The incidence and mortality of cancer are increasing. In advanced cancer when cure is impossible, symptoms should be the focus of attention. We review our recent prospective studies on symptom prevalence and severity in 1,000 patients with advanced cancer. Advanced cancer patients are polysymptomatic. Symptom prevalence differs with age, gender, and cancer site. The pattern of gastrointestinal symptoms is related to gender and severe weight loss. Specific symptoms are associated with reduced survival. There is a gender difference in survival favoring females. Pain, easy fatigue, and anorexia are consistently among the 10 most prevalent symptoms at all 17 primary sites. When pain, anorexia, weakness, anxiety, lack of energy, easy fatigue, early satiety, constipation, and dyspnea were present, 60% to 80% of patients rated them as moderate or severe, ie, of clinical importance. The most common symptoms also are the most severe. In general, the same symptoms are clinically important at most primary sites.