Stomach cancer, also known
as gastric cancer, is a malignant (cancerous) tumor within the stomach.
The stomach is a muscular
sac located in the upper middle of the abdomen, just below the ribs. The
stomach walls are lined with three layers of powerful muscles that mix food
with enzymes and acids produced by glands in the stomach's inner lining. The stomach's
delicate tissues are protected from this acidic mix by a thick, gelatinous
mucus that coats the stomach lining. Food moves from the mouth through the
esophagus to reach the stomach. In the stomach, the food becomes liquid. The
liquid then moves into the small intestine, where it is digested even further.
Most (85%) cases of gastric
cancer are adenocarcinomas that occur in the lining of the stomach (mucosa).
Adenocarcinoma is a type of cancer that develops in cells lining glandular
types of internal organs, such as the lungs, breasts, colon, prostate, stomach,
pancreas, and cervix. Approximately 40% of cases develop in the lower part of
the stomach, called the pylorus; 40% develop in the middle part, called the
body; and 15% develop in the upper part, called the cardia. In about 10% of
cases, cancer develops in more than one part of the organ.
Stomach cancer can spread
(metastasize) to the esophagus or the small intestine, and can extend through
the stomach wall to nearby lymph nodes and organs, such as the liver, pancreas,
and colon. It also can metastasize to other parts of the body, such as the
lungs, ovaries, and bones.
According to the National
Cancer Institute (NCI), approximately 760,000 cases of stomach cancer are
diagnosed worldwide and more than 24,000 cases are diagnosed in the United
States each year. Men are more likely than women to develop stomach cancer.
Incidence is highest in Japan, South America, Eastern Europe, and parts of the
The American College of
Gastroenterology has found that stomach cancer occurs twice as often in men and
it is more common in people over the age of 55. In the United States, incidence
is higher in African Americans than in Caucasians.
Cancer of the stomach is
difficult to cure unless it is found at an early stage, before it has begun to
spread. Unfortunately, because early stomach cancer causes few symptoms, the
disease is usually advanced when the diagnosis is made. However, advanced
stomach cancer can be treated and the symptoms can be relieved.
TYPES OF STOMACH CANCER
Adenocarcinomas: The great majority of stomach cancers are
adenocarcinomas, which start in the glandular cells in the stomach's inner-most
lining. Adenocarcinomas account for about 95% of all stomach cancers.
Lymphomas: Lymphomas are cancers of the immune system tissue
in the stomach wall. Some lymphomas grow fast, whereas others grow much more
slowly. Aggressive lymphomas, known medically as mucosa-associated lymphoid
tissue (MALT) lymphomas, usually stem from H. pylori bacterial infection and
are often curable when found in the early stages.
Carcinoid tumors: A small percentage of stomach cancers are
slow growing tumors that originate in the stomach's hormone-producing cells.
Carcinoid tumors tend to grow less quickly and spread (metastasize) less
frequently than adenocarcinomas.
Gastrointestinal stromal tumors (GISTs): Gastrointestinal
stromal tumors (GISTs) are rare tumors developed from cells called interstitial
cells of Cajal. Interstitial cells of Cajal are part of the autonomic nervous
system and trigger gut contraction. The autonomic nervous system consists of
the nerves in the part of the nervous system that regulate non-conscious body
functions, such as heart rate, blood pressure, and intestinal function.
Although GISTs can occur anywhere from the esophagus to the
rectum, most are found in the stomach. Approximately 5,000 GISTs are diagnosed
each year in the United States, and they occur most commonly in the stomach
(60-70%) and small intestine (20-30%). The remaining cases affect the large
intestine and esophagus. Most GISTs occur in people 40-80 years old, and GIST
is more common in men than in women. There are no known risk factors for GIST;
however, there appears to be a small increase in risk of developing GIST if
there is a family history of the disease.
Recurrent cancer: Recurrent cancer can occur in individuals
in remission from gastric cancer. Recurrent cancer means that although the
individual's tumor was either partially or completely eliminated by treatment
and was no longer detectable using diagnostic testing, a few cancer cells may
not have been completely destroyed, allowing for these cells to multiply and
return as a new tumor.
CAUSES AND RISK FACTORS
Healthy cells grow and divide in an orderly way. This
process is controlled by DNA, the genetic material that contains the
instructions for every chemical process in the body. When DNA is damaged, these
genes may not function properly, causing cells to grow out of control and
eventually form a tumor - a mass of malignant cells.
Age: Most individuals with stomach cancer develop it at age
72 or older.
Gender: Men are more likely than women to develop stomach
Ethnicity: Stomach cancer is more common in Asian, Pacific
Islander, Hispanic, and African Americans than in non-Hispanic, Caucasian
Diet: Studies suggest that people who eat a diet high in
smoked, salted, or pickled foods may be at an increased risk for stomach
cancer. Nitrates and nitrites are nitrogen-based chemicals that are added to
certain foods, especially cured meats such as ham, bacon, hot dogs, and deli
meats. Both nitrates and nitrites combine with other nitrogen-containing
substances in the stomach to form N-nitroso compounds, which are carcinogens
(cancer-causing agents) that are known to cause stomach cancer. Countries where
consumption of salted meat and fish and pickled vegetables is high (such as
Japan and Korea) tend to have correspondingly high rates of stomach cancer.
Eating a diet high in red meat, especially when the meat is barbecued or
well-done, also has been linked to stomach cancer. Eating fresh fruits and
vegetables may help protect against this disease.
Helicobacter pylori infection: Helicobacter pylori, or H.
pylori, is a type of bacteria that commonly lives in the stomach without
causing harm. H. pylori infection increases the risk of stomach inflammation
and stomach ulcers. It also increases the risk of stomach cancer, but only a
small number of infected people develop stomach cancer.
Smoking: Individuals who smoke are more likely to develop
stomach cancer than people who do not smoke. Smoking particularly increases the
risk for stomach cancers by causing irritation of the upper portion of the
stomach closest to the esophagus. The rate of stomach cancer is about doubled
Other health conditions: Conditions that cause inflammation
or other problems in the stomach may increase the risk of stomach cancer. These
include stomach surgery and chronic gastritis (long-term inflammation of the
Genetics: Several different genetic mutations, or
abnormalities, have been linked to gastrointestinal cancer.
Mutations in the serine/threonine kinase 11 (STK11) gene may
cause Peutz-Jeghers syndrome, which is characterized by polyps in the gastrointestinal
tract. These polyps may cause different types of cancers, including
gastrointestinal, pancreatic, cervical, ovarian, and breast cancers. The STK11
gene is a tumor-suppressor gene, which prevents cells from growing
Mutations in the adenomatosis polyposis coli (APC) gene may
lead to APC-associated polyposis conditions, which include: familial
adenomatous polyposis (FAP), attenuated FAP, Gardner syndrome, and Turcot
syndrome. All of these conditions predispose individuals to a higher risk of
colon cancer and other cancers.
Mutations in the E-cadherin (CDH1) gene have been linked to
hereditary diffuse gastric cancer (HDGC), which is a cancer of the stomach.
Women who have HDGC are also more susceptible to having lobular breast cancer.
SIGNS AND SYMPTOMS
Early stomach cancer usually does not cause symptoms.
Symptoms usually indicate advanced disease and include abdominal discomfort or
pain, blood in stool, bloating (especially after eating), diarrhea or
constipation, fatigue, gastrointestinal bleeding, indigestion or heartburn,
loss of appetite, nausea and vomiting, and weight loss.
Pain: Large stomach tumors may press on surrounding nerves,
leading to back or abdominal pain that can sometimes be severe.
Metastasis: Metastasis (the spreading of cancer) is the most
serious complication of stomach cancer. The stomach is surrounded by a number
of vital organs, including the pancreas, spleen, liver, lungs, and intestine.
Diagnosis of stomach cancer involves taking a medical
history and performing a physical examination and laboratory tests. A tumor or
mass may indicate advanced disease. Tests may include fecal occult blood test,
complete blood count (CBC), upper GI series (also called barium swallow),
gastroscopy, and imaging tests. A doctor will decide what tests are right for
Fecal occult blood test: A fecal occult blood test is used
to detect microscopic blood in the stool, which may indicate stomach or other
gastrointestinal (GI) cancers, such as colorectal cancer.
Complete blood count: A complete blood count (CBC) is a
simple blood test used to measure the concentration of white blood cells, red
blood cells, and platelets.
Tumor marker test: The presence of tumor markers, also
called biomarkers, may indicate cancer. Tumor markers are substances that are
either produced by the tumor or the host when cancer is present. There are
several different tumor markers for different cancers. The tumor marker
carcinoembryonic antigen (CEA) is present in ovarian, lung, breast, pancreatic,
and gastrointestinal cancers.
Genetic testing: Testing for genetic mutations may be used
to screen high risk individuals and to confirm cancer in suspected individuals.
Scientists may test for mutations in different genes, such as the
serine/threonine kinase 11 (STK11), adenomatosis polyposis coli (APC), and/or
E-cadherin (CDH1) genes.
Upper GI series: In an upper GI series, or barium swallow,
the individual drinks a thick, chalky liquid (barium) that coats the esophagus
and stomach and makes it easier to detect abnormal areas on X-rays. In
double-contrast barium swallow, air is blown into the esophagus and stomach to
help the liquid coat the wall of the organs more thoroughly. After the test,
the individual can eat normally and resume usual activities, although extra
water consumption will be necessary to help flush the barium from the system.
The most common complication of the procedure is temporary constipation.
Upper endoscopy: In an upper endoscopy, the doctor inserts a
thin tube that contains a light and camera (called a gastroscope) through the
mouth and esophagus and into the stomach. The gastroscope allows the doctor to
see the inside of the stomach. Small instruments can be passed through the gastroscope
and used to remove a sample of tissue for examination (biopsy) in a laboratory.
A local anesthetic is used to reduce sensation in the esophagus during this
procedure. Upper endoscopy takes about 20-30 minutes, although individuals are
not sent home until the medication wears off, which is usually one to two hours
later. Complications of the procedure rarely occur and include bleeding and
perforation of the stomach lining. The most common complication is a slight
sore throat from swallowing the endoscope.
Imaging tests: Imaging tests such as computerized tomography
(CT scan), ultrasound, magnetic resonance imaging (MRI), and positron emission
tomography (PET) scan may be used to detect metastatic stomach cancer. Once a
diagnosis of stomach cancer is made, the disease is staged.
Staging is a method of judging the progress of the cancer in
an individual. Once doctors know how severe the progression of the cancer is,
the best course of treatment can be followed. The staging process involves a
doctor examining the tumor and the extent to which it has spread to other parts
of the body. There are a number of levels of severity in staging stomach
cancer. These range from 0 to 4, with 4 being the most severe stage.
Stage 0: In stage 0, the cancer has just begun to affect the
inner lining of the stomach. The survival rate for those with stage 0 stomach
cancer is greater than 90%.
Stage 1: In stage 1, the cancer has begun to penetrate
toward the outer layer of stomach. Nearby lymph nodes may be involved. There is
a 50-80% survival rate with those diagnosed with stage 1 stomach cancer.
Stage 2: In stage 2, the cancer has progressed further
through tissue layers of stomach and more distant lymph nodes may be involved.
There is a 30-40% survival rate with those diagnosed with stage 2 stomach
Stage 3: Stage 3 cancer has penetrated all tissue layers of
stomach and distant lymph nodes may be involved. There is a 10-20% survival
rate with those diagnosed with stage 3 stomach cancer.
Stage 4: Stage 4 cancer has affected nearby organs and
tissues. Cancer may even have been carried through the lymph system to distant
parts of the body. This is known as metastasis. There is less than a 5%
survival rate with those diagnosed with stage 4 stomach cancer.
Treatment for stomach cancer depends on the size and
location of the tumor; the stage of the disease; and the individual's age and
overall health. The goal of treatment for early-stage stomach cancer is to cure
the disease. In advanced cases, when a cure is unlikely, the goal is to reduce
pain and restore some quality of life (called palliative treatment). Surgical
removal is the only curative treatment. Chemotherapy and radiation therapy may
be used in addition to surgery or as palliative treatment.
Surgery: The type of surgery depends on the stage of the
disease. Endoscopic mucosal resection may be used to treat early stomach
cancer. This procedure involves removing only the tumor and surrounding tissue.
Gastrectomy is the most common treatment for stomach cancer.
In this surgery, the entire stomach (total gastrectomy) or part of the stomach
(partial or subtotal gastrectomy) is removed. Parts of nearby tissues or organs
(such as the liver or spleen) may also be removed if the cancer has spread to those
organs. In most cases, surrounding lymph nodes also are removed to prevent
further spread of cancer. This is called a lymph node dissection. Surgery for
cancer of the upper stomach (cardia) may require removal of the stomach and
part of the esophagus.
Following total gastrectomy, the esophagus is attached
directly to the small intestine. When a large section of the stomach is removed
during partial gastrectomy, the surgeon reattaches the stomach to the esophagus
or small intestine. The connection between these organs is called an
anastomosis. Rarely, the new connections made between the ends of the stomach
or esophagus and small intestine may leak.
Gastrectomy requires a large incision. Most patients
experience postsurgical pain, weakness, fatigue, and loss of appetite. Recovery
from the procedure varies depending on the patient's age and overall health,
the type of surgery, and the stage of the disease.
Complications of surgery include blood clots, bowel
obstruction, inflammation of the gall bladder (cholecystitis) or pancreas
(pancreatitis), and pneumonia. With improvements in surgical techniques in
recent years, only about 1-2% of people die from surgery for stomach cancer.
This number is higher when the operation is more extensive, such as when all the
lymph nodes are removed. As many as 5-15% of patients may die from the surgery
when surgeons try to remove all the lymph nodes.
Removal of a large part or all of the stomach usually
requires permanent alterations in diet. Individuals often must eat more
frequently, eat smaller meals, reduce their sugar intake, and increase their
intake of fat and protein. In most cases, drinking fluids with meals must be
avoided. If only a small section is removed, patients may be able to gradually
return to previous eating habits. A healthcare professional will provide the
individual information about dietary concerns.
Dumping syndrome is a group of signs and symptoms that occur
in individuals who have undergone gastrectomy. Dumping syndrome results when
foods and liquids move too quickly into the small intestine. Symptoms of
dumping syndrome include dilation or constriction of blood vessels, which may
cause pain and headache, dizziness, flushing, sweating, and weakness.
Other long-term complications include vitamin B-12 deficiency
(pernicious anemia), inflammation of the esophagus (esophagitis), and reduced
bone mass (osteoporosis). Individuals who undergo gastrectomy also often
experience suppression of the immune system. These complications can be
counteracted with treatment options. The frequency depends on the health of the
Chemotherapy: Chemotherapy involves using prescription drugs
to destroy cancer cells. This treatment may be used after surgery to destroy
remaining cancer cells and prevent recurrence, called adjuvant treatment.
Chemotherapy may be administered orally or intravenously (IV, or through a
vein) and treatment is often administered on an outpatient basis.
5-fluorouracil (5-FU) is the most widely used agent in chemotherapy of gastric
cancer alone or combined with other cytotoxic drugs.
Note: There are currently few studies to support the use of
integrative therapies specifically for stomach cancer. The majority of the
therapies below have been reported useful in the support of cancer in general.
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
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 severe cases.
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.
Arginine: A combination of arginine and omega-3 fatty acids
may reduce the length of hospital stays and infections after gastrointestinal
cancer surgery. Other research suggests that arginine, omega-3 fatty acids, and
glutamine may boost the immune system and reduce inflammation after surgery.
More research with arginine alone is needed.
Avoid if allergic to arginine, or with a history of stroke,
liver, or kidney disease. Avoid if pregnant or breastfeeding. Use caution if
taking blood-thinning drugs (like warfarin or Coumadin©) and blood pressure
drugs or herbs or supplements with similar effects. Blood potassium levels
should be monitored. L-arginine may worsen symptoms of sickle cell disease.
Caution is advised in patients taking prescription drugs to control sugar
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 drawn.
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
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.
Limiting alcohol consumption: Alcohol consumption may
increase the risk of certain cancers. Alcohol irritates the gastric mucosa and
chronic (long-term) irritation may lead to cancer. This is particularly true if
the individual has a close relative, such as a parent, child or sibling, with
Chemical exposure: If the individual works with chemicals,
such as is the case with hairdressers, printers, and painters, he/she should
follow all safety instructions to avoid exposure. If an individual has his/her
own well for water, he/she may wish to have it tested for contaminants such as
lead and arsenic. Local health departments can be a source of water testing.
Nitrates and nitrites are nitrogen-based chemicals that are added to certain
foods, especially cured meats such as ham, bacon, hot dogs, and deli meats.
Both nitrates and nitrites combine with other nitrogen-containing substances in
the stomach to form N-nitroso compounds - carcinogens that are known to cause
stomach cancer. Salted, smoked, or pickled foods and red meat often contain
large amounts of nitrites and nitrates. Countries where consumption of salted
meat and fish and pickled vegetables is high, such as Japan and Korea, tend to
have correspondingly high rates of stomach cancer. Eating a diet high in red
meat, especially when the meat is barbecued or well-done, has also been linked
to stomach cancer.
Exercise and weight control: Controlling weight and exercising
regularly can reduce the risk of developing cancer by helping control
inflammation, oxidation, and blood sugar imbalances. The American Cancer
Society recommends at least 30 minutes of physical activity five or more days a
week if the individual can tolerate it.
Fruits, vegetables and whole grains: Fruits, vegetables, and
whole grains contain vitamins, minerals, fiber, and antioxidants, which may
help protect from developing various types of 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 individual's diet such as kale,
chard, spinach, dark green lettuce, peppers, and squashes.
Smoking: Smoking can increase the risk of cancer. Cigarette
smoking is the most significant and avoidable risk factor for cancer of the
pancreas. It is responsible for 20-30% of pancreatic cancers. Tobacco use also
increases the risk of developing cancers of the lung, mouth, larynx (voice
box), esophagus, kidney, bladder, and some other organs.
Vitamins and minerals: Calcium, magnesium, pyridoxine
(vitamin B6), and folic acid may help reduce the risk of certain cancers. 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. Eating fewer processed foods and red meat
is also recommended by healthcare providers.
Copyright © 2011
Natural Standard (www.naturalstandard.com)