Nausea and vomiting are common symptoms in oncology patients It is critical to consider the differential diagnosis and not just attribute all such symptoms to chemotherapy-induced nausea and vomiting (CINV) CINV can be divided into three categories: acute (within 24 hours of emetogenic treatment), delayed (2 to days after treatment), and anticipatory Anticipatory symptoms are conditioned symptoms that occur without emetogenic treatment with a variety of emotional or sensory triggers These anticipatory symptoms can become chronic in some patients Despite appropriate prophylactic therapy, almost all cancer patients experience some nausea and vomiting Radiation to the GI tract or the CNS is itself emetogenic Other causes of nausea and vomiting include GI injury from a variety of causes such as gastritis from steroids, obstipation/constipation, medication side effects (e.g., narcotics), pancreatitis (from asparaginase), GI obstruction (e.g., adhesions from prior surgery), or superior mesenteric artery syndrome in patients with severe malnutrition Management of CINV (or radiation induced) is outlined in Table 98.10 As with pain management, all medications are less effective when treating established symptoms Standard hydration and electrolyte management should be employed for all patients with severe nausea/vomiting An abdominal x-ray can be helpful if obstruction or obstipation/constipation is suspected Amylase and lipase should be measured in patients who are being treated with asparaginase Constipation is very common in oncology patients Contributing factors included decreased GI motility from vinca alkaloids, narcotics, poor oral intake, decreased activity, and/or withholding due to rectal pain from mucositis The evaluation should include a detailed history to elicit any of the contributing factors as well as a specific bowel history Physical examination should not include a digital rectal examination due to potential increased risk of bacteremia Abdominal x-ray may be helpful in establishing the amount of stool Treatment of constipation in the oncology patient should include only those agents that can be given by mouth Rectal suppositories and enemas should be avoided except in extreme circumstances Patients with severe symptoms may need to be admitted