Nausea and vomiting unrelated to chemotherapy is common in advanced cancer patients. The etiology of nausea and vomiting may from evident by the pattern of vomiting, associated symptoms, review of medications and physical examination. Radiographic studies are particularly helpful if bowel obstruction is suspected or central nervous system metastases are a possibility. Laboratory studies are helpful in a minority of cases. Multiple classes of medications are available to palliate nausea and vomiting. Classes of agents are discussed, pharmacology and cost being among the aspects covered. A four-step approach to the medical management of nausea and vomiting is presented.