Since being diagnosed with lung cancer, you may have developed symptoms including tingling or numbness in your fingers or toes, hearing loss, forgetfulness, dizziness, or constipation. These symptoms can be caused by a condition called "neuropathy."

Neuropathy means that something is wrong with nerve tissue. Although some people with lung cancer never develop this condition, it is a fairly common occurrence. It may resolve over time, or it may be a progressive and persistent problem. About half of all people with lung cancer have some neuropathy even before treatment starts. Other medical conditions, such as impaired kidney or liver function, diabetes, alcoholism, or malnutrition, increase your chances of developing the symptoms, and people over the age of 60 are also at a greater risk.

In addition to the symptoms listed above, neuropathy may bring partial or total loss of function or mobility, swelling, and in severe cases, progressive pain. When it occurs from a nerve in the brain, neuropathy may result in cognitive changes such as memory loss or dizziness.

The degree and severity of neuropathy depends to some extent on the location of primary and metastatic sites. But close monitoring and preventive strategies can make a noticeable difference.

Disease-Related Neuropathy
Every bodily function occurs as a result of the interaction between nerves and other organs. As a tumor grows and circles around a nerve, or presses on the nerve, it decreases the blood flow to that nerve. This may cause functional changes in the body part controlled by this nerve.

An example of a condition that causes disease-related neuropathy more often with lung cancer, is "brachial plexopathy," in which the brachial nerve is entrapped by tumor. Other neuropathy problems can occur as a result of harmful substances that are produced by cancer cells; this is especially a problem in small cell lung cancers.

Treatment-Related Neuropathy
New studies are looking at ways to protect normal tissues, including nerves, from the damaging side-effects of cancer treatments. Vitamin B6, for instance, is being studied for its potential to decrease neuropathy associated with chemotherapy. Various compounds thought to protect tissues from radiation are being tested in clinical trials. As in disease-related neuropathy, treatment-related neuropathy can affect the brain, spinal cord, and the nerves that originate in the brain (called cranial nerves). If and when neuropathy is noted, the treatment can be adjusted or stopped, and further damage avoided. Early detection is key to minimizing the chances of permanent damage.

Neuropathy can force treatment to be stopped before a full regimen is completed, and can cause distressing physical and emotional effects. But close monitoring and preventive strategies can make a noticeable difference.

Chemotherapy drugs used to treat lung cancer that may cause neuropathy include the following:

• Cisplatin, which can affect hearing
• Docetaxel and Paclitaxel, which may cause numbness of the hands and feet
• Vinorelbine tartrate and Vincristine, which may cause constipation, foot drop, wrist drop, and gait changes
• Etoposide, which may cause numbness of hands and feet, fatigue, headache, dizziness, and confusion.

The degree of damage to nerves usually relates to the drug dose given at each treatment cycle, how often the drug is given, how quickly the drug is given, and in some cases, to the total or "cumulative" dose.

Damage to nerves during surgery, or scar tissue formation after surgery, can cause neuropathy and permanent changes such as (depending on the surgical site) decreased range of motion or loss of function in an arm or neck, and in some cases, pain. Post-operative radiation can also result in scar tissue and fibrosis that entraps nerves, causing diminished mobility, function, and pain.

For the most part, radiation-related neuropathy happens when radiation causes damage to the blood vessels that nourish nervous tissue. When used to manage problems caused by the spread of cancer to the brain or spinal cord, radiation most often causes symptoms such as headache; nausea; sleepiness; low-grade fever; loss of sensation; and, weakness and numbness, especially in the legs and feet. In general, the larger the dose and treatment field, the greater the effect.

Preventing and Managing Neuropathy
One of the first things to do is to ask a physical therapist or nurse to help you create a range-of-motion exercise plan for your arms and legs. Regular exercise will prevent muscle wasting and other problems relating to lack of activity.

In addition, follow these guidelines:

• Before you begin any treatment plan, talk with your doctor or nurse about the likelihood of neuropathy and its early signs, and clarify expectations for reporting these signs.
• Ask the nurse to help you learn how to regularly assess your nervous system. Be alert to: numbing and tingling of hands and feet; slurred speech; changes in sensations of pain, touch, temperature, position, and vibration; or , difficulty with fine motor tasks, such as buttoning clothing.
• Consult with your oncologist or oncology nurse before taking any medications. Use all medications, including over-the-counter, only as prescribed. Some sedatives, tranquilizers, pain relievers, and anti-nausea medications can increase neuropathy.
• Work with the nurse on how to avoid constipation, a common symptom, especially with treatment of vinorelbine or vincristine, that occurs when nerves that supply the bowel and rectum are affected.
• Open lines of communication between you, your family, and members of your health care team will help you recognize early signs before neuropathy progresses. Preventing or minimizing neuropathy during treatment will not only help you complete the treatment, but can help preserve your quality of life post-treatment.
• If you have been diagnosed with lung cancer, implement these safety measures immediately, and continue them until your oncologist says you are past the chances of developing neuropathy:
• Keep the water heater setting at or below 110∞ F, in response to heat and cold insensitivity, and bathe in warm, not hot, water.
• Routinely inspect affected body areas for burns, cuts, or scratches.
• Use rubber gloves or gardening gloves when doing household chores.
• Avoid use of heating pads.
• Wear shoes or slippers at all times to protect your feet.
• Avoid extreme hot or cold temperatures.

For more information about neuropathy please contact your health professional or visit The Neuropathy Association, www.neuropathy.org.