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Background |
Risk factors and causes |
Signs and symptoms |
Diagnosis |
Staging |
Complications |
Treatment |
Integrative therapies |
Prevention |
Author information |
Bibliography
Bladder cancer
Bladder cancer is the uncontrolled growth of cells, usually originating in the bladder lining. The bladder is an organ located in the pelvic cavity that stores and discharges urine. Urine is produced by the kidneys, carried to the bladder by hollow tubes called ureters, and discharged from the bladder through a tube called the urethra.The uncontrolled growth of these abnormal bladder cells eventually form tumors. A tumor is a mass or lump of tissue made of these uncontrolled, abnormal cells. Tumors can be benign or malignant. Benign tumors are not cancerous, and cells from benign tumors do not spread to other parts of the body. In most cases, benign tumors do not come back after they are removed. Benign tumors are rarely a threat to life. Malignant tumors are cancerous. They are generally more serious and can and invade and damage nearby tissues and organs.
The wall of the bladder is lined with cells called transitional cells and squamous cells. More than 90% of bladder cancers begin in the transitional cells. The same type of cells occurs in the kidneys, ureters, and urethra, where malignant tumors may also be found.
Some bladder cancers remain confined to the bladder lining (called carcinoma in situ). But other cancers are invasive, growing into or through the bladder wall, and eventually into nearby lymph nodes and adjacent organs. The cancer may metastasize (spread) over time to other organs, including the vagina and uterus in women, the prostate in men, and the lungs, liver, or bones.
Bladder cancer accounts for approximately 90% of cancers of the urinary tract, including renal pelvis, ureters, bladder, and urethra.
Bladder cancer is the sixth most common cancer in the United States. About 53,200 Americans are diagnosed with bladder cancer each year and 12,200 die annually of the disease. The estimated new cases and deaths from bladder cancer in the U.S. in 2007 are 67,160 and 13,750, respectively.
According to the National Cancer Institute (NCI), the highest incidence of bladder cancer occurs in industrialized countries such as the U.S., Canada, and France. Incidence is lowest in Asia and South America, where it is about 70% lower than in the United States.
Smoking is the greatest single risk factor for bladder cancer.
Treating bladder cancer that has metastasized (spread) can be difficult, but if the bladder cancer is detected early, before it has metastasized, the chances of a successful treatment with minimal side effects is likely.
Background
Bladder cancer is the uncontrolled growth of cells, usually originating in the bladder lining. The bladder is an organ located in the pelvic cavity that stores and discharges urine. Urine is produced by the kidneys, carried to the bladder by hollow tubes called ureters, and discharged from the bladder through a tube called the urethra.The uncontrolled growth of these abnormal bladder cells eventually form tumors. A tumor is a mass or lump of tissue made of these uncontrolled, abnormal cells. Tumors can be benign or malignant. Benign tumors are not cancerous, and cells from benign tumors do not spread to other parts of the body. In most cases, benign tumors do not come back after they are removed. Benign tumors are rarely a threat to life. Malignant tumors are cancerous. They are generally more serious and can and invade and damage nearby tissues and organs.
The wall of the bladder is lined with cells called transitional cells and squamous cells. More than 90% of bladder cancers begin in the transitional cells. The same type of cells occurs in the kidneys, ureters, and urethra, where malignant tumors may also be found.
Some bladder cancers remain confined to the bladder lining (called carcinoma in situ). But other cancers are invasive, growing into or through the bladder wall, and eventually into nearby lymph nodes and adjacent organs. The cancer may metastasize (spread) over time to other organs, including the vagina and uterus in women, the prostate in men, and the lungs, liver, or bones.
Bladder cancer accounts for approximately 90% of cancers of the urinary tract, including renal pelvis, ureters, bladder, and urethra.
Bladder cancer is the sixth most common cancer in the United States. About 53,200 Americans are diagnosed with bladder cancer each year and 12,200 die annually of the disease. The estimated new cases and deaths from bladder cancer in the U.S. in 2007 are 67,160 and 13,750, respectively.
According to the National Cancer Institute (NCI), the highest incidence of bladder cancer occurs in industrialized countries such as the U.S., Canada, and France. Incidence is lowest in Asia and South America, where it is about 70% lower than in the United States.
Smoking is the greatest single risk factor for bladder cancer.
Treating bladder cancer that has metastasized (spread) can be difficult, but if the bladder cancer is detected early, before it has metastasized, the chances of a successful treatment with minimal side effects is likely.
Risk factors and causes
Smoking: Smoking appears to be the single greatest risk factor for bladder cancer. Carcinogens, or cancer-causing chemicals, in tobacco can become concentrated in the urine and eventually damage the lining of the bladder. This damage can increase the chances of a cancer-causing genetic mutation. Smokers are at least twice as likely to develop bladder cancer as nonsmokers are. The risk increases with the number of cigarettes smoked a day and the number of years the individual has smoked.Occupational risk factors: Repeated exposure to chemicals used in the manufacture of dyes, rubber, leather, textiles, and paint products may increase the risk of developing bladder cancer. Workers at increased risk include hairdressers, machinists, printers, painters, truck drivers, and workers in rubber, chemical, textile, metal, and leather industries. Smokers who work with toxic chemicals are at an especially high risk of bladder cancer.
Age: Incidence of bladder cancer increases with age. Individuals over the age of 70 develop the disease two to three times more often than those aged 55-69 and 15-20 times more often than those aged 30-54.
Race: Bladder cancer is more prevalent in Caucasians than in African Americans and Latinos. Asian individuals have an even lower incidence of developing bladder cancer.
Sex: Men are about four times as likely to get bladder cancer as women are. This may be in part due to hormonal imbalances.
Chemotherapy and radiation therapy: Treatment with the anti-cancer drugs cyclophosphamide (Cytoxan®) and ifosfamide (Ifex®) increases the risk of developing bladder cancer. Clinical studies of women treated with radiation therapy for cervical cancer have reported an elevated risk for developing bladder cancer.
Chronic bladder inflammation: Chronic or repeated urinary infections or cystitis (inflammation of the urinary tract) may increase the risk of developing squamous cell carcinoma of the bladder. In some parts of the developing world, especially North Africa, a chronic parasitic infection (Schistosoma haematobium) can contribute to the development of squamous cell carcinoma. Both this infection and squamous cell carcinoma are uncommon in the U.S.
Genetics: If one or more of the immediate relatives (such as a parent or sibling) has a history of bladder cancer that also may increase the risk. However, it is rare for bladder cancer to run in families. A family history of hereditary nonpolyposis colorectal cancer (a type of colon cancer, or HNPCC) can increase the risk of cancer in the urinary tract.
Personal history: An individual who has been diagnosed with bladder cancer in the past makes it more likely that it will develop again. Tumors may recur in the ureters or urethra as well as in the bladder itself.
Arsenic exposure: Drinking water containing high levels of arsenic has been associated with bladder cancer. Individuals with well water should have their water tested for contaminants such as arsenic. Local health departments can be a source of testing.
Bladder birth defect: Rare birth defects of the bladder may lead to an unusual form of bladder cancer called adenocarcinoma.
Diet: A clinical study found that the risk of bladder cancer increased by 37% with a high fat intake, by 40% with low fruit consumption, and by 16% with diets low in vegetables.
Others: Consumption of Aristolochia fangchi, a Chinese herb found as an adulterant in some weight-loss formulas, may lead to kidney diseases such as bladder cancer. Aristolochia plant species contains aristolochic acid, a known cause of kidney damage.
Signs and symptoms
There may be no signs or symptoms in the early stages of bladder cancer. The primary symptom of bladder cancer is hematuria, or blood in the urine. Blood may be visible to the naked eye or visible only under a microscope. Hematuria is usually painless. Other symptoms include polyuria, or frequent urination and dysuria, or pain upon urination.More common conditions, such as a urinary tract infection, kidney disease, kidney or bladder stones, and prostate problems, can also cause hematuria. These conditions can also cause other symptoms similar to those of bladder cancer, such as pelvic pain, pain during urination, frequent urination, inability to urinate, and slowing of the urinary stream.
If any of these symptoms are present, health care professionals recommend seeing a doctor.
Diagnosis
A diagnosis of bladder cancer includes urological tests and imaging tests. A complete medical history is used to identify potential risk factors, such as smoking, exposure to dyes and chemicals, and diet.Laboratory tests: Laboratory tests may include; NMP22®BladderChek®, which detects elevated levels of tumor markers in the urine. The NMP22®BladderChek® is a urine test used to detect elevated levels of a nuclear matrix protein (called NMP22®). Bladder cancer increases levels of this protein in the urine, even during early stages of the disease; a urinalysis, to detect microscopic hematuria; urine cytology, which detects cancer cells by examining cells flushed from the bladder during urination; and urine culture, to rule out urinary tract infection. Results of this test, which is noninvasive and is performed in a physician's office, are available during the patient's office visit. Studies have shown that when used with cystoscopy, NMP22®BladderChek® may be more effective than other diagnostic tests (such as urine tests or cystoscopy alone).
Imaging tests: Various imaging tests may also be performed. Intravenous pyelogram (IVP) is the standard imaging test for bladder cancer. In this procedure, a contrast agent (called a radiopaque dye) is administered through a vein (intravenously or IV) and x-rays are taken as the dye moves through the urinary tract. IVP provides information about the structure and function of the kidneys, ureters, and bladder. Other imaging tests include computerized tomography (CT scan), magnetic resonance imagine (MRI scan), x-ray, and bone scan.
Computerized tomography (CT): Computerized tomography (CT) is essentially a highly detailed X-ray that allows the doctor to see the bladder in two-dimensional slices. Computer processing creates these images while a series of thin X-ray beams pass through the body. In many cases, a contrast dye will be injected into a vein before the test. The dye makes it easier for the doctor to see the organs and to determine if anything abnormal is present that might suggest cancer. The greatest risk with this procedure is a possible allergic reaction to the dye.
Magnetic resonance imaging (MRI): Instead of X-rays, this test uses a powerful magnetic field and radio waves to create images of the urinary tract. During the test, the patient is enclosed in a cylindrical tube that can seem confining to some people. The machine also makes a loud thumping noise. In most cases the person will be given earplugs to help block out the noise. If claustrophobic, an open scan or some mild sedation may be an option.
Bone scan: A bone scan is used to determine whether cancer has spread to the bones. During the procedure, a small amount of a radioactive substance that collects in bone is injected into a vein in the arm. A special scanner then takes pictures of all the bones. The radioactive substance highlights areas of abnormal bone.
Chest x-ray: A chest x-ray test may help detect cancer that has spread to the lungs.
Biopsy: If bladder cancer is suspected, cystoscopy and biopsy are performed. Local anesthesia is administered and a cystoscope is inserted into the bladder through the urethra to allow the doctor to detect abnormalities. A cystoscope is a thin, telescope-like tube with a tiny camera attached. In biopsy, tissue samples are taken from the lesion(s) and examined for cancer cells. If the sample is positive, the cancer is staged using the tumor, node, metastases (TNM) system.
Fluorescence in situ hybridization (FISH): Fluorescence in situ hybridization (FISH) is used for bladder cancer can detect certain chromosomal abnormalities often found in transitional cell cancer, the most common type of bladder cancer. This test may help detect recurrent cancer cells before a tumor becomes visually apparent. This newer test is not routinely available, and more studies are needed before it can be considered standard.
Staging
If bladder cancer is diagnosed, the doctor needs to know the stage, or extent, of the disease to plan the best treatment. Staging is a careful attempt to find out whether the cancer has invaded the bladder wall, whether the disease has spread, and if so, to what parts of the body.The doctor may determine the stage of bladder cancer at the time of diagnosis, or may need to give the patient more tests, such as CT scan, magnetic resonance imaging (MRI), intravenous pyelogram, bone scan, or chest x-ray. Sometimes staging is not complete until the patient has surgery.
The stage refers to the physical location of the tumor within the bladder or, more specifically, the tumor's depth of penetration. In general, tumor stage is confined to one of two categories: (1) superficial, surface tumors, or (2) invasive, deep-spreading tumors. Superficial tumors affect only the bladder lining. They grow up and out from the lining tissue and extend into the bladder's hollow cavity. Invasive tumors grow down into the deeper layers of bladder tissue, and they may involve surrounding muscle, fat, and/or nearby organs. Invasive tumors are more dangerous than superficial tumors, since they are more likely to metastasize.
This determination requires a diagnostic procedure using a cystoscopic examination that includes a biopsy and examination under general anesthesia to assess the size and movement of the tumors, the degree of hardening of the bladder wall, and the presence of malignancy (spreading) to nearby organs. Clinical staging often underestimates the extent of tumor.
The American Joint Committee on Cancer (AJCC) has designated staging by TNM classification to define bladder cancer. TNM designates the tumor, N designates regional lymph node involvement, and M designates metastasis (spreading).
The stages are then further divided into stage groupings, consisting of; Stage 0, where the cancer cells are found only on the surface of the inner lining of the bladder (generally called superficial cancer or carcinoma in situ; Stage I, where the cancer cells are found deep in the inner lining of the bladder but may not have not spread to the muscle of the bladder; Stage II, where the cancer cells have spread to the muscle of the bladder; Stage III, where the cancer cells have spread through the muscular wall of the bladder to the layer of tissue surrounding the bladder. The cancer cells may have spread to the prostate (in men) or to the uterus or vagina (in women); and Stage IV, where the cancer extends to the wall of the abdomen or to the wall of the pelvis. The cancer cells may have spread to lymph nodes and other parts of the body far away from the bladder, such as the lungs.
Complications
Bladder cancer can lead to anemia (or the lack of red blood cells to carry adequate oxygen to the tissues), urinary incontinence (uncontrolled urine flow), and hydronephrosis or a blockage of the ureters that prevents urine from draining normally into the bladder.The most serious complication from bladder cancer is metastasis (spreading) to other organs such as bones, liver, and kidneys.
Treatment
Treatment for bladder cancer depends on the stage of the disease, the type of cancer, and the individual's age and overall health. Options include surgery, chemotherapy, radiation, and immunotherapy. In some cases, treatments are combined, such as with surgery or radiation and chemotherapy.Chemotherapy:
Chemotherapy is a systemic (whole body) treatment using prescription drugs to destroy cancer cells. Chemotherapy is administered by mouth or intravenously (IV, or through a vein) and in early bladder cancer, may be infused into the bladder through the urethra (called intravesical chemotherapy). Chemotherapy also may be administered before surgery (neoadjuvant therapy) or after surgery (adjuvant therapy).
Drugs commonly used to treat bladder cancer include valrubicin (Valstar®), thiotepa (Thioplex®), mitomycin, and doxorubicin (Rubex®). Side effects can be severe and include the abdominal pain, anemia (lack of red blood cells to carry oxygen to tissues), bladder irritation, blurred vision, excessive bleeding or bruising, fatigue (excessive tiredness), headache, infection, loss of appetite, nausea and vomiting, and general weakness.
Medications to control the side effects of chemotherapy include filgrastim (Neupogen®), which increases white blood cell counts and helps prevent infection. Erythropoietin (Procrit®, Epogen®) helps make red blood cells in individuals who experience anemia. Oprelvekin (Interleukin-11, Il-11, or Neumega®) helps make platelets. Platelets are a type of blood cell involved in blood clotting.
Radiation:
Radiation uses high-energy x-rays to destroy cancer cells. External beam radiation is emitted from a machine outside the body and internal radiation is emitted from radioactive "seeds" implanted into the tumor. Either type of radiation therapy may be used after surgery to destroy cancer cells that may remain. Radiation therapy is also used to relieve symptoms (called palliative treatment) of advanced bladder. Side effects include proctitis (inflammation of the rectum), incontinence, skin irritation, hematuria, fibrosis (buildup of fibrous tissue), and impotence (erectile dysfunction).
Surgery:
The type of surgery depends on the stage of the disease. In early bladder cancer, the tumor may be removed using instruments inserted through the urethra, termed transurethral resection.
Transurethral resection (TUR): A transurethral resection (TUR) is often used to treat superficial (on the surface) bladder cancer. During TUR, the doctor inserts a cystoscope, or an instrument with a special lens and fiber-optic lighting system, into the bladder through the urethra. The cancer is removed with a small wire loop and any remaining cells are burned away with an electric current. In some cases, a high-energy laser may be used instead of the electric current. TUR itself causes few problems, although the individual is likely to have some blood in the urine or pain when urinating for a few days following the procedure. But because superficial bladder cancer commonly recurs, the individual will need to see their doctor for a cystoscopic exam every three to six months.
Cystectomy: Bladder cancer that has spread to surrounding tissue usually requires partial or radical removal of the bladder, termed a cystectomy. Radical cystectomy also involves the removal of nearby lymph nodes and may require a urostomy. A urostomy is an opening in the abdomen created for the discharge of urine. Complications from a cystectomy include infection, urinary stones, and urine blockages. A radical cystectomy can be life altering, affecting not only the ability to urinate normally but also the individual's sex drive and performance.
In women with advanced stage bladder cancer, the standard surgical procedure is radical cystectomy, or the removal of the bladder and surrounding organs, with pelvic lymphadenectomy. Radical cystectomy in women also involves removal of the uterus (womb), ovaries, fallopian tubes, anterior vaginal wall (front of the birth canal), and urethra (tube that carries urine from the bladder out of the body). Women who lose their ovaries and fallopian tubes are no longer able to become pregnant and enter menopause immediately. In addition, removing part of the vagina during surgery can affect the ability to have sexual intercourse.
Cystoprostatectomy in men: In men, the standard surgical procedure for advanced stage bladder cancer is a cystoprostatectomy, or the removal of the bladder and prostate, with pelvic lymphadenectomy (the removal of the lymph nodes within the hip cavity). The seminal vesicles (semen-conducting tubes) also may be removed. In some cases, this can be performed in a manner that preserves sexual function.
Segmental cystectomy: Segmental cystectomy is the partial removal of the bladder, which is a bladder-preserving procedure, may be used in some cases, such as with patients with squamous cell carcinomas or adenocarcinomas that arise high in the bladder dome. When segmental cystectomy is performed, it may be preceded by radiation therapy. To remove the tumor, the surgeon makes an incision in the abdomen. General anesthesia is used, and the individual usually stays in the hospital for a week to ten days. The main side effect of this surgery is more frequent urination. Although the problem is often temporary, it may become permanent in some individuals.
Urinary tract diversion: Until recently, most bladder cancer patients who underwent cystectomy (bladder removal) required an ostomy (surgical creation of an artificial opening) and an external bag to collect urine. Newer reconstructive surgical methods include the continent urinary reservoir, the neobladder, and the ileal conduit.
The continent urinary reservoir is a urinary diversion technique that involves using a piece of the colon (large intestine) to form an internal pouch to store urine. The pouch is specially refashioned to prevent back-up of urine into the ureters (tubes that carry urine out of the kidneys and into the bladder) and kidneys. The patient drains the pouch with a catheter several times a day, and the stoma site is easily concealed by a band aid.
The neobladder procedure involves suturing a similar intestinal pouch to the urethra so the patient is able to urinate as before, without the need for a stoma. In many cases, there is no sensation to void, but some patients experience abdominal cramping as the neobladder fills.
Complications of the continent urinary reservoir and neobladder include bowel or intestinal obstruction, blood clots, pneumonia (lung infection), ureteral reflux (back-flow), and ureteral blockage.
The ileal conduit is a urinary channel that is surgically created from a small piece of the patient's bowel. During this procedure, the ureters are attached to one end of the bowel segment and the other end is brought out of the surface of the body to make a stoma. An external, urine-collecting bag is attached to the stoma and is worn at all times. Complications of the ileal conduit procedure include bowel obstruction, urinary tract infection (UTI), blood clots, pneumonia, upper urinary tract damage, and skin breakdown around the stoma.
Biologic therapy:
Biologic therapy, or immunotherapy, for bladder cancer involves instilling a liquid containing Bailcle Callmette-Guerin, which is a live, weakened form of the bacteria that causes tuberculosis, into the bladder. The bacteria seem to provoke the body's immune system, increasing its ability to kill the cancer cells that are in the bladder. The bacteria solution is placed into the bladder through a catheter tube inserted through the urethra and into the bladder. Once the solution is in the bladder, the individual will be asked to hold it in the bladder for about two hours. These treatments usually occur once a week for six weeks. Some individuals require a second six-week cycle of treatments to achieve full benefit. This form of biologic therapy used to treat bladder cancer may cause symptoms including flu-like symptoms (body aches, fatigue, fever, and chills), nausea, and urinary symptoms such as frequent need to urinate, urgent need to urinate, pain/burning with urination, and bloody urine. Rare tuberculosis-like severe infection in the lungs can also occur.
Others:
Photodynamic therapy: Photodynamic therapy is a new weapon in the treating against bladder cancer. In photodynamic therapy (PDT), photosensitizers, or light-sensitive molecules, are injected into the bloodstream and absorbed by cells throughout the body. These agents remain in cancer cells longer than in normal cells. A cystoscope is then inserted through the urethra into the bladder, where it shines a red laser light onto the tumor. When the cancer cells are exposed to laser light, the photosensitizers are activated and cause cell damage and death. Photodynamic therapy is only effect against very superficial forms of bladder cancer. The effects do not penetrate to deeper areas of the bladder. Phototherapy may cause side effects including severe photosensitivity (greatly increased tendency to sunburn), flu-like symptoms (body aches, fatigue, fever, and chills), nausea, and urinary symptoms such as frequent need to urinate, urgent need to urinate, pain/burning with urination, and bloody urine. Rare tuberculosis-like severe infection in the lungs can also occur.
Because photodynamic therapy makes the individual more sensitive to sunlight, it is best to check with a doctor or pharmacist regarding appropriate sun precautions. It is best to avoid being outside during the sunniest times of day (about ten in the morning until late afternoon). Health care professionals recommend that if an individual receiving photodynamic therapy has to go outside, a sun block with SPF of at least 30 should be used, and protective clothing along with a wide-brimmed hat should be worn.
Follow-Up:
Bladder cancer has a high rate of recurrence. Urine cytology and cystoscopy are performed every three months for two years, every six months for the next two years, and then yearly.
Superficial bladder cancer has a five year survival rate of about 85%. Invasive bladder cancer has a less favorable prognosis. Approximately 5% of patients with metastasized bladder cancer live two years after diagnosis. Cases of recurrent bladder cancer indicate an aggressive tumor and a poor prognosis.
Integrative therapies
There are limited studies using integrative therapies for the treatment of bladder cancer. However, there have been clinical studies using integrative medicine in other types of cancer. Listed below are integrative therapies that have been studied clinically in various forms of cancer.Good scientific evidence:
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 can enhance cancer patients' quality of life 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. Studies conflict on whether therapy improves self-esteem, death anxiety, self-satisfaction, etc. While some patients seek psychotherapy in hopes of extending survival, there is no conclusive evidence of effects on medical prognosis. Psychotherapy can 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.
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.
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 prevent or 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 the treatment of cancer 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.
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 diabetes and cancer patients. Arabinoxylan products may contain high calcium and phosphorus levels, which may be harmful for patients with compromised renal (kidney) function. Caution is advised when taking arabinoxylan supplements, as numerous adverse effects including drug interactions are possible. Arabinoxylan should not be used if pregnant or breast-feeding, unless otherwise directed by a doctor.
Aromatherapy: Healing with fragrant oils has been used for thousands of years. Aromatherapy is often used in people with chronic illnesses (frequently in combination with massage), with the intention to improve quality of life or well-being. There is not enough scientific evidence in this area to form a firm conclusion about the effectiveness of aromatherapy. Essential oils should only be used on the skin in areas without irritation.
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 family caregivers of cancer patients may benefit from art therapy to help them cope with the stress of care giving. 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.
Astragalus: Astragalus (Astragalus membranaceus) has been used in Chinese medicine for centuries for its immune enhancing properties. Although early laboratory and animal studies report increased immune cell function and reduced cancer cell growth associated with the use of astragalus, there is no reliable human evidence in these areas. A recent study reports that astragalus-based Chinese herbal medicine may increase effectiveness of platinum-based chemotherapy such as cisplatin (Platinol®) when combined with chemotherapy. Astragalus is also sometimes used with the intention to reduce side effects of cancer treatments, such as fatigue and weight loss. 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.
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. 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.
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 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 remains undetermined.
Bromelain: Bromelain is a sulfur-containing digestive enzyme (proteins which help with digestion) that is extracted from the stem and the fruit of the pineapple plant (Ananas comosus). There is not enough information to recommend for or against the use of bromelain in the treatment of cancer, either alone or in addition to other therapies. One small study found that a bromelain supplement decreased tumor size in 12 breast cancer patients. Patients took the supplements for different periods of time, lasting from months to years. Caution is advised when taking bromelain supplements, as numerous adverse effects including blood thinning and drug interactions are possible. Bromelain should not be used if pregnant or breast-feeding, unless otherwise directed by a doctor.
Cat's claw: Originally found in Peru, the use of cat's claw (Uncaria tomentosa) has been said to date back to the Inca civilization, possibly as far back as 2,000 years. Cat's claw has anti-inflammatory properties, and several low-quality studies suggest that cat's claw may slow tumor growth. However, this research is early and has not identified specific types of cancer that may benefit; 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.
Chelation therapy: Chelation therapy involves using a chemical called ethylenediaminetetraacetic acid (EDTA) to rid the body of heavy metals that may have accumulated from environmental exposure. Preliminary data from an exploratory study suggests concurrent administration of EDTA may have myeloprotective (muscle fiber protection) ability, which allows safe intraperitoneal administration of higher doses of radiation in treatment of ovarian cancer. Randomized controlled trials are needed before definitive recommendations can be made. Note that EDTA chelation therapy is rejected by the conventional medical community including the American Medical Association, American Hospital Association, National Institutes of Health, and U.S. Food and Drug Administration (FDA) as a beneficial treatment due to lack of scientific evidence. Side effects include low blood sugar, headache, low calcium levels, low blood pressure, and seizures. ETDA use can result in death.
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 a small amount of laboratory research, cranberry has been proposed for cancer prevention. Study is needed in humans before a recommendation can be made.
Echinacea: The evidence from a small number of randomized 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. 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 the mood and body attitude in cancer patients. Firm recommendations cannot be made until well-designed clinical trials are available.
Folic acid: Folic acid or folate is a form of a water-soluble B vitamin needed for human health. Preliminary evidence surrounding the use of folate seems promising for decreasing the risk of breast, cervical, pancreatic and gastrointestinal cancer. However, currently there is insufficient evidence available to recommend folate supplementation for any type of cancer prevention or treatment. Please follow the advice of a qualified health care provider in this area. Folic acid may mask the symptoms of pernicious, aplastic, or normocytic anemias caused by vitamin B12 deficiency and may lead to neurological damage.
Gamma linolenic acid (GLA): GLA is an omega-6 essential fatty acid. Some laboratory and human studies indicate GLA may have anti-tumor activity and may be used as an adjunct agent to a chemotherapy regimen. Clinical trials have been conducted in treatments of breast, colorectal, and liver cancer. 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. 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.
Ginseng: Several human studies suggest that Asian ginseng (Panax ginseng) may reduce the risk and progression of various organ cancers, especially if ginseng powder or extract is used. Results may have been affected by other lifestyle choices in people who use ginseng, such as exercise or dietary habits. Asian ginseng is also reported to help protect against radiation damage, increase immunity and well-being, and decrease fatigue. Additional trials are necessary before a clear conclusion can be reached. Caution is advised when taking ginseng supplements, as numerous adverse effects including an increased risk of drug interactions are possible. Ginseng should not be used if pregnant or breast-feeding, unless otherwise directed by a doctor.
Green tea: Green tea is made from the dried leaves of Camellia sinensis, a perennial evergreen shrub. Green tea has a long history of use in health and longevity, dating back to China approximately 5,000 years ago. Although used for centuries to help prevent diseases, the relationship of green tea consumption and human cancer remains inconclusive. Evidence from well-designed clinical trials is needed before a firm recommendation can be made in this area. Caution is advised when taking green tea supplements, as numerous adverse effects including an increased risk of drug interactions are possible. Green tea should not be used if pregnant or breast-feeding, unless otherwise directed by a doctor.
Healing touch: Preliminary data suggests may be of benefit in cancer patients for inducing relaxation and improving quality of life. However, due to weaknesses in design and the small number of studies, data are insufficient to make definitive recommendations. Studies with stronger designs are needed.
Hoxsey formula: "Hoxsey formula" is a misleading name, because it is not a single formula, but rather is a therapeutic regimen consisting of an oral tonic, topical (on the skin) preparations, and supportive therapy. The tonic is individualized for cancer patients based on general condition, location of cancer, and previous history of treatment. An ingredient that usually remains constant for every patient is potassium iodide. Other ingredients are then added and may include licorice, red clover, burdock, stillingia root, berberis root, pokeroot, cascara, Aromatic USP 14, prickly ash bark, and buckthorn bark. A red paste may be used, which tends to be caustic (irritating), and contains antimony trisulfide, zinc chloride, and bloodroot. A topical yellow powder may be used, and contains arsenic sulfide, talc, sulfur, and a "yellow precipitate." A clear solution may also be administered, and contains trichloroacetic acid. There are no well-designed human studies available evaluating the safety or effectiveness of Hoxsey formula. Caution is advised when taking the Hoxsey formula supplements, as numerous adverse effects including an increased risk of drug interactions are possible. Hoxsey formula should not be used if pregnant or breast-feeding, unless otherwise directed by a doctor.
Hydrazine sulfate: Hydrazine is an industrial chemical marketed as having the potential to repress weight loss and cachexia (muscle wasting) associated with cancer, and to improve general appetite status. However, in large randomized controlled trials, hydrazine has not been proven effective for improving appetite, reducing weight loss or improving survival in adults. The National Cancer Institute (NCI) sponsored studies of hydrazine sulfate that claimed efficacy in improving survival for some patients with advanced cancer. Trial results found that hydrazine sulfate did not prolong survival for cancer patients. The U.S. Food and Drug Administration (FDA) has received requests from individual physicians for approval to use hydrazine sulfate on a case-by-case "compassionate use" basis on the chance that patients with no other available effective therapy might benefit. The overall controversy in the use of hydrazine sulfate is ongoing, and relevance to clinical practice is unknown. The use of hydrazine sulfate needs to be evaluated further before any recommendations can be made. Side effects have been reported, including dizziness, nausea, and vomiting.
Iodine: Iodine is an element (atomic number 53), which is required by humans for the synthesis of thyroid hormones (triiodothyronine/T3 and thyroxine/T4). The potential role of non-radioactive iodine in cancer care remains unknown. Antioxidant and anti-tumor effects have been proposed based on laboratory research. In contrast, some scientists have asserted that tumors may uptake more iodine than normal tissues. It has been suggested that high rates of gastric (stomach) cancer or low rates of breast cancer in coastal Japan may be due to high iodine intake, although this has not been demonstrated scientifically. Povidone-iodine solutions have been used as a part of alternative cancer regimens, such as the Hoxsey formula. Preliminary study has also indicated povidone-iodone solution as a potential rectal washout for rectal cancer. Overall, no clear conclusion can be drawn based on the currently available evidence. Iodine should not be used if pregnant or breast-feeding, unless otherwise directed by a doctor.
Lavender: Perillyl alcohol (POH), derived from lavender (Lavendula officinalis), might be beneficial in the treatment of some types of cancer. This research has focused on cancers of the pancreas, breast, and intestine. Preliminary small studies in humans suggest safety and tolerability of POH, but effectiveness has not been established.
Lycopene: High levels of lycopene are found in tomatoes and in tomato-based products. Tomatoes are also sources of other nutrients such as vitamin C, folate, and potassium. Several laboratory and human studies examining tomato-based products and blood lycopene levels suggest that lycopene may be associated with a lower risk of developing cancer and may help stimulate the immune system. However, due to a lack of well-designed human research using lycopene supplements, this issue remains unclear.
Maitake mushroom: Maitake is the Japanese name for the edible mushroom Grifola frondosa. Maitake has been used traditionally both as a food and for medicinal purposes. Early studies in the laboratory as well as in humans suggest that beta-glucan extracts from maitake may increase the body's ability to fight cancer. However, these studies have not been well designed, and better research is needed before the use of maitake for cancer can be recommended. Caution is advised when taking maitake supplements, as numerous adverse effects including an increased risk of bleeding and drug interactions are possible. Maitake should not be used if pregnant or breast-feeding, unless otherwise directed by a doctor.
Melatonin: There are several early-phase and controlled human trials of melatonin in patients with various advanced stage malignancies, including brain, breast, colorectal, gastric, liver, lung, pancreatic, and testicular cancer, as well as lymphoma, melanoma, renal cell carcinoma, and soft-tissue sarcoma. Currently, no clear conclusion can be drawn in this area. There is not enough definitive scientific evidence to discern if melatonin is beneficial against any type of cancer, whether it increases (or decreases) the effectiveness of other cancer therapies, or if it safely reduces chemotherapy side effects. Melatonin is not to be used for extended periods of time. Caution is advised when taking melatonin supplements, as numerous adverse effects including drug interactions are possible. Melatonin is not recommended during pregnancy or breastfeeding unless otherwise advised by a doctor.
Milk thistle: Milk thistle (Silybum marianum) has been used medicinally in China for over 2,000 years, most commonly for the treatment of liver and gallbladder disorders. There are early reports from laboratory experiments that the components silymarin and silibinin found in milk thistle may reduce the growth of human breast, cervical, and prostate cancer cells. There is also one report of a patient with liver cancer who improved following treatment with milk thistle. However, this research is too early to draw firm conclusions, and effects have not been shown in high-quality human trials. Caution is advised when taking milk thistle supplements, as numerous adverse effects including an increased risk of bleeding and drug interactions are possible. Milk thistle should not be used if pregnant or breast-feeding, unless otherwise directed by a doctor.
Mistletoe: Mistletoe is one of the most widely used unconventional cancer treatments in Europe. Extracts have been studied for a variety of human cancers including bladder, breast, cervical, central nervous system (CNS), colorectal, head and neck, liver, lung, lymphatic, ovarian, and renal (kidney) cancers as well as melanoma and leukemia. However, efficacy has not been conclusively proven for any one condition. In fact, some studies have shown lack of efficacy of certain preparations for a variety of cancers. Larger, well-designed clinical trials are needed. Caution is advised when taking mistletoe supplements, as numerous adverse effects including nausea, vomiting, and drug interactions are possible. Mistletoe should not be used if pregnant or breast-feeding, unless otherwise directed by a doctor.
Moxibustion: Moxibustion is a healing technique employed across the diverse traditions of acupuncture and oriental medicine for over 2,000 years. Moxibustion uses the principle of heat to stimulate circulation and break up congestion or stagnation of blood and chi. Moxibustion is closely related to acupuncture as it is applied to specific acupuncture points. Preliminary evidence from one study of patients with nasopharyngeal cancer suggests that moxibustion may reduce side effects of chemotherapy or radiation therapy. More studies are needed.
Oleander: Laboratory studies of oleander (Nerium oleander) suggest possible anti-cancer effects, although reliable research in humans is not currently available. There are reports that long-term use of oleander may have positive effects in patients with leiomyosarcoma, Ewing's sarcoma, prostate, or breast cancer. More research is needed. Caution is advised when taking oleander supplements, as numerous adverse effects including drug interactions are possible. Oleander should not be used if pregnant or breast-feeding, unless otherwise directed by a doctor.
Omega-3 fatty acids: Omega-3 fatty acids are essential fatty acids found in some plants and fish. There should be a balance of omega-6 and omega-3 fatty acids for health. Several population (epidemiologic) studies report that dietary omega-3 fatty acids or fish oil may reduce the risk of developing breast, colon, or prostate cancer. Randomized controlled trials are necessary before a clear conclusion can be drawn. Caution is advised when taking omega-3 supplements, as numerous adverse effects including an increase in bleeding and drug interactions are possible. Omega-3 supplements should not be used if pregnant or breast-feeding, unless otherwise directed by a doctor.
Prayer: Initial studies in patients with cancer (such as leukemia) report variable effects on disease progression or death rates when intercessory prayer is used. Better quality research is necessary before a firm conclusion can be drawn. Studies using prayer as healing have only been conduced when people know that others might be praying for them
Reishi mushroom: Reishi (Ganoderma lucidum) has been shown to have antineoplastic and immunomodulatory effects in animal studies. One clinical trial and two case reports exist on advanced cancer patients using Ganopoly®, a Ganoderma lucidum polysaccharide extract. Results show improved quality of life and enhanced immune responses, which are typically reduced or damaged in cancer patients receiving chemotherapy and/or radiation therapy. Well-designed long-term studies are needed confirm these results and potential side effects. Caution is advised when taking reishi supplements, as numerous adverse effects including an increased risk of bleeding and drug interactions are possible. Reishi should not be used if pregnant or breast-feeding, unless otherwise directed by a doctor.
Seaweed: Bladderwrack (Fucus vesiculosus) is a brown seaweed that grows on the northern coasts of the Atlantic and Pacific oceans, and the North and Baltic seas. Bladderwrack appears to suppress the growth of various cancer cells in animal and laboratory studies. However, currently there are no reliable human studies available to support a recommendation for use in cancer. Caution is advised when taking bladderwrack supplements, as numerous adverse effects including an increased risk of drug interactions are possible. Bladderwrack should not be used if pregnant or breast-feeding, unless otherwise directed by a doctor.
Selenium: Selenium is a trace mineral found in soil, water, and some foods. It is an essential element in several metabolic pathways. Several studies suggest that low levels of selenium (measured in the blood or in tissues such as toenail clippings), may be a risk factor for developing cancer, particularly prostate cancer. Population studies suggest that people with cancer are more likely to have low selenium levels than healthy matched individuals, but in most cases it is not clear if the low selenium levels are a cause or merely a consequence of disease. It remains unclear if selenium is beneficial in the treatment of any type of cancer.
Shark cartilage: For several decades, shark cartilage has been proposed as a cancer treatment. Studies have shown shark cartilage or the shark cartilage product AE-941 (Neovastat®) to block the growth of new blood vessels, a process called "anti-angiogenesis," which is believed to play a role in controlling growth of some tumors. There have also been several reports of successful treatments of end-stage cancer patients with shark cartilage, but these have not been well-designed or included reliable comparisons to accepted treatments.
Many studies have been supported by shark cartilage product manufacturers, which may influence the results. In the United States, shark cartilage products cannot claim to cure cancer, and the U.S. Food and Drug Administration (FDA) has sent warning letters to companies not to promote products in this way. Without further evidence from well-designed human trials, it remains unclear if shark cartilage is of any benefit in cancer and patients are advised to check with their doctor and pharmacist before taking shark cartilage. Shark cartilage available in Asian grocery stores and restaurants should not be eaten due to declining populations of sharks. Caution is advised when taking shark cartilage supplements, as numerous adverse effects including an increased risk of drug interactions are possible. Shark cartilage should not be used by patients who are pregnant or breast-feeding, unless otherwise directed by a doctor.
Shiitake mushroom: Shiitake (Lentinus edodes) has been taken by mouth for boosting the immune system, decreasing cholesterol levels, and for anti-aging. Lentinan, derived from shiitake, has been injected as an adjunct treatment for cancer and HIV infection. Laboratory, animal and human studies of lentinan have shown positive results in cancer patients when used in addition to chemotherapy drugs. Further well-designed clinical trials on all types of cancer are required to confirm these results. Caution is advised when taking shiitake supplements, as numerous adverse effects including an increased risk of bleeding and drug interactions are possible. Shiitake should not be used if pregnant or breast-feeding, unless otherwise directed by a doctor.
Soy: Soy (Glycine max) contains compounds, which have been reported effective against tumors. Genistein, an isoflavone found in soy, has been found in laboratory and animal studies to possess anti-cancer effects, such as blocking new blood vessel growth (anti-angiogenesis), acting as a tyrosine kinase inhibitor (a mechanism of many new cancer treatments), or causing cancer cell death (apoptosis). In contrast, genistein has also been reported to increase the growth of pancreas tumor cells in laboratory research. Until reliable human research is available, it remains unclear if dietary soy or soy isoflavone supplements are beneficial, harmful, or neutral in people with various types of cancer. Caution is advised when taking soy supplements, as numerous adverse effects including an increased risk of drug interactions are possible. Soy should not be used if pregnant or breast-feeding, unless otherwise directed by a doctor.
Transcutaneous electrical nerve stimulation (TENS): Transcutaneous electrical nerve stimulation (TENS) is a non-invasive technique in which a low-voltage electrical current is delivered through wires from a small power unit to electrodes located on the skin. Although TENS has been used with some success in pain associated with cancer, there is not enough reliable evidence to draw a firm conclusion in this area. TENS is often used in combination with acupuncture.
Thiamin (Vitamin B1): Thiamin deficiency has been observed in some cancer patients, possibly due to increased metabolic needs. It is not clear if lowered levels of thiamin in such patients may actually be beneficial. Currently, it remains unclear if thiamin supplementation plays a role in the management of any particular type(s) of cancer.
Traditional Chinese Medicine (TCM): The ancient Chinese philosophy of Taoism provided the basis for the development of Chinese medical theory. TCM uses over 120 different herbs in cancer treatment, depending on the type of cancer and its cause according to Chinese medical theory. Studies have reported significant benefits include reducing tumors, reducing treatment side effects and improved response to treatment. More studies of stronger design are needed before TCM can be recommended with confidence as an adjunct to cancer treatment, although centuries of traditional use in cancer cannot be discounted.
Turmeric: Turmeric (Curcuma longa) is commonly used for its anti-inflammatory properties. Several early animal and laboratory studies report anti-cancer (colon, skin, breast) properties of curcumin. Many mechanisms have been considered, including antioxidant activity, anti-angiogenesis (prevention of new blood vessel growth), and direct effects on cancer cells. Currently it remains unclear if turmeric or curcumin has a role in preventing or treating human cancers. There are several ongoing studies in this area. Caution is advised when taking turmeric supplements, as numerous adverse effects including an increased risk of bleeding and drug interactions are possible. Turmeric should not be used if pregnant or breast-feeding, unless otherwise directed by a doctor.
Vitamin C (ascorbic acid): Dietary intake of fruits and vegetables high in vitamin C has been associated with a reduced risk of various types of cancer in population studies (particularly cancers of the mouth, esophagus, stomach, colon, or lung). However, it is not clear that it is specifically the vitamin C in these foods that is beneficial, and vitamin C supplements have not been found to be associated with this protective effect. Experts have recommended increasing dietary consumption of fruits and vegetables high in vitamin C, such as apples, asparagus, berries, broccoli, cabbage, melon (cantaloupe, honeydew, watermelon), cauliflower, citrus fruits (lemons, oranges), fortified breads/grains/cereal, kale, kiwi, potatoes, spinach, and tomatoes. Vitamin C has a long history of adjunctive use in cancer therapy, and although there have not been any definitive studies using intravenous (or oral) vitamin C, there is evidence that it has benefit in some cases. Better-designed studies are needed. Large doses (greater than 2 grams) may cause diarrhea and gastrointestinal upset.
Vitamin E: There is no reliable scientific evidence that vitamin E is effective as a treatment for any specific type of cancer. Caution is merited in people undergoing treatment with chemotherapy or radiation, because it has been proposed that the use of high-dose antioxidants may actually reduce the anti-cancer effects of these therapies. This remains an area of controversy and studies have produced variable results. Patients interested in using high-dose antioxidants such as vitamin E during chemotherapy or radiation should discuss this decision with their medical oncologist or radiation oncologist. Caution is advised when taking vitamin E supplements, as numerous adverse effects including an increased risk of bleeding and drug interactions are possible.
Yoga: Yoga is an ancient system of relaxation, exercise, and healing with origins in Indian philosophy. Several studies in cancer patients report enhanced quality of life, 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.
Fair negative scientific evidence:
Integrative therapies used in cancer therapies which have fair negative scientific evidence include apricot (Prunus armeniaca), beta-carotene, flaxseed and flaxseed oil (Linum usitatissimum), hypnotherapy, iridology, and PSK.
Traditional or theoretical uses which lack scientific evidence:
Integrative therapies with historical or theoretical uses in cancer but lack sufficient clinical evidence, include acerola (Malpighia glabra, Malpighia punicifolia), aconite (Aconitum napellus), African wild potato (Hypoxis hemerocallidea), alfalfa (Medicago sativa), Andrographis (Andrographis paniculata Nees, Kan Jang®, SHA-10), L-arginine, ashwagandha (Withania somnifera), asparagus (Asparagus officinalis), barley (Hordeum vulgare), bilberry (Vaccinium myrtillus), boron, bupleurum (Bupleurum falcatum), chicory (Cichorium intybus), DHEA, feverfew (Tanacetum parthenium), garcinia (Garcinia cambogia), Hydroxycitric acid, holy basil (Ocimum sanctum), kava kava (Piper methysticum), licorice (Glycyrrhiza glabra), neem (Azadirachta indica), ozone therapy, PC-SPES, podophyllum (Podophyllum peltatum), pycnogenol (Pinus pinaster), rehmannia (Rehmannia glutinosa), spiritual healing, sweet almond (Prunus amygdulus dulcis), thymus extract, watercress (Nasturtium officinale), and yew (Taxus sp.).
Prevention
Smoking cessation: Smoking causes carcinogens (cancer-causing) chemicals to collect in the bladder, potentially damaging cells of the bladder and causing the development of bladder cancer.Avoiding chemical exposure: If the individual, such as hairdressers, printers, and painters, works with chemicals, they should follow all safety instructions to avoid exposure. If an individual has their own well for water, they may wish to have it tested for contaminants such as lead and arsenic. Local health departments can be a source of water testing.
Fluids: Drinking liquids, especially water, dilutes toxic substances that may be concentrated in the urine. Toxins are then flushed out of the bladder more quickly.
Dietary factors: Dietary factors that significantly influence the risk of dev eloping cancer include eating more antioxidant containing fresh fruits and vegetables, and decreasing the intake of red meats and foods high in animal fat, such as dairy products (includes milk, cheese, sour cream). A 10-year study conducted by researchers at the Harvard School of Public Health indicates that a high intake of cruciferous vegetables, such as broccoli and cabbage, may cut the risk of developing bladder cancer in men. The Harvard doctors studied only men, and it's not known if the results apply to women.
Exercise: An increase in physical activity has been reported to decrease the chances of developing cancer. A doctor can advise the patient as to what type of exercise would be best for that individual.
Weight control: The incidence of obesity is increasing in the developed world such that it now contributes as much as smoking to overall cancer deaths. Women with a body mass index (BMI)>40 have a 60% higher risk of dying from all cancers than women of normal weight. They are also at increased risk from gynecological cancer.
Seeking medical attention: If and individual notices hematuria, or blood in the urine, health care professionals recommend seeing a doctor immediately.
Author information
Natural Standard is an international research collaboration that aggregates and synthesizes data on complementary and alternative therapies. Using a comprehensive methodology and reproducible grading scales, information is created that is evidence-based, consensus-based, and peer-reviewed, tapping into the collective expertise of a multidisciplinary Editorial Board. The mission of this collaboration is to provide objective, reliable information that aids clinicians, patients, and healthcare institutions to make more informed and safer therapeutic decisions. Natural Standard is widely recognized as one of the worlds premier sources of information in this area.Bibliography
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American Urological Association. www.auanet.org. Accessed June 14, 2007.
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Fabbri C, Ravaioli A, Ravaioli A, et al. Risk of cancer of the prostate and of the kidney parenchyma following bladder cancer. Tumori. 2007;93(2):124-8. View Abstract.
Haber GP, Gill IS. Laparoscopic radical cystectomy for cancer: oncological outcomes at up to 5 years. BJU Int. 2007 Jul;100(1):137-42. View Abstract.
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Steinmaus C, Yuan Y, Bates MN, et al. Case-control study of bladder cancer and drinking water arsenic in the western United States. Am J Epidemiol. 2003;158(12):1193-201. View Abstract.
Related Terms
Adenocarcinoma, anemia, Aristolochia fangchi, aristolochic acid, arsenic, Bailcle Callmette-uerin, benign, biological therapy, bladder, bone scan, carcinoma in situ, chemotherapy, computerized tomography, contrast dye, CT scan, cystectomy, cystoprostatectomy, cystoscope, cystoscopy, dysuria, fallopian tube, FISH, fluorescence in situ hybridization, genetic, hematuria, hydronephrosis, ileal conduit, immunotherapy, incontinence, intravenous pyelogram, IVP, kidney, lymph, lymphadenectomy, lymphatic system, magnetic resonance imaging (MRI), malignant, metastasize, MRI scan, neobladder, nonpolyposis, nuclear matrix protein, ostomy, ovary, PDT, photodynamic therapy, photosensitizers, pneumonia, polyuria, proctitis, prostate, radical cystectomy, radiopaque, renal pelvis, Schistosoma haematobium, segmental cystectomy, smoking, squamous cells, transitional cells, transurethral resection, tumor, TUR, ureteral reflux, ureters, urethra, urinary reservoir, urinary tract infection, urinary tract, urostomy, UTI, vagina, x-ray.
Natural Standard Bottom Line Monograph, Copyright © 2009 (www.naturalstandard.com). Commercial distribution prohibited. This monograph is intendedfor informational purposes only, and should not be interpreted as specific medical advice. You should consult with a qualified healthcare provider before making decisions about therapies and/or health conditions.
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