Lung Cancer - Gale Encyclopedia of Alternative Medicine - by Mai Tran

Definition

Lung cancer is a disease in which the cells of the lung tissues grow uncontrollably and form tumors. It is the leading cause of death from cancer among both men and women in the United States. The American Cancer Society estimated that in 1998, at least 172,000 new cases of lung cancer will have been diagnosed, and that lung cancer will account for 28% of all cancer deaths, or approximately 160,000 people.

Description

Types of lung cancer

There are two kinds of lung cancers, primary and secondary. Primary lung cancer (also called adenocarcinoma) starts in the lung itself. Primary lung cancer is divided into small cell lung cancer and non-small cell lung cancer, depending on how the cells look under the microscope. Secondary lung cancer is cancer that starts somewhere else in the body (for example, the breast or colon) and spreads to the lungs.

Small cell cancer was formerly called oat cell cancer, because the cells resemble oats in their shape. About one-fourth of all lung cancers are small cell cancers. This type is a very aggressive cancer and spreads to other organs within a short time. It is generally found in people who are heavy smokers. Non-small cell cancers account for the remaining 75% of lung cancers. They can be further subdivided into three categories.

Incidence of lung cancer

Lung cancer is rare among young adults. It is usually found in people who are 50 years of age or older, with the average age at diagnosis being 60. While the incidence of the disease is decreasing among Caucasian men, it is steadily rising among African-American men, and among both Caucasian and African-American women. This change is probably due to the increase in the number of smokers in these groups. In 1987, lung cancer replaced breast cancer as the number one cancer killer among women.

Causes & symptoms

Causes

Tobacco smoking is the leading cause of lung cancer. Ninety percent of lung cancers can be prevented by completely giving up tobacco. Smoking marijuana cigarettes is considered yet another risk factor for cancer of the lung. These cigarettes have a higher tar content than tobacco cigarettes. In addition, they are inhaled very deeply; as a result, the smoke is held in the lungs for a longer period of time.

Repeated exposure to asbestos fibers, either at home or in the workplace, is also considered a risk factor for lung cancer. Studies show that compared to the general population, asbestos workers are seven times more likely to die from lung cancer. Asbestos workers who smoke increase their risk of developing lung cancer by 50-100 times. Besides asbestos, mining industry workers who are exposed to coal products or radioactive substances, such as uranium, and workers exposed to chemicals, such as arsenic, vinyl chloride, mustard gas, and other carcinogens, also have a higher than average risk of contracting lung cancer.

Environmental contamination

High levels of a radioactive gas (radon) that cannot be seen or smelled pose a risk for lung cancer. This gas is produced by the breakdown of uranium, and does not present any problem outdoors. In the basements of some houses that are built over soil containing natural uranium deposits, however, radon may accumulate and reach dangerous levels. Having one's house inspected for the presence of radon gas when buying or renting is a good idea. Other forms of environmental pollution (e.g., auto exhaust fumes) may also slightly increase the risk of lung cancer.

Inflammation and scar tissue are sometimes produced in the lung by diseases, such as silicosis and berylliosis, which are caused by inhalation of certain minerals, tuberculosis, and certain types of pneumonia. This scarring may increase the risk of developing lung cancer.

Although the exact cause of lung cancer is not known, people with a family history of lung cancer appear to have a slightly higher risk of contracting the disease.

Symptoms

Because lung cancers tend to spread very early, only 15% are detected in their early stages. The chances of early detection, however, can be improved by seeking medical care at once if any of the following symptoms appear:

• a cough that does not go away
• chest pain
• shortness of breath
• persistent hoarseness
• swelling of the neck and face
• significant weight loss that is not due to dieting or vigorous exercise
• fatigue and loss of appetite
• bloody or brown-colored spit or phlegm (sputum)
• unexplained fever
• recurrent lung infections, such as bronchitis or pneumonia

However, these symptoms may be caused by diseases other than lung cancer. It is vital, however, to consult a doctor to rule out the possibility that they are the first symptoms of lung cancer.

If the lung cancer has spread to other organs, the patient may have other symptoms, such as headaches, bone fractures, pain, bleeding, or blood clots . Early detection and treatment can increase the chances of a cure for some patients. For others, it can at least prolong life.

Diagnosis

Physical examination and initial tests

If the patient's doctor suspects lung cancer, he or she will take a detailed medical history to check all the symptoms and assess the risk factors. The assessment of the patient's medical history will be followed by a complete physical examination. The doctor will examine the patient's throat to rule out other possible causes of hoarseness or coughing, and listen to the patient's breathing and the sounds made when the patient's chest and upper back are tapped (percussed). The physical examination, however, is not conclusive.

If the doctor has reason to suspect lung cancer--particularly if the patient has a history of heavy smoking or occupational exposure to substances that are known to irritate the lungs--he or she may order a chest x ray to see if there are any masses in the lungs. Special imaging techniques, such as CT scans or MRIs, may provide more precise information about the possibility, size, shape, and location of any tumors.

Sputum analysis

Sputum analysis involves microscopic examination of the cells that are either coughed up from the lungs, or are collected through a special instrument called a bronchoscope. Sputum analyses can diagnose at least 30% of lung cancers, some of which do not show up even on chest x rays. In addition, the test can help detect cancer in its very early stages, before it spreads to other regions. The sputum test does not, however, provide any information about the location of the tumor and must be followed by other tests, such as the bronchoscopy, where machines can detect cancerous cells without the need for the lung to be opened.

Lung biopsy

Lung biopsy is the most definitive diagnostic tool for cancer. It can be performed in several different ways. The doctor can perform a bronchoscopy, which involves the insertion of a slender, lighted tube, called a bronchoscope, down the patient's throat and into the lungs. In addition to viewing the passageways of the lungs, the doctor can use the bronchoscope to obtain samples of the lung tissue. In another procedure known as a needle biopsy, the location of the tumor is first identified using a CT scan or MRI. The doctor then inserts a needle through the chest wall and collects a sample of tissue from the tumor. In the third procedure, known as surgical biopsy, the chest wall is opened up and a part of the tumor, or all of it, is removed. A doctor who specializes in the study of diseased tissue (a pathologist) examines the tumor samples to identify the cancer's type and stage.

Treatment

Alternative therapies should be complementary to conventional treatment, not replace it. Before participating in any alternative treatment programs, patients should consult their doctor concerning the appropriateness and the role of such programs in patient's overall cancer treatment plan. Appropriate alternative treatments can help prolong patient's life or at least improve their quality of life, prevent recurrence of tumors, or prolonging the remission period and reduce adverse reactions to chemotherapy and radiation.

The use of beta-carotene and vitamin A supplements in lung cancer patients is controversial. Vitamin A and beta-carotene was advocated as an antioxidant that has lung-protective effects and may decrease the risk of lung cancer. However, recent studies suggest that beta-carotene supplement may have no effect or increase the risk of lung cancer in smokers. They may have no effects on nonsmokers. Therefore, use of beta-carotene supplement in lung cancer patients or as preventive measure in smokers is not recommended at the present time. However, researchers believe that patients do benefit from nature's source of beta-carotene and vitamin A. Beta-carotene in food carries all the benefits, yet does not have any harmful effects as the controversial high-dose supplements may have.

The effectiveness of many of the anticancer drugs used to treat lung cancer can be reduced when patients take megadoses of antioxidants . These antioxidants, in patients not undergoing chemotherapy, can be very helpful in protecting the body against cancer. However, taken during chemotherapy, these antioxidants protect the cancer cells from being killed by chemos. Because high-dose supplementation of antioxidants can interfere with conventional chemotherapy treatment, patients should only take them at dosages much above the recommended daily allowance (RDA) during chemotherapy or radiation therapy.

Dietary guidelines

The following dietary changes may help improve a patient's quality of life, as well as boost the immune function to better fight the disease. They may also help prevent lung cancer.

• Avoid fatty and spicy foods. High-fat diet may be associated with increased risk of lung cancer. Also, lung cancer patients may have a hard time digesting heavy foods.
• Eat new and exciting foods. Tasty foods stimulate appetite so that patients can eat more and have the energy to fight cancer.
• Increase consumption of fresh fruits and vegetables. They are nature's best sources of antioxidants, as well as vitamins and minerals. Especially helpful are the yellow and orange fruits (orange, cantaloupes) and dark green vegetables. They contain high amounts of vitamin A and carotene.
• Eat more broccoli sprouts. These young sprouts are a good source of sulforaphane, a lung cancer fighting substance.
• Eat multiple (5-6) meals per day. Small meals are easier to digest.
• Establish regular eating time and do not eat around bedtime.
• Avoid foods containing preservatives or artificial coloring.
• Monitor weight and intakes of adequate calories and protein.

Nutritional supplements

A naturopath may recommend some of the following nutritional supplements to boost the patient's immune function and help fight tumor:

• Vitamins and minerals. Vitamins that are especially of benefit to cancer patients include B-complex vitamins, especially vitamins B₆, C, D, E, and K. Most important minerals are calcium, chromium, copper, iodine, molybdenum, germanium, selenium, tellurium, and zinc. Many of these vitamins and minerals are strong antioxidants or cofactors for antioxidant enzymes. However, patients should not take mega doses of these supplements without first consulting their doctor. Significant adverse or toxic effects may occur at high dosages, which is especially true for the minerals.
• Other nutritional supplements that may help fight cancer and support the body. They include essential fatty acids (fish or flaxseed oil), flavonoids, pancreatic enzymes (to help digest foods), hormones such as DHEA, melatonin, or phytoestrogens.

Traditional Chinese medicine

Conventional treatment for leukemia is associated with significant side effects. These adverse effects (such as nausea, vomiting, and fatigue) can be reduced with Chinese herbal preparations. Patients should consult an experienced herbalist who will prescribe remedies to treat specific symptoms that are caused by conventional cancer treatments.

Juice therapy

Juice therapy may be helpful for patients with cancer. Patients should mix one part of pure juice with one part of water before drinking.

Homeopathy

There are conflicting evidences regarding the effectiveness of homeopathy in cancer treatment. Because cancer chemotherapy may suppress the body's response to homeopathic treatment, homeopathy may not be effective during chemotherapy. Therefore, patients should wait until after chemotherapy to try this relatively safe alternative treatment.

Acupuncture

Acupunture is the use of needles on the body to stimulate or direct the meridians (channels) of energy flow in the body. Acupuncture has not been shown to have any anticancer effects. However, it is an effective treatment for nausea, and other common side effects of chemotherapy and radiation.

Other treatments

Other alternative treatments include stress reduction, meditation, yoga, t'ai chi , and the use of guided imagery .

Allopathic treatment

Treatment for lung cancer depends on the type of cancer, its location, and its stage. The most commonly used modes of treatment are surgery, radiation therapy, and chemotherapy.

Surgery

Surgery is not usually an option for small cell lung cancers, because they have usually spread beyond the lung by the time they are diagnosed. Because non-small cell lung cancers are less aggressive, however, surgery can be used to treat them. The surgeon will decide on the type of surgery, depending on how much of the lung is affected. Surgery may be the primary method of treatment, or radiation therapy and/or chemotherapy may be used to shrink the tumor before surgery is attempted.

There are three different types of surgical operations:

• Wedge resection. This procedure involves removing a small part of the lung.
• Lobectomy. A lobectomy is the removal of one lobe of the lung. If the cancer is limited to one part of the lung, the surgeon will perform a lobectomy.
• Pneumonectomy. A pneumonectomy is the removal of an entire lung. If the surgeon feels that removal of the entire lung is the best option for curing the cancer, a pneumonectomy will be performed.

The pain that follows surgery can be relieved by medications. A more serious side effect of surgery is the patient's increased vulnerability to bacterial and viral infections. Antibiotics, antiviral medications, and vaccines are often needed.

Radiotherapy

Radiotherapy involves the use of high-energy rays to kill cancer cells. It is used either by itself or in combination with surgery or chemotherapy. There are two types of radiotherapy treatments: external beam radiation therapy and internal (or interstitial) radiotherapy. In external radiation therapy, the radiation is delivered from a machine positioned outside the body. Internal radiotherapy uses a small pellet of radioactive materials placed inside the body in the area of the cancer.

Radiation therapy may produce such side effects as tiredness, skin rashes, upset stomach, and diarrhea. Dry or sore throats, difficulty in swallowing, and loss of hair in the treated area are all minor side effects of radiation. These may disappear either during the course of the treatment or after the treatment is over. The side effects should be discussed with the doctor.

Chemotherapy

Chemotherapy uses anticancer medications that are either given intravenously or taken by mouth (orally). These drugs enter the bloodstream and travel to all parts of the body, killing cancer cells that have spread to different organs. Chemotherapy is used as the primary treatment for cancers that have spread beyond the lung and cannot be removed by surgery. It can also be used in addition to surgery or radiation therapy.

Chemotherapy is tailored to each patient's needs. Most patients are given a combination of several different drugs. Besides killing the cancer cells, these drugs also harm normal cells. Hence, the dose has to be carefully adjusted to minimize damage to normal cells. Chemotherapy often has severe side effects, including nausea, vomiting, hair loss , anemia, weakening of the immune system, and sometimes infertility. Most of these side effects end when the treatment is over. Other medications can be given to lessen the unpleasant side effects of chemotherapy.

Expected results

If the lung cancer is detected before it has had a chance to spread to other organs, and if it is treated appropriately, at least 49% of patients can survive five years or longer after the initial diagnosis. Only 15% of lung cancers, however, are found at this early stage.

Due to improvements in surgical technique and the development of new approaches to treatment, the one-year survival rate for lung cancer has improved considerably. As of 1998, approximately 40% of patients survive for at least a year after diagnosis, as opposed to 30% that survived 20 years ago. The five-year survival rate for all stages of lung cancer is 14%.

Prevention

The best way to prevent lung cancer is not to smoke or to quit smoking if one has already started. Secondhand smoke from other people's tobacco should also be avoided when possible. Appropriate precautions should be taken when working with cancer-causing substances (carcinogens). Monitoring the diet and eating well-balanced meals that consist of whole foods, vegetables, and fruits; eliminating toxins, exercising routinely, and weight reduction; testing houses for the presence of radon gas, and removing asbestos from buildings are also useful preventive strategies.

Key Terms

Biopsy

The surgical removal and microscopic examination of living tissue for diagnostic purposes.

Bronchoscope

A thin, flexible, lighted tube that is used to view the air passages in the lungs.

Carcinogen

Any substance capable of causing cancer.

Chemotherapy

Treatment of cancer with synthetic drugs that destroy the tumor either by inhibiting the growth of cancerous cells or by killing them.

Lobectomy

Surgical removal of an entire lobe of the lung.

Pathologist

A doctor who specializes in the diagnosis of disease by studying cells and tissues under a microscope.

Pneumonectomy

Surgical removal of an entire lung.

Radiation therapy

Treatment using high energy radiation from x-ray machines, cobalt, radium, or other sources.

Sputum

Mucus or phlegm that is coughed up from the passageways of the lungs.

Stage

A term used to describe the size and extent of spread of cancer.

Wedge resection

Removal of only a small portion of a cancerous lung.

Further Reading

For Your Information

Books

• Dollinger, Malin, Ernest H. Rosenbaum, and Greg Cable. Everyone's Guide to Cancer Therapy. Kansas City, MO: Somerville House Books Limited, 1994.
• Labriola, Dan. Complementary Cancer Therapies: Combining Traditional and Alternative Approaches for the Best Possible Outcome. Roseville, CA: Prima Health, 2000.
• "Lung Cancer." In Reader's Digest Guide to Medical Cures and Treatments. Canada: The Reader's Digest Association, Inc., 1996.
• Morra, Marion E., and Eve Potts. Choices. New York: Avon Books, 1994.
• "Pulmonary Disorders: Tumors of the Lung." In The Merck Manual of Diagnosis and Therapy, edited by Robert Berkow, et al. Rahway, NJ: Merck Research Laboratories, 1992.

Organizations

• American Cancer Society. 1599 Clifton Road, N.E., Atlanta, GA 30329. (800)227-2345.
• American Lung Association. 1740 Broadway, New York, NY 10019-4374. (800) 586-4872.
• Cancer Research Institute. 681 Fifth Avenue, New York, NY 10022. (800) 992-2623.
• National Cancer Institute (National Institutes of Health). 9000 Rockville Pike, Bethesda, MD 20892. (800) 422-6237.

Other

• "Beta Carotene and Vitamin A Halted in Lung Cancer Prevention Trial." Medical Sciences Bulletin. http://pharminfo.com.
• Rosenberg, Z'ev. "Treating the Undesirable Effect of Radiation and Chemotherapy with Chinese Medicine." Oriental Chinese Journal. http://www.healthypeople.com.

Gale Encyclopedia of Alternative Medicine. Gale Group, 2001.