differentiate them, but the physiological symptoms do not. There is overlap of symptoms between depression and fatigue. Fatigue may be caused directly by the disease and indeed many patients attribute their fatigue to the cancer ‘stealing’ their energy. Neurasthenia is being reconsidered as a psychiatric syndrome for this reason. Motion-induced nausea, a conflict between visual and vestibular sensors, can worsen rapidly and be mercifully relieved by vomiting. Females suffering gynaecological cancers are at particular risk for this variant of nausea.
