Digestive Health

Updated 21 April 2017

Gastrointestinal (GI) / Stomach cancer

Stomach cancer, also known as gastric cancer, is a malignant (cancerous) tumor within the stomach.


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 Middle East.

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.


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.


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 cancer.

Ethnicity: Stomach cancer is more common in Asian, Pacific Islander, Hispanic, and African Americans than in non-Hispanic, Caucasian Americans.

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 in smokers.

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 stomach lining).

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 uncontrollably.

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.


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.


Laboratory tests:

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 the individual.

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 cancer.

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 individual.

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 results.

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 deficiency.

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 pacemakers.

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 levels.

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 pregnant.

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 a doctor.

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 breastfeeding.

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 doctor.

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 therapies.

Allergy associated with Coenzyme Q10 supplements has not been reported, although rash and itching have been reported rarely. Stop use two weeks before surgery/dental/diagnostic procedures with bleeding risk and do not use immediately after these procedures. Use caution with a history of blood clots, diabetes, high blood pressure, heart attack, or stroke, or with anticoagulants (blood thinners) or antiplatelet drugs (like aspirin, warfarin, clopidogrel (like Plavix©), or blood pressure, blood sugar, cholesterol or thyroid drugs. Avoid if pregnant or breastfeeding.

Copper: Copper is a mineral that occurs naturally in many foods, including vegetables, legumes, nuts, grains and fruits, as well as shellfish, avocado, and beef (organs such as liver). Preliminary research reports that lowering copper levels theoretically may arrest the progression of cancer by inhibiting blood vessel growth (angiogenesis). Copper intake has not been identified as a risk factor for the development or progression of cancer. Copper is potentially unsafe when used orally in higher doses than the RDA. Copper supplements should not be used if pregnant or breast-feeding, unless otherwise directed by a doctor.

Cranberry: Several laboratory studies have reported positive effects of proanthocyanidins, flavonoid components of cranberry (Vaccinium macrocarpon) and other fruits such as blueberries, grape seed, and pomegranate, on health. Based on early laboratory research, cranberry has been proposed for cancer prevention. Additional study is needed in humans before a conclusion can be made.

Avoid if allergic to cranberries, blueberries or other plants of the Vaccinium species. Sweetened cranberry juice may effect blood sugar levels. Use cautiously with a history of kidney stones. Avoid more than the amount usually found in foods if pregnant or breastfeeding.

Dandelion: Limited animal research does not provide a clear assessment of the effects of dandelion on tumor growth. Well-conducted human studies are needed to better determine dandelion's effects on cancer.

Avoid if allergic to chamomile, feverfew, honey, yarrow, or any related plants such as aster, daisies, sunflower, chrysanthemum, mugwort, ragweed, or ragwort. Use cautiously with diabetes or bleeding disorders, gastroesophageal reflux disease (GERD), kidney or liver diseases, or a history of stroke or electrolyte disorders. Monitor potassium blood levels. Stop use two weeks before surgery/dental/diagnostic procedures with bleeding risk and do not use immediately after these procedures. Avoid if pregnant or breastfeeding.

Echinacea: There is currently a lack of clear human evidence that echinacea affects any type of cancer. The evidence from a small number of clinical trials evaluating efficacy of echinacea in the treatment of radiation-induced leukopenia (decrease in white blood cells) is equivocal. Studies have used the combination product Esberitox©, which includes extracts of echinacea (Echinacea purpurea and pallida) root, white cedar (Thuja occidentalis) leaf, and wild indigo (Baptisia tinctoria) root. Additional clinical studies are needed to make a conclusion.

Caution is advised when taking echinacea supplements, as numerous adverse effects including drug interactions are possible. Echinacea should not be used if pregnant or breast-feeding, unless otherwise directed by a doctor.

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 treat cancer.

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 cancer.

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)


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Dr. Estelle Wilken is a Senior Specialist in Internal Medicine and Gastroenterology at Tygerberg Hospital. She obtained her MBChB in 1976, her MMed (Int) in 1991 and her gastroenterology registration in 1995.

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