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Lung Cancer

Lung cancer is any malignancy that originates in the lungs, in contrast to cancers that arise elsewhere and then spread to the lungs, as many do. It is the most common fatal malignancy in the United States, with about 170,000 new cases annually, and accounting for 153,000 deaths every year. Smoking is the main cause of lung cancer. However, one in eight occurrences are in people who have never smoked. In these cases, the direct cause is unknown, but long term exposure to such environmental elements as air pollution, asbestos, secondhand tobacco smoke, or radon (a colorless, odorless gas that can accumulate to unhealthful levels in a home) seem to increase the risk. Continuous occupational exposure to certain chemicals, radiation, and chromium compounds is also believed to playa role in inducing some lung cancers. And evidence suggests that a diet high in saturated fats may be a factor, especially in women. Four major types are described below: The first two are the most common; the last two are relatively rare. Squamous cell carcinoma, also known as epidermoid carcinoma, usually begins in the larger bronchial tubes. Adenocarcinoma usually starts in the smaller, more distant bronchial tubes. These cancers frequently spread to the lymph nodes and then to the brain and other organs. Small cell carcinoma, also known as oat cell carcinoma, is the most aggressive type of lung cancer, it is often fatal within a year of diagnosis. Large cell carcinoma tends to spread or metastasize through the bloodstream to other parts of the body, in particular the adrenal glands, brain, and bones. Lung cancer often mimics other pulmonary disorders, especially in the early stages. Symptoms include a persistent cough, an aching chest pain, shortness of breath, and the spitting up of bloody sputum. They may develop slowly and are often mistakenly attributed to chronic bronchitis or another condition. As the cancer advances, it causes extreme weakness and fatigue, loss of appetite and weight, and swollen, tender lymph nodes, usually in the neck or under the arm.

Diagnostic Studies And Procedures

Unfortunately, lung cancer is rarely discovered early, because there are no effective screening tests and symptoms do not usually occur until the disease is well advanced. Sometimes a laboratory examination of sputum can detect abnormal cells when the disease is in its earliest stages, but at that point it may be extraordinarily difficult to pinpoint the site. Often, by the time lung cancer can be seen on a chest X-ray, it has spread, or metastasized, to other parts of the body. If symptoms indicate the possibility of lung cancer, diagnostic studies begin with a complete physical examination that includes blood tests, laboratory analysis of a sputum sample, chest X-rays, a CT scan, and bronchoscopy. For this last test a flexible tube, or bronchoscope, is inserted down the throat to enable direct examination of the lung itself. Using the tube, doctors can also extract a sample of tissue for a biopsy, though they may instead use a large bore needle if the site is difficult to reach. When lung cancer is diagnosed, additional tests and scans may be done to see if it has spread to other areas.

Medical Treatments

Treatment depends on the size of the cancer and whether it has spread. Surgery is often the first step; removal of all or part of the lung in which the tumor is located can sometimes cure a small, localized cancer. For example, squamous cell cancer grows slowly in its initial stages, so surgery alone may produce a cure if it is detected early. Unfortunately, most lung cancer has spread by the time it is diagnosed. If the disease is in both lungs or has spread to nearby lymph nodes, radiation therapy may be used to shrink tumors or slow their growth. When the cancer has spread beyond these areas, chemotherapy may be best, using such drugs as cyclophosphamide, cisplatin, vinblastine, and/or methotrexate. In many cases, a combination of approaches may be used. For example, for those with oat cell cancer, chemotherapy combined with radiation may produce an extended remission. Or if the cancer has spread to the brain (a common occurrence), radiation treatment of the head may be tried. While aggressive therapy can often produce a remission, lung cancer usually recurs. Only about 13 percent of patients survive five or more years after treatment. In the 16 percent of patients whose disease is diagnosed when it is still localized, the five year survival rate is considerably higher, at 46 percent. In those with localized small cell lung cancer, the two-year survival rate has risen from 40 percent to 75 percent because of treatment with the relatively new combination of chemotherapy and radiation. However, when the cancer has already spread to the lymph nodes or into the mediastinum (the part of thechest containing the heart and other organs), the cure rate is only 5 percent. Antibiotics may be prescribed to counter the increased risk of infection from the bone-marrow suppression caused by chemotherapy and radiation. Drugs like ondansetron or metoclopramide may be used to reduce the attendant nausea.

Alternative Therapies

Lung cancer requires intensive medical and surgical treatment to prevent or delay death. Nonetheless, alternative therapies may play an additional role both in its care and prevention.

Meditation Self Hypnosis And Visualization

Cancer patients who participate in group support sessions that include these techniques may experience longer than average survival. A number of researchers believe that these therapies help mobilize the immune system to fight cancer.

Nutrition Therapy

Some nutritionists recommend daily supplements of beta carotene and vitamins C and E to help prevent cancer, but studies indicate that food sources of these antioxidants are more protective than vitamin pills. Foods rich in these nutrients include yellow and orange fruits and orange and dark green vegetables, especially cruciferous vegetables, such as broccoli, Brussels sprouts, cabbage, and cauliflower. Studies at Johns Hopkins University showed that sulforaphane, a chemical in broccoli, lowered the incidence of lung cancer among smokers. The role of other dietary components remains controversial, although some studies suggest that a low fat diet can reduce the risk of lung cancer.

Self Treatment

Prevention is the best approach to lung cancer. If you smoke, quitting is the most important measure. Studies show that within weeks of stopping cigarette use, suspicious precancerous lesions begin to heal, and in 5 to 10 years, the risk of lung cancer in exsmokers is only slightly higher than that of people who have never smoked. Even if you already have lung cancer, quitting smoking and keeping your environment as free of smoke and other pollutants as possible may help slow its growth and improve chances of a cure. Another preventive approach is to check your home for the presence of radon. If tests show radon levels above government standards, hire a qualified firm to improve ventilation, thereby preventing a buildup of the gas. If you are undergoing treatment for lung cancer, a balance of rest and exercise is important to maintain strength and foster a sense of well being. A daily walk or other exercise appropriate to your physical condition may help boost the immune system by releasing endorphins, chemicals produced by the brain that affect mood and diminish pain. In many cases, patients die of starvation rather than cancer itself, because both the disease and its treatment can cause severe loss of appetite and weight. You can best deal with nausea from the side effects of chemotherapy and radiation by avoiding situations that worsen it. For example, stay out of the kitchen and away from cooking odors that may trigger nausea. If you must cook, avoid aromatic foods, such as cabbage and onions, and fatty, spicy, or other strongly flavored dishes. Foods served cold or at room temperature have less smell than those served hot, and they are usually better tolerated. Eat slowly in a relaxed, pleasant atmosphere, avoiding a room that is stuffy or too warm. Eat dry, bland foods, such as crackers and toast, before meals. Plan to have your largest meal in the morning, when you are less likely to experience nausea, or eat small meals throughout the day, stopping if nausea hits. When it does develop, breathe deeply and sip small quantities of flat ginger ale or chew ice chips until it passes. Rest for a half hour after eating; if possible, sit in an upright position, because reclining may trigger reflux of stomach contents into the esophagus, as well as nausea and vomiting. If you know when nausea and vomiting are likely to occur, such as after a treatment, eat a bland, easy-to-digest meal several hours beforehand. Avoid milk and milk products, which may be difficult to digest. Many cancer patients find that red meat takes on an unpleasant taste. Chicken or turkey may be more palatable. If poultry cannot be tolerated, try eating combinations of grains and legumes, which provide equally high-quality protein and meet other nutritional requirements. After an episode of vomiting, sip a clear liquid, such as tea or broth, every 10 minutes. Gradually increase the amount until you can hold down two tablespoonfuls every 30 minutes. Other liquids can then be added until you feel well enough to resume a regular diet. Enriched nutritional supplements may be recommended for patients who suffer from lack of appetite. Maintaining an adequate food intake is essential, especially if surgery is part of the treatment. In some cases, cachexia, a severe form of malnutrition and weight loss, appears to result from the body’s response to the cancer itself. Some oncologists caution against trying to force feed cachectic patients with supplemental nutrition, because their condition may reflect the body’s attempt to “starve” the tumor. Although family members may find it difficult to watch a patient eat minimally and progressively lose weight, it may be wise to allow this person to limit food intake while aggressive cancer therapy is undertaken to destroy the tumor.

Other Causes of Pulmonary Symptoms

Persistent coughing, wheezing, and chest pain may be signs of asthma, congestive heart failure, tuberculosis, chronic bronchitis, or a lung abscess.

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