Lung cancer, also known as
bronchogenic carcinoma ("carcinoma" means cancer), is the most fatal
form of cancer, reports the Centers for Disease Control and Prevention (CDC).
In 2003, lung cancer accounted for more deaths than breast cancer, prostate
cancer, and colon cancer combined in the United States.
Lung cancer is not an
AIDS-defining illness. However, HIV-infected patients have a greater chance of
developing lung cancer than patients without HIV. Some researchers believe that
low numbers of natural killer cells (white blood cells that attack and kill
tumor cells or microbial cells) may lead to the growth of abnormal cells or,
HIV may stimulate abnormal growth factors. As the life expectancy of HIV patients
increases with the help of highly active antiretroviral therapy (HAART), lung
cancer is expected to increase among the patient population. There is no
evidence that HAART causes lung cancer or any other cancer.
Several studies show that
lung cancer is more common in HIV-positive patients than non-HIV infected
patients. For instance, researchers reviewed cancer and HIV registers in Texas
between 1990 and 1995 and found that people with HIV were almost seven times
more likely to develop lung cancer than non-infected people. In New York, an
HIV cohort had three times the risk of developing lung cancer compared to the
general American population. A review of cancer and HIV registers in New South
Wales, Australia, also provides evidence that HIV-infected patients have an
increased risk of developing lung cancer. These trends have also been
demonstrated in American women.
Regardless of the cause of
lung cancer, studies have shown that people with HIV have a worse prognosis
than non-infected people, with an average survival time of five months in
HIV-positive patients and ten months in HIV-negative patients. Since current
treatments are often inadequate and most patients are diagnosed when they have
late-stage cancer, only about 10% of non-HIV related lung cancers are cured.
There is evidence that lung cancer is more aggressive among people who have
weakened immune systems, including HIV patients.
The three main types of
treatment are surgery, radiation therapy, and chemotherapy. Patients often
receive combinations of these therapies, depending on the stage of the lung
cancer. Surgery can be performed if the cancer is limited to the lungs and has
not spread to other areas of the body. However, about half of people with lung
cancer are not candidates for surgery because the cancer has spread too far.
Also, surgical procedures can cause lymphocytopenia (low levels of white blood
cells) in patients, which can further impair an HIV patient's immune system.
Radiation therapy generally
does not cure lung cancer. Rather, it improves and extends a person's quality
of life. Chemotherapy drugs, which destroy cancer cells by preventing them from
growing and multiplying, are the primary treatment for small cell lung cancer,
particularly if it is restricted to the lung.
TYPES OF LUNG CANCER
Lung cancers are classified into two major groups: small
cell lung cancers (SCLC) and non-small cell lung cancers (NSCLC). This
classification is based on the microscopic appearance of the tumor cells.
Small cell lung cancers (SCLC) :
Small cell lung cancers (SCLCs), also called oat cell
carcinomas, make up about 20% of lung cancers, and they are the most aggressive
and rapidly growing of all lung cancers. SCLCs are strongly associated with
cigarette smoking. In fact, only 1% of SCLC tumors occur in non-smokers. SCLC
can metastasize (spread to other areas of the body) rapidly. The cancer is
usually diagnosed after it has spread extensively.
Non-small cell lung cancers (NSCLC) :
Non-small cell lung cancers (NSCLCs) are the most common
lung cancers, accounting for about 80% of all lung cancers. NSCLC has three
main types, which are named based on the type of cells present in the tumor.
Adenocarcinomas: Adenocarcinomas, which account for about
50% of all NSCLC cases in the United States, are the most common type of NSCLC.
While adenocarcinomas may be associated with smoking, they are most commonly
seen in non-smokers. Most adenocarcinomas occur in the peripheral (outer) areas
of the lungs. Bronchioloalveolar carcinoma is a subtype of adenocarcinoma that
often develops in multiple areas in the lungs and spreads along the alveolar
Squamous cell carcinomas: Squamous cell carcinomas, also
called epidermoid carcinomas, account for about 30% of NSCLC. Squamous cell
cancers usually occur in the central chest area in the bronchi.
Large cell carcinomas: Large cell carcinomas, sometimes
called undifferentiated carcinomas, are the least common type of NSCLC.
In general, lung cancer is strongly correlated with smoking
tobacco. In both HIV-infected and non-infected patients, lung cancer
predominately affects smokers. In fact, researchers estimate that about 90% of
lung cancer cases are caused by smoking. This is because tobacco smoke contains
over 4,000 chemical compounds, many of which have been shown to be carcinogenic
(cancer-causing). In addition, recent research suggests that the human
chromosome number 6 is likely to contain a gene that confers an increased
vulnerability to the development of lung cancer in smokers.
The risk of lung cancer is "substantially
elevated" among HIV-infected patients, according to a cohort study
conducted by researchers at the National Cancer Institute. The researchers
reported an incidence of 170 per 100,000 HIV patients. Also, HIV patients who
smoke have an even greater risk of developing lung cancer. The researchers
reported that 85% of the patients who developed lung cancer were smokers.
According to the researchers, the incidence of lung cancer was unrelated to
There are several theories that aim to explain the
prevalence of lung cancer among HIV patients. Some researchers believe that low
numbers of natural killer cells (white blood cells that attack and kill tumor
cells or microbial cells) may lead to the growth of abnormal cells or that HIV
may stimulate abnormal growth factors.
Certain lung diseases, especially chronic obstructive
pulmonary disease (COPD), are associated with a slightly increased risk (four
to six times the risk of a non-smoker) for the development of lung cancer.
Lung cancer survivors are also more likely to develop lung
cancer than the general population. Survivors of non-small cell lung cancers
have an increased risk of about 1-2% per year for developing lung cancer a
second time. Small cell lung cancer survivors have an increased risk of nearly
6% of developing lung cancer a second time.
Exposure to air pollution can increase the risk of
developing lung cancer. Up to one percent of lung cancer deaths can be
attributed to breathing polluted air.
Small cell and non-small cell cancers generally cause
similar symptoms, including cough, shortness of breath, bloody sputum, loss of
appetite, weight loss, chest pain, and wheezing or pneumonia. Adenocarcinoma
may also cause chest pain with breathing.
If the cancer has metastasized (spread) to other parts of
the body, symptoms may include hoarseness of the voice, difficulty swallowing,
headaches, enlarged lymph nodes, pain or discomfort under the ribs, weakness,
numbness, paralysis, bone or abdominal pain, or swelling of the face, arms, and
In addition, many nonspecific symptoms are also seen in lung
cancer patients, including weight loss, weakness, depression, mood changes, and
General: If lung cancer is suspected, imaging studies or a
bronchoscopy is performed to determine if there is a tumor in the lungs. If
there is abnormal tissue growth in the lungs, a biopsy of the tumor is
performed to confirm a diagnosis.
Chest X-ray: If lung cancer is suspected, a chest X-ray is
usually the first diagnostic test that is conducted. Chest X-rays may help the
physician detect abnormal tissue growth in the lungs. The healthcare provider
may observe calcified nodules or tumors. However, X-rays cannot determine
whether these areas are cancerous or not.
Computerized tomography (CT) scan: A computerized tomography
(CT) scan may be performed on the chest, abdomen, and/or brain to look for both
metastatic and primary tumors. The test is often performed when X-rays are
negative or do not yield sufficient information about the extent or location of
a tumor. CT scans are X-ray procedures that combine multiple images with the
aid of a computer to generate cross-sectional views of the body. CT scans are more
sensitive than standard chest X-rays in the detection of lung nodules.
Sometimes intravenous (injected into the vein) contrast material is
administered before the procedure to help identify the organs and their
positions. According to scientific studies, CT scans used to detect lung cancer
generally have a sensitivity ranging from 70-90% and a specificity ranging from
Magnetic resonance imaging (MRI) scan: Magnetic resonance
imaging (MRI) scans may be conducted to determine the precise location of the
tumor. MRI images are detailed and can detect tiny changes of structures within
the body. A substance called gadolinium (chemical substance) is injected into
the patient through a vein in order to provide detailed images of the lungs.
The gadolinium clumps around the cancer cells so they show up brighter in the
picture. People with heart pacemakers, metal implants, artificial heart valves,
and other surgically implanted structures cannot be scanned with an MRI because
of the risk that the magnet may move the metal parts of these structures.
Positron emission tomography (PET): During a positron
emission tomography (PET) test, a small amount of radionuclide glucose (sugar)
is injected into a vein to help make the tissues and organs more visible. The
PET scanner rotates around the body and takes a picture of where glucose is
being used in the body. Malignant tumor cells appear brighter in the image
because they are more active and consume more glucose than normal cells.
Sensitivities up to 95% and specificities up to 86% have been reported with
Bone scans: Once lung cancer has been diagnosed, a qualified
healthcare professional may conduct a bone scan to determine whether the cancer
has metastasized to the bones. During the procedure, a small amount of
radioactive material is injected into the bloodstream. The bone scan can detect
abnormal areas in the bones because the radioactive substance collects in areas
that contain metastatic tumors.
Sputum cytology: A sputum cytology test is the least invasive
diagnostic test, but it is limited because tumor cells are not always present
in the sputum. Also, non-cancerous cells occasionally undergo changes in
reaction to inflammation or injury and they may be mistaken for cancer cells.
During the procedure, the patient coughs hard, expelling material from the
lungs into a culture. The sputum sample is then analyzed in a laboratory for
Bronchoscopy: During a bronchoscopy, a thin, flexible tube
with a camera (bronchoscope) is inserted through the mouth, into the esophagus.
The test allows the healthcare provider to look inside the lungs for tumors. If
a tumor is seen, a tissue sample can be taken and analyzed in the lab to
confirm a diagnosis. This procedure is generally accurate when the tissue from
the affected area is adequately sampled. However, sometimes, uninvolved areas
of the lung are mistakenly sampled, which may cause a false negative test
result. The procedure can be uncomfortable and requires sedation or anesthesia.
Needle biopsy: Fine needle aspiration (FNA) through the
skin, usually performed with radiological imaging for guidance, may be
performed to retrieve a tissue sample from tumor nodules in the lungs. Needle
biopsies are especially useful when the tumor is peripherally located in the
lung and not accessible to sampling by bronchoscopy. During the procedure, a
local anesthetic is administered before the thin needle is inserted through the
chest wall into the abnormal area in the lung. Cells are suctioned into the
syringe and are examined under the microscope for cancerous cells. This
procedure is generally accurate when performed correctly. However, in some
cases, uninvolved areas of the lung may be sampled by mistake. If a sample is
taken from an unaffected area, the results may be false negative.
Thoracentesis: Sometimes lung cancers involve the lining
tissue of the lungs (pleura), which can lead to an accumulation of fluid in the
space between the lungs and chest wall (called a pleural effusion). Aspiration
of a sample of this fluid with a thin needle (thoracentesis) may reveal the
cancer cells and establish the diagnosis.
Surgical tests: If lung cancer is suspected, but all other
diagnostic methods produce negative results, surgical methods may be
considered. During a mediastinoscopy, a probe is surgically inserted to collect
a tissue sample of the tumor mass in the chest cavity between the lungs. During
a thoracotomy, the chest wall is surgically opened and the surgeon removes as
much of the tumor as possible. A thoracotomy is rarely able to completely
remove all of the lung cancer and both mediastinoscopy and thoracotomy carry
the risks of major surgical procedures (complications such as bleeding,
infection, as well as risks of anesthesia and medications).
Blood tests: Blood tests alone cannot diagnose lung cancer.
However, they may detect biochemical or metabolic abnormalities that are
associated with cancer. For instance, elevated levels of calcium or the enzyme
alkaline phosphatase have been associated with cancer that has metastasized to
the bones. Also, elevated levels of certain enzymes normally present in liver
cells, including aspartate aminotransferase and alanine aminotransferase,
signal liver damage, possibly due to the presence of a metastatic tumor.
General: Since current treatments are often inadequate and
most patients are diagnosed when they have late-stage cancer, only about 10% of
non-HIV related lung cancers are cured. Studies have shown that people with HIV
have a worse prognosis than non-infected people, with an average survival time
of five months in HIV-positive patients and 10 months in HIV-negative patients.
The three main types of treatment are surgery, radiation therapy, and
chemotherapy. Lung cancer patients often receive combinations of these
therapies, depending on the stage of the cancer. Surgery can be performed if
the cancer is limited to the lungs and has not spread to other areas of the
body. However, about half of people with lung cancer are not candidates for
surgery because the cancer has metastasized (spread to other areas in the
body). Also, surgical procedures can cause lymphocytopenia (low levels of white
blood cells) in patients, which can further impair an HIV patient's immune
Radiation therapy generally does not cure lung cancer.
Instead, it improves and extends a person's quality of life. Chemotherapy, or
anti-cancer drugs, are the primary treatments for small cell lung cancer, and
may kill the cancer, especially if it is restricted to the lung. Some lung
cancer patients receive a combination of chemotherapy and radiation therapy
prior to surgery. These treatments help shrink the malignant (cancerous) tumor,
requiring less tissue removal during surgery.
Chemotherapy: During chemotherapy, drugs are administered to
stop the growth of cancer cells, either by killing the cells or preventing them
from multiplying. These drugs are toxic to cancerous cells. However, healthy
cells are also harmed during the process, which is responsible for the side
effects of treatment. Once chemotherapy is discontinued, healthy cells usually
repair themselves and side effects gradually subside. Sometimes chemotherapy is
the only treatment that a patient receives. However, chemotherapy is usually
used in addition to other treatments, such as surgery or radiation therapy
(treatment that uses high-energy rays to destroy cancer cells).
HIV patients who have lung cancer typically receive chemotherapy
in pill form or as an intravenous infusion. The drugs are administered in a
series of treatments, called cycles, over the course of several weeks to
months, with breaks between cycles. When chemotherapy is administered
intravenously (IV), a thin needle is inserted into a vein on the lower arm in
order to administer the drug. The needle is removed at the end of the treatment
session. Chemotherapy can also be delivered intravenously through catheters,
ports, or pumps. It can also be taken orally in a capsule or liquid form. When
chemotherapy is taken orally or injected into a vein or muscle, the drugs enter
the bloodstream and can reach cancer cells throughout the body (systemic
Chemotherapy can also be administered directly to the
affected area. When chemotherapy is administered directly into the spinal
column, it is called intrathecal chemotherapy. When chemotherapy is
administered directly into an organ or a body cavity such as the abdomen, it is
called regional chemotherapy.
Combination chemotherapy, which involves more than one
antineoplastic (anticancer) agent, has also been used to treat lung cancer.
Chemotherapy may have adverse effects on the bone marrow and
may lead to a decreased production of white blood cells, which are the primary
cells of the immune system. Therefore, colony-stimulating factors have been
administered in combination with chemotherapy in patients who have weakened
immune systems (such as HIV patients). This treatment has been used to
stimulate the production of white blood cells and boost the immune system.
Since healthy cells are also destroyed during chemotherapy,
there are many side effects associated with the drugs including skin rash,
temporary alopecia (hair loss), loss of appetite, weight loss, mouth sores, esophagitis
(inflamed esophagus), fatigue, diarrhea, constipation, peripheral neuropathy
(burning, weakness, tingling or numbness in the hands and/or feet), anemia,
confusion, acne, dry skin, rash, yellow and brittle nails, flu-like symptoms,
fluid retention, decreased sperm motility, reduced sexual hormone production in
women, nausea, and vomiting. Normal cells usually recover when chemotherapy is
over, so most side effects gradually subside after treatment ends. Most
patients have no serious long-term problems from chemotherapy. Chemotherapy
also destroys healthy immune cells. Therefore, patients undergoing chemotherapy
are immunocompromised and susceptible to infections.
Radiation therapy: Radiation therapy involves high-energy
X-rays that kill cancer cells. This therapy changes the DNA (genetic makeup) of
cancer cells, which prevents the cells from multiplying. Radiation therapy does
not cure lung cancer. Instead, it improves and extends a person's quality of
life. There are two types of radiation therapy: external and internal. External
radiation therapy uses a machine outside the body to send radiation toward the
cancer. Internal radiation therapy uses a radioactive substance, which is
sealed inside needles, seeds, wires, or catheters, and placed directly into or
near the cancer.
Most often, radiation therapy is delivered to lung cancer
patients by the external beam technique, which aims a beam of X-rays directly
at the tumor. Treatment is administered in a series of sessions, usually over
Side effects of radiation therapy are similar to
chemotherapy and may include red or irritated skin, mouth sores, difficulty or
soreness swallowing, shortness of breath, temporary alopecia (hair loss),
fatigue, flushing, macularpapular rash, loss of appetite, weight loss, nausea,
and vomiting. Normal cells usually recover when radiation therapy is over, so
most side effects gradually subside once treatment is completed.
Surgery: Surgery may be performed to remove cancerous tumors
that have not spread beyond the lung. This is the primary treatment for
patients with early-stage lung cancer who are in good general health. Several
surgical techniques may be used. A thoracotomy (when the chest wall is opened)
and median sternotomy (when surgery is performed by cutting through the
breastbone) are the standard techniques. Alternative approaches include
anterior limited thoractomy (ALT), thoractomy performed on the frontal chest
using a small incision; anterioraxillary thoracotomy (AAT), thoracotomy
performed on the frontal chest near the underarm; and posterolateral
thoracotomy (PLT), thoracotomy performed on the back/side region of the trunk.
ALT is less invasive than the standard thoracotomy and it may cause less
surgical blood loss, less post-operative drainage, and less post-operative pain
than standard thoracotomy.
Recently, surgeons have developed other, less invasive
procedures to remove tumorous tissue. For instance, during video-assisted
thoracoscopy (VAT), also called video-assisted thoracic surgery (VATS), the surgeon
uses a video camera to help visualize and operate on the lung. The surgical
incisions made during VAT are much smaller than those needed for thoracotomy or
sternotomy. However, some physicians caution that VAT does not allow complete
lung examination to identify and remove metastases that are not detected by
chest X-rays before surgery. Therefore, VAT might be most beneficial for Stage
1 and Stage 2 cancers that require lobectomy (surgical removal of a lung
lobule) with lymphadenectomy (removal of one or more lymph nodes) and for
peripheral (outer edge) lung tumors. Follow-up care is required to establish a
However, about half of people with lung cancer are not
candidates for surgery due to the spread of the cancer. Also, surgical
procedures can cause lymphocytopenia, low levels of lymphocytes (white blood
cells), in patients, which can further impair an HIV patient's immune system.
Highly active retroviral therapy (HAART): When HIV
reproduces, different strains of the virus emerge, and some are resistant to
antiretroviral drugs. Therefore, it is common for healthcare providers to
recommend a combination of antiretroviral drugs known as HAART. This strategy,
developed by the National Institute of Allergy and Infectious Diseases (NIAID)
support researchers, usually combines drugs from at least two different classes
of antiretroviral drugs. While HAART cannot cure the virus, it has been shown
to suppress it.
The U.S. Food and Drug Administration (FDA) has approved
several antiretroviral drugs to treat HIV. These drugs fall into three major
classes: reverse transcriptase (RT) inhibitors, fusion inhibitors, and protease
inhibitors. In July 2006, the FDA approved a multi-class combination called
Reverse transcriptase (RT) inhibitors disrupt the reverse
transcription stage in the HIV lifecycle. During this stage, an HIV enzyme,
known as reverse transcriptase, converts HIV RNA to HIV DNA. There are two main
types of RT inhibitors: non-nucleoside RT inhibitors and nucleoside/nucleotide
RT inhibitors. Non-nucleoside RT inhibitors bind to reverse transcriptase,
preventing HIV from converting the HIV RNA into HIV DNA. Approved
non-nucleoside RT inhibitors include Rescriptor©, Sustiva©, and Viramune©.
Nucleoside/nucleotide RT inhibitors serve as faulty DNA
building blocks. Once they are incorporated into the HIV DNA, the DNA chain
cannot be completed. Therefore, the drugs prevent HIV from replicating inside a
cell. Approved drugs include Combivir©, Emtriva©, Epivir©, Epzicom©, Hivid©, Retrovir©,
Trizivir©, Truvada©, Videx EC©, Videx©, Viread©, Zerit©, and Ziagen©.
Fusion inhibitors prevent the virus from fusing with the
cellular membrane, thus blocking entry into the cell. The fusion inhibitor
Fuzeon© is FDA-approved.
Protease inhibitors (PIs) interfere with the protease enzyme
that HIV uses to produce infectious viral particles. PIs prevent viral
replication by inhibiting the activity of protease, an enzyme used by the virus
to cleave nascent proteins for final assembly of new virons. FDA-approved
protease inhibitors include Agenerase©, Aptivus©, Crixivan©, Invirase©,
Kaletra©, Lexiva©, Norvir©, Prezista©, Reyataz©, and Viracept©.
Individuals taking antiretroviral drugs often have a
difficult time following complicated drug regimens. The recommended treatment
requires patients to take several antiretroviral drugs every day from at least
two different classes. Also, some of the drugs require fasting and may cause
side effects such as nausea and vomiting. Other antiretroviral drugs may cause
serious medical problems, including metabolic changes like abnormal lipid and
glucose metabolism, as well as bone loss. The National Institute of Allergy and
Infectious Diseases is among many research organizations that is investigating
simpler, less toxic, and more effective drug regimens.
Good scientific evidence :
Greater celandine : Ukrain™, a semisynthetic drug derived
from greater celandine (Chelidonium majus), has been studied in clinical trials
of various types of cancer with consistently positive outcomes. However, the
quality of the research performed to date is inadequate, and higher quality
studies are needed.
Use cautiously in patients taking amphetamines, morphine,
hexobarbital, MAOIs, or dopaminergic or serotonergic drugs, or in patients
undergoing radiation therapy. Avoid in patients with liver disease or in
pregnant and lactating women.
Guided imagery : Early research suggests that guided imagery
may help reduce cancer pain. Further research is needed to confirm these
Guided imagery is usually intended to supplement medical
care, not to replace it, and guided imagery should not be relied on as the sole
therapy for a medical problem. Contact a qualified health care provider if
mental or physical health is unstable or fragile. Never use guided imagery
techniques while driving or doing any other activity that requires strict
attention. Use cautiously with physical symptoms that can be brought about by
stress, anxiety or emotional upset because imagery may trigger these symptoms.
If feeling unusually anxious while practicing guided imagery, or with a history
of trauma or abuse, speak with a qualified health care provider before
practicing guided imagery.
Meditation : There is good evidence that various types of
meditation may help improve quality of life in cancer patients. Studies have
shown benefits for mood, sleep quality, and the stresses of treatment. The
specific effects of meditation are not fully understood. Additional research is
needed in this area.
Use cautiously with underlying mental illnesses. People with
psychiatric disorders should consult with their primary mental healthcare
professional(s) before starting a program of meditation, and should explore how
meditation may or may not fit in with their current treatment plan. Avoid with
risk of seizures. The practice of meditation should not delay the time to
diagnosis or treatment with more proven techniques or therapies, and should not
be used as the sole approach to illnesses.
Psychotherapy : Psychotherapy is an interactive process
between a person and a qualified mental health care professional (psychiatrist,
psychologist, clinical social worker, licensed counselor, or other trained
practitioner). There is good evidence that psychotherapy may enhance quality of
life in cancer patients by reducing emotional distress and aiding in coping
with the stresses and challenges of cancer. Therapy may be
supportive-expressive therapy, cognitive therapy or group therapy. While some
patients seek psychotherapy in hopes of extending survival, there conclusive
evidence of effects on medical prognosis is currently lacking. Psychotherapy
may help people come to terms with the fact that they may die of cancer, which
is the 4th stage of dealing with a terminal illness, including denial, anger,
bargaining, and acceptance.
Psychotherapy is not always sufficient to resolve mental or
emotional conditions. Psychiatric medication is sometimes needed. The
reluctance to seek and use appropriate medication may contribute to worsening
of symptoms or increased risk for poor outcomes. In order to be successful,
psychotherapy requires considerable personal motivation and investment in the
process. This includes consistent attendance and attention to treatment
recommendations provided by the practitioner. Not all therapists are
sufficiently qualified to work with all problems. The client or patient should
seek referrals from trusted sources and should also inquire of the
practitioner's training and background before committing to work with a
particular therapist. Some forms of psychotherapy evoke strong emotional
feelings and expression. This can be disturbing for people with serious mental
illness or some medical conditions. Psychotherapy may help with post-partum
depression, but is not a substitute for medication, which may be needed in
Yoga : Yoga is an ancient system of relaxation, exercise,
and healing with origins in Indian philosophy. Several studies report enhanced
quality of life in cancer, lower sleep disturbance, decreased stress symptoms
and changes in cancer-related immune cells after patients received relaxation,
meditation and gentle yoga therapy. Yoga is not recommended as a sole treatment
for cancer but may be helpful as an adjunct therapy.
Yoga is generally considered to be safe in healthy
individuals when practiced appropriately. Avoid some inverted poses with disc
disease of the spine, fragile or atherosclerotic neck arteries, risk for blood
clots, extremely high or low blood pressure, glaucoma, detachment of the
retina, ear problems, severe osteoporosis, or cervical spondylitis. Certain
yoga breathing techniques should be avoided in people with heart or lung
disease. Use cautiously with a history of psychotic disorders. Yoga techniques
are believed to be safe during pregnancy and breastfeeding when practiced under
the guidance of expert instruction (the popular Lamaze techniques are based on
yogic breathing). However, poses that put pressure on the uterus, such as
abdominal twists, should be avoided in pregnancy.
Unclear or conflicting scientific evidence :
Acupuncture : Acupuncture, or the use of needles to
manipulate the "chi" or body energy, originated in China over 5,000
years ago. There has been limited research on acupuncture for cancer pain, and
the research that was done was shown to have mixed results. More studies are
needed to determine potential benefits. Evidence from several small studies
supports use of acupuncture at a specific point on the wrist (P6) to help
chemotherapy patients reduce nausea and vomiting. Acupuncture may also reduce
the pain associated with cancer.
Needles must be sterile in order to avoid disease
transmission. Avoid with valvular heart disease, infections, bleeding disorders
or with drugs that increase the risk of bleeding (anticoagulants), medical
conditions of unknown origin, or neurological disorders. Avoid on areas that
have received radiation therapy and during pregnancy. Use cautiously with
pulmonary disease (like asthma or emphysema). Use cautiously in elderly or
medically compromised patients, diabetics or with history of seizures. Avoid
electroacupuncture with arrhythmia (irregular heartbeat) or in patients with
Aloe : Transparent gel from the pulp of the meaty leaves of
Aloe vera has been used on the skin for thousands of years to treat wounds,
skin infections, burns, and numerous other skin conditions. Dried latex from
the inner lining of the leaf has traditionally been used as an oral laxative.
Preliminary research suggests that aloe may help in the area of cancer
prevention or may aid in the regression of cancerous tumors. Additional
research is needed in this area.
Caution is advised when taking aloe supplements as numerous
adverse effects including a laxative effect, cramping, dehydration and drug
interactions are possible. Aloe should not be used if pregnant or
breast-feeding, unless otherwise directed by a doctor.
American pawpaw : Evidence supporting the use of the
American pawpaw (Asimina triloba) tree for cancer treatment in humans is largely
anecdotal and subjective. However, use in humans has reported minimal side
effects, and evidence from animal and test tube studies suggest that American
pawpaw extract does have some anticancer activity. Pawpaw standardized extract
has been used for 18 months in patients with various forms of cancer.
Well-designed studies on the long-term effects of pawpaw extracts are currently
lacking. Pawpaw should not be used if pregnant or breast-feeding, unless
otherwise directed by a doctor.
Antineoplastons : Antineoplastons are a group of naturally
occurring peptide fractions, which were observed by Stanislaw Burzynski, MD,
PhD in the late 1970s to be absent in the urine of cancer patients. There is
inconclusive scientific evidence regarding the effectiveness of antineoplastons
in the treatment of cancer. Several preliminary human studies (case series,
phase I/II trials) have examined antineoplaston types A2, A5, A10, AS2-1, and
AS2-5 for a variety of cancer types. It remains unclear if antineoplastons are
effective, or what doses may be safe. Until better research is available, no
clear conclusion can be drawn.
Avoid if allergic or hypersensitive to antineoplastons. Use
cautiously with high medical or psychiatric risk, an active infection due to a
possible decrease in white blood cells, high blood pressure, heart conditions,
chronic obstructive pulmonary disease, liver disease or damage, or kidney
disease or damage. Avoid if pregnant or breastfeeding.
Arabinoxylan : Arabinoxylan is made by altering the outer
shell of rice bran using enzymes from Hyphomycetes mycelia mushroom extract.
Arabinoxylan has been found to improve immune reactions in patients with
diabetes and cancer of various types. Arabinoxylan products may contain high
calcium and phosphorus levels, which may be harmful for patients with
compromised renal (kidney) function. Caution is advised when taking
arabinoxylan supplements, as numerous adverse effects including drug
interactions are possible. Arabinoxylan should not be used if pregnant or
breast-feeding, unless otherwise directed by a doctor.
Aromatherapy : Healing with fragrant oils has been used for
thousands of years. Aromatherapy is often used in people with chronic illnesses
(frequently in combination with massage), with the intention to improve quality
of life or well-being. There is currently not enough scientific evidence to
form a firm conclusion about the effectiveness of aromatherapy for quality of
life in cancer.
Essential oils should only be used on the skin in areas
without irritation. Essential oils should be administered in a carrier oil to
avoid toxicity. Avoid with a history of allergic dermatitis. Use cautiously if
driving or operating heavy machinery. Avoid consuming essential oils. Avoid
direct contact of undiluted oils with mucous membranes. Use cautiously if
Art therapy : Art therapy involves the application of a
variety of art modalities including drawing, painting, clay and sculpture. Art
therapy enables the expression of inner thoughts or feelings when verbalization
is difficult or not possible. Limited evidence suggests that art therapy may be
of benefit in cancer caregiving for families of cancer patients. Possible
benefits include reduced stress, lowered anxiety, increased positive emotions
and increased positive communication with cancer patients and health care
professionals. Art therapy may also reduce pain and other symptoms in cancer
patients. More studies are needed to determine how best to use this form of
intervention with this population. Art therapy may also benefit children
hospitalized with leukemia during and after painful procedures. Limited
available study suggests that art therapy improves cooperation with treatment.
Children requested art therapy again when procedures were repeated, and parents
reported that children were more manageable after art therapy.
Art therapy may evoke distressing thoughts or feelings. Use
under the guidance of a qualified art therapist or other mental health
professional. Some forms of art therapy use potentially harmful materials. Only
materials known to be safe should be used. Related clean-up materials (like
turpentine or mineral spirits) that release potentially toxic fumes should only
be used with good ventilation.
Astragalus : Astragalus (Astragalus membranaceus) has been
used in Chinese medicine for centuries for its immune enhancing properties.
Although early laboratory and animal studies report immune stimulation and
reduced cancer cell growth associated with the use of astragalus, reliable
human evidence in these areas is currently lacking. In Chinese medicine, astragalus-containing
herbal mixtures are also sometimes used with the intention to reduce side
effects of chemotherapy and other cancer treatments. Astragalus-containing
herbal combination formulas may also have beneficial effects in aplastic
anemia. Due to a lack of well-designed research, a firm conclusion cannot be
Caution is advised when taking astragalus supplements, as
numerous adverse effects including drug interactions are possible. Astragalus
should not be used if pregnant or breast-feeding, unless otherwise directed by
Baikal skullcap : Although the outcomes of early studies
using baikal skullcap for cancer are promising, high-quality clinical studies
are needed in this area before a conclusion can be made. Avoid if allergic or
hypersensitive to Baikal skullcap (Scutellaria barbata), its constituents, or
members of the Lamiaceae family. Use cautiously if taking sedatives and/or
operating heavy machinery. Use cautiously if taking antineoplastic (anticancer)
agents or agents metabolized by cytochrome P450 enzymes. Avoid if pregnant or
breastfeeding. Baikal skullcap is an ingredient in PC-SPES, a product that has
been recalled from the U.S. market and should not be used.
Bee pollen : Bee pollen is considered a highly nutritious
food because it contains a balance of vitamins, minerals, proteins,
carbohydrates, fats, enzymes, and essential amino acids. Research has found
that bee pollen may reduce some adverse effects of cancer treatment side
effects. Additional study is needed before a firm recommendation can be made.
Caution is advised when taking bee pollen supplements as allergic reactions may
occur in sensitive individuals. Bee pollen should not be used if pregnant or
breast-feeding, unless otherwise directed by a doctor.
Beta-glucan : Treatment with a beta-glucan, called lentinan,
plus chemotherapy (S-1) may help prolong the lives of patients with cancer that
has returned or cannot be operated on. More research is needed in this area.
Avoid if allergic or hypersensitive to beta-glucan. When taken by mouth,
beta-glucan is generally considered safe. Use cautiously with AIDS or
AIDS-related complex (ARC). Avoid using particulate beta-glucan. Avoid if
pregnant or breastfeeding.
Bitter melon : Bitter melon (Momordica charantia) is used in
Avurvedic medicine from India to lower blood sugar levels. Research has also
found that bitter melon extracts may be beneficial in cancer therapies. MAP30,
a protein isolated from bitter melon extract, is reported to possess
anti-cancer effects in laboratory studies. Potential anti-cancer effects have
not been studied appropriately in humans. Caution is advised when taking bitter
melon supplements, as numerous adverse effects including blood sugar lowering
and drug interactions are possible. Bitter melon should not be used if pregnant
or breast-feeding, unless otherwise directed by a doctor.
Black tea : Black tea (Camellia sinensis) is from the same
plant as green tea, but the leaves are processed differently. Black tea usually
contains more caffeine than green tea. Several studies have explored a possible
association between regular consumption of black tea and rates of cancer in
several populations. This research has yielded conflicting results, with some
studies suggesting benefits, and others reporting no effects. Laboratory and
animal studies report that components of tea, such as polyphenols, have
antioxidant properties and effects against tumors. However, effects in humans
remain unclear, and these components may be more common in green tea rather
than in black tea. Some animal and laboratory research suggests that components
of black tea may actually be carcinogenic, or cancer causing, although effects
in humans are not clear. Overall, the relationship of black tea consumption and
human cancer prevention remains undetermined.
Avoid if allergic or hypersensitive to caffeine or tannins.
Skin rash and hives have been reported with caffeine ingestion. Use caution
with diabetes. Use cautiously if pregnant. Heavy caffeine intake during
pregnancy may increase the risk of SIDS (sudden infant death syndrome). Very
high doses of caffeine have been linked with birth defects. Caffeine is
transferred into breast milk. Caffeine ingestion by infants can lead to sleep
disturbances/insomnia. Infants nursing from mothers consuming greater than 500
milligrams of caffeine daily have been reported to experience tremors and heart
rhythm abnormalities. Tea consumption by infants has been linked to anemia,
decreased iron metabolism, and irritability.
Bovine cartilage : In early study, bovine tracheal cartilage
(preparations such as Catrix© and VitaCarte©) has been studied for the
treatment of cancer with encouraging results. High quality clinical research is
needed to better determine the effectiveness of bovine tracheal cartilage preparations
for cancer treatment.
Avoid if allergic or hypersensitive to bovine cartilage or
any of its constituents. Use cautiously with cancer, renal (kidney) failure, or
hepatic (liver) failure. Avoid if pregnant or breastfeeding.
Bromelain : Bromelain is a sulfur-containing digestive
enzyme (proteins which help with digestion) that is extracted from the stem and
the fruit of the pineapple plant (Ananas comosus). There is not enough
information to recommend for or against the use of bromelain in the treatment
of cancer, either alone or in addition to other therapies. One small study
found that a bromelain supplement decreased tumor size in 12 breast cancer
patients. Patients took the supplements for different periods of time, lasting
from months to years. Caution is advised when taking bromelain supplements, as
numerous adverse effects including blood thinning and drug interactions are
possible. Bromelain should not be used if pregnant or breast-feeding, unless
otherwise directed by a doctor.
Cat's claw : Originally found in Peru, the use of cat's claw
(Uncaria tomentosa) has been said to date back to the Inca civilization,
possibly as far back as 2,000 years. Cat's claw has anti-inflammatory
properties, and several low-quality studies suggest that cat's claw may slow
tumor growth. However, this research is early and has not identified specific
types of cancer that may benefit; thus, the results are not clear. A few
studies suggest that cat's claw may also boost the immune system. Caution is
advised when taking cat's claw supplements, as numerous adverse effects
including blood thinning and drug interactions are possible. Cat's claw should
not be used if pregnant or breast-feeding, unless otherwise directed by a
Chaparral : Chaparral was used by the Native Americans for
various health conditions. The chaparral component nordihydroguaiaretic acid
(NDGA) has been evaluated as a treatment for cancer but due to risk of toxicity
is considered unsafe and not recommended for use. Chaparral and NDGA have been
associated with cases of kidney and liver failure, liver cirrhosis, kidney
cysts, and kidney cancer in humans. In response to these reports, the U.S. Food
and Drug Administration (FDA) removed chaparral from its "generally
recognized as safe" (GRAS) list in 1970. Chaparral and NDGA are generally
considered unsafe and are not recommended for use.
Avoid if allergic to chaparral or any of its components,
including nordihydroguaiaretic acid. Use cautiously if taking blood thinners
(anticoagulants), blood sugar medication, or drugs that are broken down by the
liver (like amiodarone, phenobarbital, valproic acid). Stop use two weeks
before surgery/dental/diagnostic procedures with bleeding risk, and do not use
immediately after these procedures. Use cautiously if driving or operating
heavy machinery. Avoid if pregnant or breastfeeding.
Chlorophyll : Preliminary evidence in suggest that
chlorophyll may aid in the reduction of side effects associated with
photodynamic therapies, such as those used in management of malignant tumors.
Further research is required to support the use of chlorophyll as a laser
therapy adjunct for cancer treatment.
Avoid if allergic or hypersensitive to chlorophyll or any of
its metabolites. Use cautiously with photosensitivity, compromised liver
function, diabetes or gastrointestinal conditions or obstructions. Use
cautiously if taking immunosuppressant agents or antidiabetes agents. Avoid if
pregnant or breastfeeding.
Chrysanthemum : Early study indicates that hua-sheng-ping
(includes Chrysanthemum morifolium, Glycyrrhiza uralensis, and Panax
notoginseng) may be beneficial for patients with precancerous lesions. However,
more research is needed.
Avoid if allergic or hypersensitive to Chrysanthemum, its
constituents, or members of the Asteraceae/Compositae family, such as
dandelion, goldenrod, ragweed, sunflower, and daisies. Use cautiously if taking
medication for gout, cancer, or HIV. Use cautiously with compromised immune
systems or if taking immunomodulators. Avoid with photosensitivity or if taking
photosensitizers. Avoid large acute or chronic doses of ingested pyrethrin.
Avoid pyrethrin with compromised liver function, epilepsy, or asthma. Avoid
ocular exposure to pyrethrin. Avoid if pregnant or breastfeeding.
Coenzyme Q10 : Further research is needed to determine if
coenzyme Q10 (CoQ10) may be of benefit for cancer when used with other
Allergy associated with Coenzyme Q10 supplements has not
been reported, although rash and itching have been reported rarely. Stop use
two weeks before surgery/dental/diagnostic procedures with bleeding risk and do
not use immediately after these procedures. Use caution with a history of blood
clots, diabetes, high blood pressure, heart attack, or stroke, or with
anticoagulants (blood thinners) or antiplatelet drugs (like aspirin, warfarin,
clopidogrel (like Plavix©), or blood pressure, blood sugar, cholesterol or
thyroid drugs. Avoid if pregnant or breastfeeding.
Copper : Copper is a mineral that occurs naturally in many
foods, including vegetables, legumes, nuts, grains and fruits, as well as
shellfish, avocado, and beef (organs such as liver). Preliminary research
reports that lowering copper levels theoretically may arrest the progression of
cancer by inhibiting blood vessel growth (angiogenesis). Copper intake has not
been identified as a risk factor for the development or progression of cancer.
Copper is potentially unsafe when used orally in higher doses than the RDA.
Copper supplements should not be used if pregnant or breast-feeding, unless
otherwise directed by a doctor.
Cranberry : Several laboratory studies have reported
positive effects of proanthocyanidins, flavonoid components of cranberry
(Vaccinium macrocarpon) and other fruits such as blueberries, grape seed, and
pomegranate, on health. Based on early laboratory research, cranberry has been
proposed for cancer prevention. Additional study is needed in humans before a
conclusion can be made.
Avoid if allergic to cranberries, blueberries or other
plants of the Vaccinium species. Sweetened cranberry juice may effect blood
sugar levels. Use cautiously with a history of kidney stones. Avoid more than
the amount usually found in foods if pregnant or breastfeeding.
Dandelion : Limited animal research does not provide a clear
assessment of the effects of dandelion on tumor growth. Well-conducted human
studies are needed to better determine dandelion's effects on cancer.
Avoid if allergic to chamomile, feverfew, honey, yarrow, or
any related plants such as aster, daisies, sunflower, chrysanthemum, mugwort,
ragweed, or ragwort. Use cautiously with diabetes or bleeding disorders,
gastroesophageal reflux disease (GERD), kidney or liver diseases, or a history
of stroke or electrolyte disorders. Monitor potassium blood levels. Stop use
two weeks before surgery/dental/diagnostic procedures with bleeding risk and do
not use immediately after these procedures. Avoid if pregnant or breastfeeding.
Echinacea : There is currently a lack of clear human
evidence that echinacea affects any type of cancer. The evidence from a small
number of clinical trials evaluating efficacy of echinacea in the treatment of
radiation-induced leukopenia (decrease in white blood cells) is equivocal. Studies
have used the combination product Esberitox©, which includes extracts of
echinacea (Echinacea purpurea and pallida) root, white cedar (Thuja
occidentalis) leaf, and wild indigo (Baptisia tinctoria) root. Additional
clinical studies are needed to make a conclusion.
Caution is advised when taking echinacea supplements, as
numerous adverse effects including drug interactions are possible. Echinacea
should not be used if pregnant or breast-feeding, unless otherwise directed by
Essiac© : Essiac© contains a combination of herbs, including
burdock root (Arctium lappa), sheep sorrel (Rumex acetosella), slippery elm
inner bark (Ulmus fulva), and Turkish rhubarb (Rheum palmatum). The original
formula was developed by the Canadian nurse Rene Caisse (1888-1978) and is
thought to be effective in cancer therapies, although currently there is not
enough evidence to recommend for or against the use of this herbal mixture as a
therapy for any type of cancer. Different brands may contain variable
ingredients, and the comparative effectiveness of these formulas is not known.
None of the individual herbs used in Essiac© has been tested in rigorous human
cancer trials, although some components have anti-tumor activity in laboratory
studies. Numerous individual patient testimonials and reports from
manufacturers are available on the Internet, although these cannot be
considered scientifically viable as evidence. Individuals with cancer are
advised not to delay treatment with more proven therapies. Caution is advised when
taking Essiac© supplements, as numerous adverse effects including drug
interactions are possible. Essiac© should not be used if pregnant or
breast-feeding, unless otherwise directed by a doctor.
Focusing : Focusing (experiential therapy) is a method of psychotherapy
that involves being aware of one's feelings surrounding a particular issue and
understanding the meaning behind words or images conveyed by those feelings.
Early evidence suggests focusing may improve mood and attitude in cancer
patients. Firm recommendations cannot be made until well-designed clinical
trials are available.
Side effect reporting is rare, but patients should consult
with a qualified healthcare practitioner before making decisions about medical
conditions and practices. Individuals with severe emotional difficulties should
not abandon proven medical and psychological therapies but rather choose
focusing as a possible adjunct.
Folic acid : Folic acid or folate is a form of a
water-soluble B vitamin needed for human health. Preliminary evidence suggests
that folate may decrease the risk of several types of cancer. Additional
research is needed to make a conclusion. Folic acid supplementation may mask
the symptoms of pernicious, aplastic, or normocytic anemias caused by vitamin
B12 deficiency and may lead to neurological damage.
Avoid if allergic or hypersensitive to folate or any folate
product ingredients. Use cautiously if receiving coronary stents and with
anemia and seizure disorders. It is recommended that pregnant women consume 400
micrograms daily in order to reduce the risk of fetal defects. Folate is likely
safe if breastfeeding.
Gamma linolenic acid (GLA) : GLA is an omega-6 essential
fatty acid. Some laboratory and human studies indicate that GLA may have
anti-tumor activity and may be used as a cancer treatment adjunct. Additional
research is needed in this area.
Caution is advised when taking GLA supplements, as numerous
adverse effects including an increased risk of bleeding and drug interactions
are possible. GLA should not be used if pregnant or breast-feeding, unless
otherwise directed by a doctor.
Garlic : Preliminary human studies suggest that regular
consumption of garlic (Allium sativum) supplements may reduce the risk of
developing several types of cancer. Some studies use multi-ingredient products
so it is difficult to determine if garlic alone may play a beneficial role in
cancer prevention. Further well-designed human clinical trials are needed to
conclude whether eating garlic or taking garlic supplements may prevent or
Caution is advised when taking garlic supplements, as
numerous adverse effects including an increased risk of bleeding and drug
interactions are possible. Garlic should not be used if pregnant or
breast-feeding, unless otherwise directed by a doctor.
Ginseng : Early studies report that ginseng taken by mouth
may be of benefit in cancer prevention, especially if ginseng powder or extract
is used. Weak studies suggest that ginseng in combination with other herbs may
improve cell activity, immune function, and red and white blood cell counts in
patients with aplastic anemia; however, other studies have found decreases in
blood cell counts. Early studies suggest that ginseng may decrease radiation
therapy side effects and may be used as a chemotherapy adjunct to improve body
weight, quality of life, and the immune response. There is currently not enough
evidence to recommend the use of Panax ginseng or American ginseng for these
indications. Study results are unclear, and more research is needed before a
clear conclusion can be reached.
Caution is advised when taking ginseng supplements, as
numerous adverse effects including an increased risk of drug interactions are
possible. Ginseng should not be used if pregnant or breast-feeding, unless otherwise
directed by a doctor.
Currently, known methods for prevention of lung cancer are
unavailable. However, smoking cessation may reduce the risk of developing lung
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Natural Standard (www.naturalstandard.com)