Colon cancer is cancer of
the large intestine (colon), which is the lower part of the digestive system.
Rectal cancer occurs on the last eight to ten inches of the colon. They are
often referred to together as colorectal cancers, and are the second-leading
cause of cancer-related deaths in the United States.
The colon and rectum are
part of the digestive tract. They comprise the large intestine, or large bowel,
which is located in the abdomen between the small intestine and the anus.
The incidence is slightly
higher in men than women, and is highest in African American men. The incidence
of colorectal cancer is highest in developed countries such as the United
States and Japan, and lowest in developing countries such as Africa and Asia.
Estimated number of new
cases and deaths from colon and rectal cancer in the United States in 2007 are
as follows: new cases: 112,340 (colon); 41,420 (rectal); deaths: 52,180 (colon
and rectal combined).
individuals have a higher incidence of a specific genetic mutation (called
I1307K) that increases the risk for colorectal cancer.
The American Cancer Society
states that most (over 95%) colon cancers are adenocarcinomas (cancer in the
glands or secretory cells) that develop when a change occurs in cells that line
the wall of the colon or rectum. The disease often begins as an intestinal
polyp, also called an adenoma, which is an abnormal growth of tissue. Polyps
can gradually become precancerous and then cancerous.
Age: The chances of having colorectal cancer increases after
the age of 50. According to the American Cancer Society, more than 9 out of 10
people with colorectal cancer are older than 50.
Previous colorectal cancer: Although the colorectal cancer
has been completely removed, there is a risk that new cancers could grow in
other areas of the colon and rectum.
History of polyps: An increased risk for colorectal cancer
may depend on a larger size or greater number of polyps.
Inflammatory intestinal conditions: Inflammatory bowel
diseases such as ulcerative colitis and Crohn's disease increase the risk of
colon cancer. In these conditions, the colon is inflamed over a long period of
time and there may be ulcers in the lining.
Genetics: If an individual has close relatives (such as a
parent or sibling) that have had colon cancer, their risk is increased. This is
especially true if the family member had cancer before the age of 60.
Individuals with a family history of colorectal cancer should talk to their
doctors about how often screening tests should be performed.
An estimated 25% of colon cancer cases may be linked to
genetics. Some mutations are inherited, while others occur randomly during a
person's life. Mutations in three main types of genes have been linked to colon
cancer. These include tumor-suppressor genes, proto-oncogenes, and stability
Tumor-suppressor genes help prevent cancer by regulating
cell growth. They prevent cells from dividing too rapidly or uncontrollably.
When tumor-suppressor genes are mutated, they do not function properly. As a
result, cells may grow uncontrollably and possibly lead to cancerous tumors.
Mutations in several different tumor-suppressor genes, including the APC, DCC,
DPC4 (also known as SMAD4), LKB1, MSH2, and MLH1 genes, have been linked to
colon cancer or colorectal cancer. Some tumor-suppressor genes, such as the
TP53 (p53) gene, are associated with many different types of cancers, including
Proto-oncogenes also help regulate cell division. When a
proto-oncogene is mutated, it is called an oncogene. Mutations in several
proto-oncogenes, including C-MYC and MYB, have been linked to colon cancer.
Researchers have recently discovered that the CDK8 oncogene may also increase a
person's susceptibility to colon cancer.
Stability genes repair DNA damage or abnormalities that
occur during cellular division. When these genes are mutated, it may cause
genetic mutations that can lead to cancer. Examples of stability genes
associated with colon cancer include hMLH1 hMSH2, hMSH6, PMS2, MYH (MutYH), and
Ethnic background: Jewish individuals of Eastern European
descent (Ashkenazi) have a higher rate of colon cancer.
Diet: A diet high in fat, especially from animal sources,
may increase the risk of colorectal cancer. Poor food choices may result in a
deficiency of nutrients, such as calcium, magnesium, pyridoxine (vitamin B6)
and folic acid, and these nutrients may be helpful in reducing the risk of
Lack of exercise: People who are inactive have a higher risk
of colorectal cancer.
Obesity: Obesity increases an individual's risk for
Smoking: Recent studies have shown that smokers are 30-40%
more likely than nonsmokers to die of colorectal cancer.
Alcohol: Heavy and chronic use of alcohol has been linked to
Diabetes: Individuals with diabetes have as a high as a 40%
increased risk of developing colorectal cancer.
Other cancers and their treatment: A recent report on
testicular cancer survivors found that men with this condition had a higher
rate of colorectal cancer. Men who receive radiation therapy for prostate
cancer have also been reported to have a higher risk of rectal cancer.
The risk factors mentioned above leave the individual
susceptible to developing colon or rectal cancers.
Polyps: In the colon and rectum, the exaggerated growth of
cells may cause precancerous polyps (adenomas, or adenomatous polyps), which
form in the lining of the intestine. Over a period of time some of these polyps
may become cancerous. In the later stages of the disease, these cancerous
polyps may penetrate the colon walls and metastasize (spread) to nearby lymph
nodes and other organs.
SIGNS AND SYMPTOMS
There may be no symptoms in the early stages of the disease.
When symptoms appear, they'll likely vary, depending on the cancer's size and
location in the large intestine. In some cases, symptoms may result from a
condition other than cancer, such as inflammatory bowel disease (IBD),
irritable bowel syndrome (IBS), Crohn's disease, and sometimes diverticulosis
or diverticulitis (conditions in which pouches form in the colon wall,
weakening it and causing inflammation). Like colorectal cancer, these
conditions are treatable.
Signs and symptoms to be aware of include a change in bowel
habits including: diarrhea, constipation, a change in the consistency of the
stool for more than a couple of weeks, narrow stools, rectal bleeding or blood
in the stool, persistent abdominal discomfort such as cramps, gas or pain,
abdominal pain with a bowel movement, a feeling that the bowel is not emptying
completely, and/or an unexplained weight loss.
Blood in the stool may be a sign of cancer, but it can also
indicate other conditions. Bright red blood on bathroom tissue or in the toilet
may come from hemorrhoids or minor tears (fissures) in the anus, or from
certain foods such as beets, spinach, red cabbage, or food dyes. Iron
supplements and some anti-diarrheal medications may make stools appear black.
Detection of early colon cancer is difficult due to a lack
of symptoms. Most colon cancers develop from adenomatous polyps, which is why
screening is extremely important for detecting polyps early. Symptoms usually
appear with a more advanced disease.
Digital rectal exam: Digital rectal exams are performed in a
doctor's office. A gloved finger is used to check the first few inches of the
rectum for large polyps and cancers. Although safe and painless, the exam is
limited to the lower rectum and cannot detect problems with the upper rectum
and colon. In addition, it's difficult for a doctor to feel small polyps.
Fecal occult (hidden) blood test: This test checks a sample
of the stool for blood. It can be performed in the doctor's office, or a kit
may be given to the patient that explains how to take the sample at home. In
colorectal cancer most polyps don't bleed, which can result in a negative stool
test result, even though an individual may have cancer. Blood may also be the
result of hemorrhoids or minor tears, so it can only aide in the diagnosis of
Flexible sigmoidoscopy: The doctor uses a flexible, slender
and lighted tube to examine the rectum and sigmoid colon (approximately the
last two feet of the colon). The test is fast but can sometimes be
uncomfortable. If a polyp or colon cancer is found during this exam, the doctor
will recommend a colonoscopy to look at the entire colon and remove any polyps
for further examination under a microscope.
Barium enema: This diagnostic test allows the doctor to
evaluate the entire large intestine with an X-ray. Barium, a contrast dye, is
placed into the bowel using an enema, and air may also be added. The barium
fills and coats the lining of the bowel, creating a clear outline of the
rectum, colon, and occasionally a small portion of the small intestine. A flexible
sigmoidoscopy is often done in addition to the barium enema to aid in detecting
small polyps that a barium enema X-ray may miss. This commonly occurs in the
lower bowel and rectum.
Colonoscopy: This procedure is the most sensitive test for
colon cancer, rectal cancer, and polyps. Colonoscopies are similar to flexible
sigmoidoscopies, but the instrument used is a colonoscope, a long, flexible,
and slender tube attached to a video camera and monitor. This allows the doctor
to view the entire colon and rectum. If any polyps are found during the exam,
the doctor may remove them immediately or take tissue samples (biopsies) for
analysis. This is done through the colonoscope and is virtually painless, but
the patient may receive a mild sedative for comfort. Preparation for the
procedure involves drinking a large amount of fluid containing a laxative to
clean out the colon.
Genetic testing: If there is a family history of colorectal
cancer, the individual may be a candidate for genetic testing.
Blood tests: Blood tests may include a test for anemia (if
bleeding occurs). A newer test checks a stool sample for DNA of abnormal cells.
It is called the carcinoembryonic antigen (CEA) assay. It is useful because CEA
is released into the bloodstream from both cancer cells and normal cells, and
has been found in colon cancer.
Biopsy: For a biopsy, the doctor removes a small piece of
tissue that is sent to the lab and examined under the microscope to see if any
cancer is present.
Ultrasound: Ultrasound uses sound waves to produce a picture
of the inside of the body. Two special types of ultrasound may be useful for
people with colon or rectal cancer. In one, the instrument that gives off sound
waves is placed into the rectum. In the other test, the instrument is used during
surgery and is placed against the surface of the liver to see if the cancer has
CT scan (computed tomography): A CT scan uses x-rays to take
many pictures of the body and then combines the pictures by computer which
provides a detailed picture. A CT scan can often show whether the cancer has
spread to the liver, lungs, or other organs. CT scans can also be used to help
guide a biopsy needle into a tumor. A newer way to use a CT scan is to perform
a "virtual colonoscopy." Once the colon is cleaned and filled with
air, a computer puts together a picture of the inside of the colon. The same
preparation for a colonoscopy is used and there may be some discomfort from the
bowel being filled with air. If anything abnormal is detected, a follow-up colonoscopy
will be needed.
MRI (magnetic resonance imaging): Similar to CT scans, MRI's
display a cross-section of the body using radio waves and strong magnets
instead of radiation. A contrast dye may be injected, although it is used less
often with MRI's. An MRI scan is most helpful when looking at the brain and
spinal cord. They may take longer than CT scans, and the patient is placed
inside a confining tube.
Chest x-ray: This test may be done to see whether colorectal
cancer has spread to the lungs.
PET scan (positron emission tomography): PET scans for colon
cancer use a type of radioactive sugar, because cancer cells absorb high
amounts of sugar. A special camera is used to visualize where the cancerous
cells may reside.
Angiography: A dye is injected and a series of x-ray
pictures are taken during this procedure. Surgeons may use this method to find
blood vessels near cancers that have spread to the liver.
American Cancer Society Colorectal Cancer Screening
Guidelines state that beginning at age 50, both men and women with an average
risk should follow one of the five screening options including: yearly stool
blood tests, flexible sigmoidoscopy every five years, yearly stool blood test
plus flexible sigmoidoscopy every five years, a double contrast barium enema
every five years, or a colonoscopy every ten years.
Despite its high incidence, colorectal cancer is one of the
most detectable and, if found early enough, most treatable forms of cancer.
Over 90% of those diagnosed when the cancer remains localized survive more than
five years. However, currently only 37% of colorectal cancers are detected
while still localized.
Staging colon cancer: Once diagnosed with colorectal cancer,
a doctor will determine the "stage" of the cancer. Staging helps
determine how well the individual will do and what treatments are most
Stage 0: Stage 0 cancer is the earliest stage. The cancer
hasn't grown beyond the inner layer (mucosa) of the colon or rectum. This stage
is also known as carcinoma in situ.
Stage I: In stage I, the cancer has grown through the
mucosa, but hasn't spread beyond the colon wall or rectum.
Stage II: In stage II, the cancer has grown through the wall
of the colon or rectum, but hasn't spread to nearby lymph nodes.
Stage III: In stage III, the cancer has invaded nearby lymph
nodes, but isn't affecting other parts of the body.
Stage IV: In stage IV, the cancer has spread to distant
sites such as the liver, lung, membrane lining of the abdominal cavity, or to
Recurrent: Recurrent colon cancer may happen following
treatment occurring in the colon, rectum, or other parts of the body.
Metastasis (spreading) to other organs, such as the liver,
pancreas, lungs, and lymph nodes may occur causing an increase chance of death.
Colonoscopy procedures may cause complications including
perforation (a hole), bleeding, infection, abdominal distension (bloating),
postpolypectomy coagulation syndrome (damage to the colon wall from a snare
loop or hot forceps used in diagnostic procedures), splenic rupture, and small
Surgery: Surgery is the treatment of choice for colorectal
cancer. Treatment depends on the stage of the disease and the overall health of
the patient. Chemotherapy and radiation therapy may be used as adjuvant
treatment (in addition to surgery).
Radical bowel resection, also called partial colectomy and
hemicolectomy, is used to treat 80 to 90% of colorectal cancer patients. This
procedure may be performed through a large incision in the abdomen (open
surgery) or through several small incisions (laparoscopic surgery). If the
cancer has spread, the lymph nodes will be removed. Removal of the lymph nodes
is called lymphadenectomy.
Recovery from surgery varies depending on the patient's age,
overall health, and the extent of the surgery. After surgery, patients may
experience pain, weakness, fatigue, and loss of appetite. Dietary modifications
may be necessary until the digestive tract heals. Complications that may occur
include allergic reaction to anesthesia, formation of a blockage of the
intestine, formation of blood clots or bleeding, wound infection, and leakage
at the reconnection site.
If the colon cannot be reconnected, a temporary or permanent
colostomy is performed, which allows feces from the colon to pass into a
collection vessel outside the body. Approximately 15% of patients require a
Chemotherapy: Chemotherapy is used to reduce the likelihood
of metastasis (spreading), shrink tumor size, or slow tumor growth.
Chemotherapy is often used after surgery (adjuvant), before surgery
(neo-adjuvant), or as the primary therapy if surgery is not indicated
(palliative). It may be combined with biological therapy (also called
immunotherapy) and radiation therapy.
Adjuvant (after surgery) chemotherapy: The most commonly
used intravenous regimen is called FOLFOX, and includes 5-fluorouracil (5-FU)
or capecitabine (Xeloda©), leucovorin (folinic acid), and oxaliplatin
Chemotherapy for metastatic disease: Commonly used first
line chemotherapy regimens involve the combination of 5-fluorouracil,
leucovorin, and oxaliplatin (FOLFOX) with bevacizumab (Avastin©), or
5-fluorouracil, leucovorin, and irinotecan (Camptosar©) (called FOLFIRI) with
Other chemotherapy combinations and agents: Chemotherapy
combinations used to prevent recurrence following surgery or used to shrink the
tumors prior to surgery include FOLFOX (5-FU, leucovorin, and oxaliplatin) and
FOFIRI (5-FU, leucovorin, and irinotecan). Colorectal cancer with liver
metastasis also may be treated using floxuridine (FUDR©) administered through
an artery. Other agents for metastatic colon cancer include bortezomib
(Velcade©), panitumumab (Vectibix©), oblimersen (Genasense©, G3139), gefitinib
and erlotinib (Tarceva©), topotecan (Hycamtin©), Bacillus Calmette-Gu©rin
(BCG), and levamisole (Ergamisol©).
Chemotherapy side effects: Side effects of chemotherapy include
nausea, vomiting, inflammation of the intestine (enteritis), diarrhea, mouth
irritation (mucositis), low white blood cell count (neutropenia), and hair loss
(alopecia). Biological therapy may cause flu-like side effects such as chills,
diarrhea, fever, loss of appetite, muscle aches, weakness, and nausea/vomiting.
Radiation Therapy: Radiation therapy uses X-rays to kill any
cancer cells that might remain after surgery, to shrink large tumors before
operations so that they can be removed easily, or to relieve symptoms of colon
cancer and rectal cancer. The goal of therapy is to damage the tumor without
harming the surrounding tissue. If the cancer has spread through the wall of
the rectum, radiation treatments in combination with chemotherapy after surgery
may be used. This may help prevent cancer from reappearing in the same place.
Side effects of radiation therapy may include diarrhea, rectal bleeding,
fatigue, reddened and swollen skin, loss of appetite and nausea /vomiting.
Vaccine: A new vaccine, called TroVax©, works by using the
patient's own immune system to fight the disease. TroVax© is in clinical trials
and has reported positive results for colon cancer therapy.
Follow-up Treatment: Follow-up care is recommended for
colorectal cancer patients to ensure that recurrent or metastatic disease is
detected as soon as possible. Patients will generally undergo regular physical
examinations, fecal occult blood tests, colonoscopies, CT scans, and chest
Prognosis: Prognosis depends on the stage of the disease and
the overall health of the patient. Overall, colorectal cancer patients have a
5-year survival rate of about 61%. The 5-year survival rate is about 92% when the
disease is treated before it has spread (metastasized); 64% when the cancer has
spread to nearby organs or lymph nodes; and 7% when it has spread to other
parts of the body (e.g. liver, lungs).
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.
Probiotics: Probiotics are beneficial bacteria (sometimes
referred to as "friendly germs") that help maintain the health of the
intestinal tract and aid in digestion. They also help keep potentially harmful
organisms in the gut (harmful bacteria and yeasts) under control. Most
probiotics come from food sources, especially cultured milk products. There is
recent evidence that supplementation with Lactobacillus casei may help reduce
the recurrence of colorectal tumors in patients who have previously undergone
surgery for colon cancer. Additional research is needed in this area.
Probiotics are generally considered safe and well-tolerated.
Diarrhea may be a sign of too many probiotics. Avoid if allergic or
hypersensitive to probiotics. Use cautiously if lactose intolerant. Caution is
advised when using probiotics in neonates born prematurely or with immune
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
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. Additionally, although there is
evidence from animal and laboratory studies that black tea may help prevent
colorectal cancer, human studies are limited in this area as well. Additional
research is needed.
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.
Calcium: Several large prospective studies have found
increased calcium intake to be weakly associated with a decreased risk of
colorectal cancer. Further studies are needed to verify these results.
Treatment of colorectal cancer should only be done under the supervision of a
qualified healthcare professional.
Avoid if allergic or hypersensitive to calcium or lactose.
High doses taken by mouth may cause kidney stones. Avoid with hypercalcaemia
(high levels of calcium in the blood), hypercalciuria (high levels of calcium
in urine), hyperparathyroidism (high levels of parathyroid hormone), bone
tumors, digitalis toxicity, ventricular fibrillation (ventricles of the heart
contract in unsynchronized rhythm), kidney stones, kidney disease, or
sarcoidosis (inflammation of lymph nodes and various other tissues). Calcium
supplements made from dolomite, oyster shells, or bone meal may contain
unacceptable levels of lead. Use cautiously with achlorhydria (absence of
hydrochloric acid in gastric juices) or arrhythmia (irregular heartbeat).
Calcium appears to be safe in pregnant or breastfeeding women; talk to a
healthcare provider to determine appropriate dosing during pregnancy and
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
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
Fruits, vegetables and whole grains: Fruits, vegetables and
whole grains contain vitamins, minerals, fiber and antioxidants, which may help
protect from developing cancer. Eating five or more servings of fresh fruits
and vegetables every day is important for health. A variety of produce should be
included in the patient's diet such as kale, chard, spinach, dark green
lettuce, peppers, and squash.
Fat intake reduction: People who eat high-fat diets may have
a higher rate of colorectal cancer. It is important to limit saturated fats
from animal sources such as red meat. Other foods that contain saturated fat
include milk, cheese, ice cream, coconut and palm oils. It is best to restrict
the total fat intake to about 30% of the daily calories, with no more than 10%
coming from saturated fats.
Vitamins and minerals: Calcium, magnesium, pyridoxine
(vitamin B6), and folic acid may help reduce the risk of colorectal cancer.
Good food sources of calcium include skim or low-fat milk and other dairy
products, shrimp, and soy products such as tofu and soy milk. Magnesium is
found in leafy greens, nuts, peas and beans. Food sources of vitamin B6 include
grains, legumes, peas, spinach, carrots, potatoes, dairy foods and meat. Folic
acid is found in dark leafy greens such as spinach and lettuce, and in legumes,
melons, bananas, broccoli and orange juice.
Alcohol consumption avoidance: Consuming moderate to heavy
amounts of alcohol, such as more than one drink a day for women and two for
men, may increase the risk of developing colon cancer. This is particularly true
if the individual has a close relative, such as a parent, child or sibling with
Smoking cessation: Smoking can increase the risk of
colorectal and other cancers.
Exercise and weight control: Controlling weight and
exercising regularly can reduce the risk of developing colorectal cancer.
Exercise, including light walking, stimulates movement through the bowel and
reduces the time the colon is exposed to harmful substances (carcinogens) that
may cause cancer. The American Cancer Society recommends at least 30 minutes of
physical activity five or more days a week if the individual can tolerate it.
Screening tests: It is best to follow the early detection
screening guidelines to help find colon or rectal cancer. When these cancers
are found and treated early, they can often be cured. Screening can also find
polyps, and their removal helps prevent some cancers.
Anti-inflammatory drugs: Aspirin and other anti-inflammatory
drugs, such as ibuprofen and celecoxib (Celebrex©), appear to help prevent the
growth of polyps. They may also help reduce polyps for some people whose family
members tend to develop polyps.
Statin drugs: Statin drugs are commonly used to lower blood
cholesterol levels. The regular use of these drugs has recently been found to
decrease the risk of developing colon cancer. However, another study found no
benefit between taking stains and colon cancer prevention, but the use of
statins did seem to reduce the risk of stage IV cancer.Copyright © 2011 Natural Standard