Lung cancer is the most common cause of cancer death, responsible for an estimated 160,000 deaths in the United States annually. There are two major types: non-small cell lung cancer and small cell lung cancer, so named because of how the cells look under a microscope. Non-small cell lung cancer is more common, and it generally grows and spreads more slowly. There are three main types of non-small cell lung cancer, named for the type of cells in which the cancer develops: squamous cell carcinoma, adenocarcinoma, and large cell lung cancer. Small cell lung cancer grows more quickly and is more likely to spread to other organs in the body.

Lung cancer is accompanied by the following 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

Multiple exposure to carcinogens (cancer-causing agents) results in damage to DNA in the cells of the body.

Tobacco smoke is the biggest carcinogen, responsible for 85 percent 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 for developing lung cancer. Other risk factors include the following.

• Family history
• Environmental and occupational exposure to certain substances, including arsenic, asbestos, ether, chromium, nickel, and radon
• Exposure to excessive radiation (wartime or industrial exposure, or radiotherapy to the chest)
• Lung diseases
• Poor diet (however, diets high in fruits and vegetables can decrease your risk)

If you are experiencing symptoms associated with lung cancer, you should see your health care provider. He or she will evaluate your medical history, smoking history, exposure to environmental and occupational substances, and family history of cancer, and will perform a physical exam. 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. 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 cancer is present, 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 computed tomography (CT) scan, magnetic resonance imaging (MRI), radionuclide scan, and bone scan.

The best means of prevention is to never start smoking or using chewing tobacco, or to stop using tobacco products. A healthy diet is an important part of prevention.

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

Various therapies can be used to treat lung cancer.

• Chemotherapy can control cancer growth and relieve symptoms.
• Photodynamic therapy involves the use of a chemical that is injected into the bloodstream and absorbed by cells all over the body, and which remains in cancer cells for a longer time. 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.

Surgery is the only treatment that offers hope of a cure of 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. Radiation therapy is used before surgery to shrink a tumor, or after surgery to destroy remaining cancer cells. Radiation therapy may also be used instead of surgery or to relieve symptoms such as shortness of breath.

A comprehensive treatment plan for lung cancer may include a range of complementary and alternative therapies. Ask your team of health care providers about the best ways to incorporate these therapies into your overall treatment plan.

Include in your diet dark green, yellow, and orange vegetables, as well as dark berries, green tea, onions, garlic, broccoli, brussels sprouts, kale, and cabbage. Increase whole grains and anti-inflammatory oils (nuts, seeds, and cold-water fish). Eliminate refined foods, sugar, alcohol, and saturated fats (animal products, especially dairy).

Potentially beneficial nutrient supplements include the following.

• Vitamin C (250 to 500 mg twice per day), vitamin E (400 IU twice per day), selenium (200 mcg twice a day), zinc (30 mg per day), and coenzyme Q10 (100 mg three times per day)
• Avoid vitamin A (and beta carotene) supplements if you have a history of alcohol or nicotine abuse.
• Coenzyme Q10 and L-carnitine (600 mg three times per day) can reduce toxicity from certain chemotherapies.
• Anti-inflammatory omega-3 and omega-6 oils (1,500 mg three times per day)
• Glutathione (500 mg twice a day)
• N-acetylcysteine (200 mg three times per day)
• Melatonin (10 mg per day) may improve survival rate in non-small cell lung cancer patients who do not respond to a type of medication called cisplatin
• Bromelain (250 to 500 mg between meals)

Herbal remedies may help cleanse the body, inhibit tumor growth, and support the immune system. Herbs are generally available as dried extracts (pills, capsules, or tablets), teas, or tinctures (alcohol extraction, unless otherwise noted). Dose for teas is 1 heaping tsp. per cup of water steeped for 10 minutes (roots need 20 minutes).

• Turmeric (Curcuma longa) 500 mg four times a day
• Quercetin (250 to 500 mg three to four times a day)
• Ginkgo (Ginkgo biloba) 120 mg standardized extract twice a day to reduce toxicity of certain chemotherapies
• To help your body's immune system and support healthy lung tissue, combine equal parts of red clover (Trifolium pratense), gotu kola (Centella asiatica), mullein (Verbascum densiflorum), elecampane (Inula helenium), Indian tobacco (Lobelia inflata), and blood root (Sanguinaria canadensis). Take 30 to 60 drops tincture three to four times a day, or drink one cup of tea three times a day
• Herbal mixes containing burdock root (Arctium lappa), sheep sorrel (Rumex acetosella), slippery elm (Ulmus fulva), turkey rhubarb (Rheum palmatum), and other herbs: for brand name products, follow dosing instructions on the product labeling

Homeopathy may help reduce symptoms, relieve side effects from treatments, and reduce the effects of stress.

Castor oil pack over lungs may decrease side effects of chemotherapy and aid the lungs in detoxification. Saturate a cloth with castor oil and apply directly to the skin, placing a heat source (heating pad or water bottle) on top. Leave in place for 30 minutes or more. For best results, use castor oil packs for three to four consecutive days per week. Packs may be used daily.

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 that often accompanies chemotherapy treatment). There have also been studies indicating 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; this is a technique that patients can learn and then use to treat themselves.

Some acupuncturists prefer to work with a patient only after the completion of conventional medical cancer therapy. Others will provide acupuncture and/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, a qi deficiency is usually detected in the spleen or kidney meridians.

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 is key to better chances of survival.

Periodic follow-up is useful in helping 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.

Alimi D, Rubino C, Leandri EP, Brule SF. Analgesic effects of auricular acupuncture for cancer pain [letter]. J Pain Symptom Manage. 2000;19(2):81-82.

Bartram T. Encyclopedia of Herbal Medicine. Dorset, England: Grace Publishers; 1995: 91.

Birdsall TC. The biological effects and clinical uses of the pineal hormone melatonin. Alt Med Rev. 1996; 1(2):94-102.

Boik J. Cancer & Natural Medicine: A Texbook of Basic Science and Clinical Research. Princeton, Minn: Oregon Medical Press; 1996: 75, 166-168.

Carr AC, Frei B. Toward a new recommended dietary allowance for vitamin C based on antioxidant and health effects in humans. Am J Clin Nutr. 1999;69(6):1086-1107.

Coultas DB, Samet TM. Occupational lung cancer. In: Epler GR, ed. Clinics of Chest Medicine. Vol 13. No 2. Philadelphia, PA: Saunders; 1992: 341-359.

Ezzo J, Berman B, Hadhazy VA, Jadad AR, Lao L, Singh BB. Is acupuncture effective for the treatment of chronic pain? A systematic review. Pain. 2000;86:217-225.

Fedullo PF. Lung cancer. In: Bordeau RA, Moser KM, eds. Manual of Clinical Problems in Pulmonary Medicine. 4^th ed. Boston, MA: Little, Brown; 1996: 461, 465, 470.

Filshie J, Penn K, Ashley S, Davis CL. Acupuncture for the relief of cancer-related breathlessness. Palliat Med. 1998;10:145-150.

Fishman AP. Pulmonary Diseases and Disorders. 3^rd ed. New York, NY: McGraw-Hill; 1998: 1707, 1783.

Fraser RS, et al. Pulmonary carcinoma. Diseases of the Chest. 4^th ed. Vol 2. Philadelphia, PA: Saunders; 1989: 1069.

JAMA Patient Page. How much vitamin C do you need? JAMA. 1999;281(15):1460.

Jett J, et al. Pretreatment evaluation of non-small cell lung cancer. Am J Respir Crit Care Med. 1997; 156:320-322.

Johnston CS. Recommendations for vitamin C intake. JAMA. 1999;282(22):2118-2119.

Levine M, Rumsey SC, Daruwala R, Park JB, Wang Y. Criteria and recommendations for vitamin C intake. JAMA. 1999;281(15):1415-1453.

Maa SH, Gauthier D, Turner M. Acupressure as an adjunct to a pulmonary rehabilitation program. J Cardiopulm Rehabil. 1997;17(4):268-276.

Murray TF, Nadel JA, et al. Textbook of Respiratory Medicine. 2^nd ed. Philadelphia, PA: Saunders; 1994: 1528-1596.

Mountain CG. Revisions in the international system of staging lung cancer. Chest. 1997; 111:1710-1717.

Moss RW. Alternative pharmacological and biological treatments for cancer: Ten promising approaches. J Naturopathic Med. 1996; 6(1): 23-32.

NIH Consensus Statement: Acupuncture. National Institutes of Health, Office of the Director. 1997;15(5):1-34. Accessed at http://odp.od.nih.gov/consensus/cons/107/107_statement.htm on September 24, 2001.

Pan CX, Morrison RS, Ness J, Fugh-Berman A, Leipzig RM. Complementary and alternative medicine in the management of pain, dyspnea, and nausea and vomiting near the end of life: a systematic review. J Pain Symptom Manage. 2000;20(5):374-387.

Sellick SM, Zaza C. Critical review of five nonpharmacologic strategies for managing cancer pain. Cancer Prev Control. 1998;2(1):7-14.

2. Shen J, Wenger N, Glaspy J, et al. Electroacupuncture for control of myeloablative chemotherapy-induced emesis. JAMA. 2000;284(21):2755-2761.

Stoner GD, Mukhtar H. Polyphenols as cancer chemopreventive agents. J Cell Biochem. 1995; 22 (suppl): 169-180.

Van Zandwijk N. N-acetylcysteine and glutathione: antioxidant and chemopreventive properties, with special reference to lung cancer. J Cell Biochem. 1995; 22 (Suppl): 24-32.

Vickers AJ. Can acupuncture have specific effects on health? A systematic review of acupuncture antiemesis trials. J R Soc Med. 1996;89:303-311.

Werbach M. Nutritional Influences on Illness. New Canaan, Conn: Keats Publishing; 1988: 109.

Younes RN, et al. Follow-up in lung cancer: how often and for what purpose. Chest. 1999; 115: 1494-1499.