Lung cancer

Signs and Symptoms

• A persistent cough that gets worse over time
• Constant chest pain
• Coughing up blood
• Shortness of breath, wheezing, or hoarseness
• Repeated pneumonia or bronchitis
• Swelling of the neck and face
• Loss of appetite or weight loss
• Fatigue

What Causes It?

Exposure to carcinogens (cancer causing agents) damages DNA in the cells of the body. The major cause of lung cancer is cigarette smoking. Other contributing factors include environmental tobacco smoke, occupational exposure to carcinogens, and diet.

Who Is Most At Risk?

Tobacco smoke is the biggest carcinogen, responsible for 85% of all lung cancers in the United States. Risk increases with the amount of tobacco used, and the amount of time it has been used. Non smokers exposed to tobacco smoke are also at risk of developing lung cancer. Other forms of tobacco use, such as cigar smoking and pipe smoking, are also associated with lung cancer. Other risk factors include:

• Family history.
• Environmental and occupational exposure to certain substances, including arsenic, asbestos, ether, chromium, silica, cadmium, nickel, and radon.
• Exposure to excessive radiation (wartime or industrial exposure, or radiotherapy to the chest).
• Lung diseases, including chronic obstructive pulmonary disease (COPD).
• Poor diet (however, diets high in fruits and vegetables may reduce risk).

What to Expect at Your Doctor's Office

If you have symptoms associated with lung cancer, see your health care provider. Your health care provider will evaluate your medical history, smoking history, exposure to environmental and occupational substances, and family history of cancer. You will also have a physical exam, and your provider may analyze your breath to determine if you have lung cancer.

You may be sent for a chest x-ray and other tests. These include a sputum cytology, the microscopic examination of cells obtained from a deep cough sample of mucus in the lungs. In some cases, your doctor may order a computed tomography (CT) scan. Research suggests these scans may reduce deaths from lung cancer by 20%. A biopsy -- the removal of a small sample of tissue for examination under a microscope by a pathologist -- can confirm whether you have cancer.

If you have cancer, your provider will want to learn the stage (or extent) of the disease to find out whether the cancer has spread, particularly to the brain or bones, using tests such as CT scan, magnetic resonance imaging (MRI), radionuclide scan, positron emission tomography (PET), and bone scan.

Treatment Options

Prevention

The best means of prevention is to never start smoking or chewing tobacco, or to stop using tobacco products. A healthy diet is also an important part of prevention. In fact, studies show adquate vitamin D levels are associated with a reduced risk of lung cancer.

Treatment Plan

A treatment plan depends on the cell type, stage of disease, possibility for removing the tumor, and the patient's ability to survive surgery.

Drug Therapies

Various therapies can treat lung cancer.

• Chemotherapy. Can control cancer growth and relieve symptoms.
• Photodynamic therapy. Involves injecting a chemical into the bloodstream, which is absorbed by cells all over the body, including cancer cells. A laser light activates the chemical, which then kills the cancer cells. Photodynamic therapy may be used to control bleeding, relieve breathing problems, or to treat very small tumors.
• Immunotherapy. Unleashes the immune system to more effectively fight cancer.

Surgical and Other Procedures

Surgery is one of the few treatments capable of curing non-small cell lung cancer. Removal of a small part of the lung is a segmental or wedge resection, removal of an entire lobe of the lung is a lobectomy, and removal of an entire lung is a pneumonectomy. Doctors may prescribe radiation therapy before surgery to shrink a tumor, or after surgery to destroy remaining cancer cells. They may also use radiation therapy instead of surgery, or to relieve symptoms, such as shortness of breath.

Complementary and Alternative Therapies

A comprehensive treatment plan for lung cancer may include a range of complementary and alternative therapies (CAM). Studies show several CAM therapies may be helpful in improving the overall care of patients with lung cancer. Ask your team of doctors about the best ways to incorporate these therapies into your overall treatment plan. Some CAM therapies may be contraindicated in lung cancer, and some may interact negatively with medications or therapies used in conventional cancer care. Work with a qualified professional when deciding if and what CAM therpaies to use. Always tell your doctor about the herbs and supplements you are taking.

Nutrition and Supplements

These nutritional tips may help reduce symptoms:

• Try to eliminate suspected food allergens. Your doctor may want to test you for food allergies.
• Eat foods high in B-vitamins and iron, such as whole grains (if no allergy), dark leafy greens (such as spinach and kale), and sea vegetables.
• Eat antioxidant-rich foods, including fruits (such as blueberries, cherries, and tomatoes) and vegetables (such as squash and bell pepper). Low concentrations of vitamins A, C, and E have been associated with development of lung cancer.
• Avoid refined foods, such as white breads, pastas, and sugar.
• You should use quality protein sources, such as organic meat and eggs, whey and vegetable protein shakes as part of a balanced program aimed at gaining muscle mass and preventing wasting, which can sometimes be a side effect of cancer therapies.
• Use healthy cooking oils, such as coconut oil. Avoid cooking oils at high temperatures, as carcinogens may form.
• Reduce or eliminate trans-fatty acids, found in such commercially-baked goods as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
• Avoid caffeine and other stimulants, alcohol, and tobacco.
• Exercise lightly, if possible. Speak to your doctor to determine the best regimen for you.
• Eat foods containing curcumin. Studies show this spice, common in Indian cuisine, suppresses lung tumor growth.

You may address nutritional deficiencies with the following supplements:

• Probiotic supplement (containing Lactobacillus acidophilus). 5 to 10 billion CFUs (colony forming units) a day, for maintenance of gastrointestinal and immune health. Some probiotic supplements may need refrigeration. Check the label. Probiotics may not be appropriate for people who are severely immunocompromised. Speak with your physician.
• Omega-3 fatty acids. Such as fish oil, 1 to 2 capsules or 1 tbsp. (15 mL) of oil, 1 to 2 times daily, to help reduce inflammation and enhance immunity. Fish oils may increase bleeding in sensitive individuals, such as those taking blood-thinning medications (including aspirin).
• Melatonin. 2 to 6 mg at bedtime, for immune support and sleep. Higher doses may be beneficial in lung cancer, so check with your doctor. Melatonin can interfere with many medications, including sedatives, antidepressants, birth control, and others.

Herbs

Herbs may be an important part of an integrated cancer care strategy, but they should only be prescribed by a knowledgeable practitioner who is collaborating with all of your physicians.

• Mistletoe (iscador). Studies suggest taking iscador in conjunction with chemotherapy, can reduce side effects of chemotherapy. You should only take mistletoe under the supervision of a knowledgeable prescriber, in consultation with all of your treating physicians. Speak to your doctor.

Homeopathy

Few studies have examined the effectiveness of specific homeopathic therapies, however professional homeopaths may consider the following remedies for the treatment of gastritis symptoms (such as nausea and vomiting) based on their knowledge and experience. Before prescribing a remedy, homeopaths take into account your constitutional type, includes your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for you as an individual.

An experienced homeopath may prescribe a regimen to support general health during lung cancer. Acute remedies may be useful to relieve symptoms associated with complications. You should only take homeopathic remedies under the direction of an experienced homeopath, and in consultation with all of your treating physicians.

Homeopathy may help reduce symptoms and strengthen overall constitution, reduce the effects of stress during cancer, and also help reduce the side effects of chemotherapy.

• Radium bromatum. Is specific for radiation poisoning, especially followed by arthritic complaints. Acute dose is 3 to 5 pellets of 12X - 30C every 1 to 4 hours until symptoms are relieved.

Acupuncture

While acupuncture is not used as a treatment for cancer itself, evidence suggests it can be a valuable therapy for cancer-related symptoms (particularly nausea and vomiting, which often accompany chemotherapy treatment). Studies indicate that acupuncture may help reduce pain and shortness of breath. Acupressure (pressing on rather than needling acupuncture points) has also proved useful in controlling breathlessness. Patients can treat themselves using this technique.

Some acupuncturists prefer to work with a patient only after the completion of conventional medical cancer therapy. Others will provide acupuncture or herbal therapy during active chemotherapy or radiation. Acupuncturists treat cancer patients based on an individualized assessment of the excesses and deficiencies of qi located in various meridians. In many cases of cancer-related symptoms, acupuncturists detect a qi deficiency in the spleen or kidney meridians.

Prognosis/Possible Complications

The outlook varies by cell type and stage of the disease. In general, the prognosis is better for squamous cell cancers than for adenocarcinomas. Early detection improves chances of survival.

Following Up

Periodic follow up is useful to help to detect recurrence of the lung cancer or other smoking-related cancers. Frequent follow up and rehabilitation for loss of lung function from cancer, surgery, or other treatment may be necessary.

Supporting Research

Aberle Dr, Adams AM, Berg CD, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011;365(5):395-409.

Alberg AJ, Nonemaker J. Who is at high risk for lung cancer? Population-level and individual-level perspectives. Semin Respir Crit Care Med. 2008:29(3):223-232.

Amichai T, Grossman M, Richard M. Lung cancer patients' beliefs about complementary and alternative medicine in the promotion of their wellness. Eur J Oncol Nurs. 2012;16(5):520-527.

Bar-Sela G, Wollner M, Hammer L, Agbarya A, Dudnik E, Haim N. Mistletoe as complementary treatment in patients with advanced non-small-cell lung cancer treated wit hcarboplatin-based combinations: a randomised phase II study. Eur J Cancer. 2013;49(5):1058-1064.

Bast A, Haenen GR. Lipoic acid: a multifunctional antioxidant. Biofactors. 2003;17(1-4):207-213.

Bauer JD, Capra S. Nutrition intervention improves outcomes in patients with cancer cachexia receiving chemotherapy -- a pilot study. Support Care Cancer. 2005;13(4):270-274.

Baur JA, Sinclair DA. Therapeutic potential of resveratrol: the in vivo evidence. Nat Rev Drug Discov. 2006;5(6):493-506.

Cabrera C, Artacho R, Gimenez R. Beneficial effects of green tea -- a review. J Am Coll Nutr. 2006;25(2):79-99.

Chan HP, Lewis C, Thomas PS. Exhaled breath analysis: novel approach for early detection of lung cancer. Lung Cancer. 2009;63(2):164-168.

Chen GC, Zhang ZL, Wan Z, et al. Circulating 25-hydroxyvitamin D and risk of lung cancer: a dose-response meta-analysis. Cancer Causes Control. 2015;26(12):1719-1728.

Cross AJ, Leitzmann MF, Gail MH, et al. A prospective study of red and processed meat intake in relation to cancer risk. PLoS Med. 2007;4(12):e325.

de Torres JP, Casanova C, Marin JM, et al. Exploring the impact of screening with low-dose CT on lung cancer mortality in mild to moderate COPD patients: a pilot study. Respir Med. 2013;107(5):702-707.

de Torres JP, Marin JM, Casanova C, et al. Lung cancer in patients with chronic obstructive pulmonary disease--incidence and predicting factors. Am J Respir Crit Care Med. 2011;184(8):913-919.

Dela Cruz C, Tanoue L, Matthay R. Lung Cancer: Epidemiology, Etiology, and Prevention. Clin Chest Med. 2011;32(4):605-644.

Deng GE, Rausch SM, Jones LW, et al. Complementary therapies and integrative medicine in lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013;143(5 Suppl):e420S-e436S.

Doron S, Gorbach SL. Probiotics: their role in the treatment and prevention of disease. Expert Rev Anti Infect Ther. 2006;4(2):261-275.

Dryden GW Jr, Deaciuc I, Arteel G, McClain CJ. Clinical implications of oxidative stress and antioxidant therapy. Curr Gastroenterol Rep. 2005;7(4):308-316.

Gnagnarella P, Maisonneuve P, Bellomi M, et al. Nutrient intake and nutrient patterns and risk of lung cancer among heavy smokers: results from the COSMOS screening study with annual low-dose CT. Eur J Epidemiol. 2013;28(6):503-511.

Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016.

Horvath I, Lazar Z, Gyulai N, Kollai M, Losonczy G. Exhaled biomarkers in lung cancer. Eur Respir J. 2009;34(1):261-275.

Humphrey LL, Deffebach M, Pappas M, et al. Screening for lung cancer with low-dose computed tomography: a systematic review to update the US Preventive services task force recommendations. Ann Intern Med. 2013;159(6):411-420.

Jett JR, Midthun DE. Screening for lung cancer: for patients at increased risk for lung cancer, it works. Ann Intern Med. 2011;155(8):540-542.

Labinskyy N, Csiszar A, Veress G, et al. Vascular dysfunction in aging: potential effects of resveratrol, an anti-inflammatory phytoestrogen. Curr Med Chem. 2006;13(9):989-996.

Latimer KM, Mott TF. Lung cancer: diagnosis, treatment principles, and screening. Am Fam Physician. 2015;91(4):250-256.

Lichtenstein AH, Russell RM. Essential nutrients: food or supplements? Where should the emphasis be? JAMA. 2005;294(3):351-358.

Lis CG, Cambron JA, Grutsch JF, et al. Self-reported quality of life in users and nonusers of dietary supplements in cancer. Support Care Cancer. 2006;14(2):193-199.

Lissoni P, Rovelli F, Malugani F, et al. Anti-angiogenic activity of melatonin in advanced cancer patients. Neuro Endocrinol Lett. 2001;22(1):45-47.

Liu J, Huang W, Zhou R, et al. Bisphosphonates in the Treatment of Patients With Metastatic Breat, Lung, and Prostate Cancer: A Meta-Analysis. Medicine (Baltimore). 2015;94(46):e2014.

MacLean CH, Newberry SJ, Mojica WA, et al. Effects of omega-3 fatty acids on cancer risk: a systematic review. JAMA. 2006;295(4):403-415. Review.

McWilliams A, Lam B, Sutedja T. Early proximal lung cancer diagnosis and treatment. Eur Respir J. 2009;33(3):656-665.

Miller MF, Bellizzi KM, Sufian M, et al. Dietary supplement use in individuals living with cancer and other chronic conditions: a population-based study. J Am Diet Assoc. 2008;108(3):483-494.

Molina JR, Yang P, Cassivi SD, Schild SE, Adjei AA. Non-small cell lung cancer: epidemiology, risk factors, treatment, and survivorship. Mayo Clin Proc. 2008;83(5):584-594.

Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, eds. Abeloff's Clinical Oncology. 5th ed. Philadelphia, PA: Elsevier Saunders; 2014.

Punturieri A, Szabo E, Croxton TL, Shapiro SD, Dubinett SM. Lung cancer and chronic obstructive pulmonary disease: needs and opportunities for integrated research. J Natl Cancer Inst. 2009;101(8):554-559.

Rotsein OD. Oxidants and antioxidant therapy. Crit Care Clin. 2001;17(1):239-247.

Slatore CG, Littman AJ, Au DH, Satia JA, White E. Long-term use of supplemental multivitamins, vitamin C, vitamin E, and folate does not reduce the risk of lung cancer. Am J Respir Crit Care Med. 2008;177(5):524-530.

Simopoulos AP. Omega-3 fatty acids in inflammation and autoimmune diseases. J Am Coll Nutr. 2002;21(6):495-505.

Suvatne J, Browning R. Asbestos and lung cancer. Dis Mon. 2011;57(1):55-68.

Tang NP, Zhou B, Wang B, Yu RB, Ma J. Flavonoids intake and risk of lung cancer: a meta-analysis. Jpn J Clin Oncol. 2009;39(6):352-359.

Velicer CM, Ulrich CM. Vitamin and mineral supplement use among US adults after cancer diagnosis: a systematic review. J Clin Oncol. 2008;26(4):665-673.

Wender R, Fontham ET, Barrera E, et al. American Cancer Society lung cancer screening guidelines. CA Cancer J Clin. 2013;63(2):107-117.

Wu L, Guo L, Liang Y, Liu X, Jiang L, Wang L. Curcumin suppresses stem-like traits of lung cancer cells via inhibiting the JAK2/STAT3 signaling pathway. Oncol Rep. 2015;34(6):3311-3317.

Yi E, Chang JE, Leem C, Kim S, Jheon S. Clinical results of photodynamic therapy in tracheobronchial malignancy. J Photochem Photobiol B. 2016;156:56-60

Yoon JH, Baek SJ. Molecular targets of dietary polyphenols with anti-inflammatory properties. Yonsei Med J. 2005;46(5):585-596.

Zhang D, Chen Z, Wang DC, Wang X. Regulatory T cells and potential inmmunotherapeutic targets in lung cancer. Cancer Metastasis Rev. 2015;34(2):277-290.