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Background |
Causes |
Signs and symptoms |
Diagnosis |
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Integrative therapies |
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Bone cancer
Bone cancer occurs when bone cells grow uncontrollably. Unlike normal cells, cancer cells do not stop reproducing after they have doubled 50-60 times. These abnormal cells form clumps of tissue, called tumors, inside bones. The first symptom of bone cancer is typically pain in the affected bone(s). Sometimes, a bump either on the bone or in the tissues surrounding the bone may be felt.Primary bone cancer, or cancer that starts in the bone cells, is rare. Fewer than 2,500 Americans are diagnosed with this type of cancer each year. Children are more likely to develop primary bone cancer than adults.
Most cases of bone cancer occur when cancer from another part of the body, such as breast, prostate, or lung, has spread to bone cells. This is sometimes called metastatic bone cancer or secondary bone cancer.
The most common types of bone cancer are osteosarcoma, chondrosarcoma, and Ewing's sarcoma. These cancers can be primary or secondary cancer.
Osteosarcoma: Osteosarcoma, the most common type of bone cancer, primarily develops in growing bones, and it usually affects people between the ages of 10 and 25. This aggressive type of bone cancer often affects the arms and legs, particularly the knees and shoulders of children. In some cases, osteosarcoma spreads to the lungs. About 65% of people with osteosarcoma survive five years after diagnosis.
Chondrosarcoma: Chondrosarcoma develops in the cartilage. It often affects the bones in the pelvis and hips. It is most common among people who are 50 years of age or older, and it is slightly more common in males than females. Chondrosarcoma is the second most common bone cancer, accounting for about 25% of all cancerous bone tumors. The five-year survival for the aggressive form of chondrosarcoma is about 30%, and the five-year survival rate for slow-growing tumors is about 90%.
Ewing's sarcoma: Ewing's sarcoma develops in the nerve tissue in bone marrow of children who are 4-15 years old. It is very rare in people who are older than 30 years of age. Ewing's sarcoma often develops after a person undergoes treatment, such as radiation or chemotherapy, for another type of cancer. Ewing's sarcoma is the most aggressive bone cancer. It typically affects the middle of the long bones in the arms and legs. The three-year survival rate is about 65%, but this rate is much lower if the cancer has spread to the lungs or other parts of the body.
Surgery is often the main treatment for bone cancer. In addition to having bone tumors surgically removed, patients may also undergo chemotherapy, and/or radiation therapy. In some cases, patients may need to undergo a surgical amputation, but this is performed less often today. Specific treatment options depend on the type of bone cancer, as well as its location, size, and stage.
In general, the prognosis for patients with bone cancer is based on many factors, including the type of cancer, at what stage the cancer was discovered, and where the tumor is located. For instance, if the tumor is small and limited to a localized area, the patient's prognosis is generally better than if the cancer has spread to other parts of the body.
Background
Bone cancer occurs when bone cells grow uncontrollably. Unlike normal cells, cancer cells do not stop reproducing after they have doubled 50-60 times. These abnormal cells form clumps of tissue, called tumors, inside bones. The first symptom of bone cancer is typically pain in the affected bone(s). Sometimes, a bump either on the bone or in the tissues surrounding the bone may be felt.Primary bone cancer, or cancer that starts in the bone cells, is rare. Fewer than 2,500 Americans are diagnosed with this type of cancer each year. Children are more likely to develop primary bone cancer than adults.
Most cases of bone cancer occur when cancer from another part of the body, such as breast, prostate, or lung, has spread to bone cells. This is sometimes called metastatic bone cancer or secondary bone cancer.
The most common types of bone cancer are osteosarcoma, chondrosarcoma, and Ewing's sarcoma. These cancers can be primary or secondary cancer.
Osteosarcoma: Osteosarcoma, the most common type of bone cancer, primarily develops in growing bones, and it usually affects people between the ages of 10 and 25. This aggressive type of bone cancer often affects the arms and legs, particularly the knees and shoulders of children. In some cases, osteosarcoma spreads to the lungs. About 65% of people with osteosarcoma survive five years after diagnosis.
Chondrosarcoma: Chondrosarcoma develops in the cartilage. It often affects the bones in the pelvis and hips. It is most common among people who are 50 years of age or older, and it is slightly more common in males than females. Chondrosarcoma is the second most common bone cancer, accounting for about 25% of all cancerous bone tumors. The five-year survival for the aggressive form of chondrosarcoma is about 30%, and the five-year survival rate for slow-growing tumors is about 90%.
Ewing's sarcoma: Ewing's sarcoma develops in the nerve tissue in bone marrow of children who are 4-15 years old. It is very rare in people who are older than 30 years of age. Ewing's sarcoma often develops after a person undergoes treatment, such as radiation or chemotherapy, for another type of cancer. Ewing's sarcoma is the most aggressive bone cancer. It typically affects the middle of the long bones in the arms and legs. The three-year survival rate is about 65%, but this rate is much lower if the cancer has spread to the lungs or other parts of the body.
Surgery is often the main treatment for bone cancer. In addition to having bone tumors surgically removed, patients may also undergo chemotherapy, and/or radiation therapy. In some cases, patients may need to undergo a surgical amputation, but this is performed less often today. Specific treatment options depend on the type of bone cancer, as well as its location, size, and stage.
In general, the prognosis for patients with bone cancer is based on many factors, including the type of cancer, at what stage the cancer was discovered, and where the tumor is located. For instance, if the tumor is small and limited to a localized area, the patient's prognosis is generally better than if the cancer has spread to other parts of the body.
Causes
Primary bone cancer: There is no known cause of primary bone cancer. Some inherited disorders have been shown to increase a person's risk of developing bone cancer. For instance, Li-Fraumeni syndrome is a rare disorder that predisposes people to certain cancers, including bone cancer. People with Rothmund-Thomson syndrome, an inherited skin disorder, also have an increase risk of developing bone cancer. An inherited eye cancer, called hereditary reinotblastoma, and an inherited cartilage disorder, called multiple exostoses, have also been associated with an increased risk of bone cancer.Metastatic bone cancer: Most cases of bone cancer occur when cancer from another part of the body, such as the breast, prostate, or lung, has spread to bone cells.
People who undergo radiation therapy or chemotherapy for other types of cancer have an increased risk of developing bone cancer. Research has shown that the risk is greatest if high doses are used, if therapy is performed for prolonged periods of time, or if therapy is performed at a young age. This is because these therapies may change the genetic makeup of cells.
Signs and symptoms
The most common symptom of bone cancer is pain in the affected bone(s). Pain generally worsens over time. At first, pain may be mild and only occur periodically, such as after exercising. That is why some people may not seek medical treatment for weeks to years after symptoms develop.Although bone cancer can develop in any of the bones, it most commonly affects the long bones of the arms and legs, such as the femur. Other common symptoms include swelling around the affected site, weakened bones (which may lead to bone fractures), fatigue, weight loss, frequent infections (such as respiratory infections), nausea, vomiting, constipation, problems with urination, weakness or numbness in the legs, and/or small bumps on the bone or surrounding tissue.
Diagnosis
General: If bone cancer is suspected, a doctor may perform imaging studies and/or a bone scan to determine if there are tumors in the bone. If a tumor is found, a biopsy is needed to determine if it is cancerous.Imaging studies: Imaging studies, such as computerized tomography (CT) scan or magnetic resonance imaging (MRI) scan, provide detailed images of the bones. During these procedures, a small amount of radioactive material is injected into the patient. This substance can be detected by a special camera used to create images of the patient's bones. These tests can detect tumors in the bones.
Biopsy: A biopsy is a diagnostic procedure that involves analyzing a small tissue sample from a patient under a microscope. There are two types of biopsies that may be performed to determine if a person has bone cancer: a needle biopsy and surgical biopsy. During a needle biopsy, a thin needle is used to remove a small sample of tissue from the tumor. During a surgical biopsy, a small incision is made through the skin, and either the entire tumor or part of the tumor is removed. Local or general anesthesia may be used, depending on the size and location of the tumor. The tissue sample is then analyzed in a laboratory for the presence of cancerous cells. The type of biopsy performed depends on the size and location of the bone tumor(s).
Additional tests: Additional tests may be performed to determine if the cancer has spread to other parts of the body. For example, a bone scan, which identifies areas of rapidly growing or changing bone, may be performed on the whole body to determine if other parts of the body are affected. Blood tests may also be performed. If cancer markers are detected in the bloodstream, this indicates that the cancer has spread to other areas.
Staging: Stage 1 bone cancer is considered low-grade cancer. In these cases, the cancer has not spread to any other organ, including the lymph nodes. This type is further subdivided into stage 1A and stage 1B. Stage 1A means that the cancer is still completely inside the bone. Stage 1B means that the bone cancer has grown through the bone wall.
Stage 2 bone cancer is considered high-grade cancer, but the cancer has not spread to any other organ, including the lymph nodes. All cases of Ewing sarcomas are high grade, which means all patients with this type of cancer automatically start out with stage 2 bone cancer. Stage 2 is subdivided into stage 2A and stage 2B. Stage 2A means that the cancer is still completely inside the bone. Stage 2B means that the cancer has grown through the bone wall.
Stage 3 bone cancer is either low-grade or high-grade cancer that has spread to another body organ, including the lymph nodes. This is the most severe stage.
Complications
Bone fractures: Bone cancer generally causes the affected bones to become weak. This is because cancerous cells infiltrate the bone, preventing healthy bone cells from growing and functioning properly. As a result, the patient has an increased risk of experiencing bone fractures after little or no trauma. In addition, healing time after a bone fracture may be increased.Metastasis: Bone cancer may spread to other parts of the body, such as the lungs or lymph nodes. When cancer spreads to another organ, it may lead to organ dysfunction or death.
Treatment
General: Specific treatment options depend on the type of bone cancer, as well as its location, size, and stage. Surgery is often the main treatment for bone cancer. In addition to having bone tumors surgically removed, patients may also undergo chemotherapy and/or radiation therapy. In some cases, patients may need to undergo a surgical amputation, but this is performed less often today. There are many treatment centers that specialize in sarcomas (connective tissue cancers), including bone cancer.In general, the prognosis for patients with bone cancer is based on many factors, including the type of cancer, at what stage the cancer was discovered, and where the tumor is located.
Surgery: Surgery is often used to treat bone cancer. Tumors and some of the surrounding tissue are surgically removed. Sometimes this may require the removal of portions of muscle, nerves, and/or blood vessels. Depending on the size and location of the affected bone, surgeons may replace the cancerous bone with an artificial device (called a prosthesis) or bone from either the patient's own body or a donor instead of amputating a limb.
Before surgery, some patients may undergo chemotherapy to help kill the cancer cells in the body. This helps shrink the size of the cancer so that surgery may be more effective. After surgery, patients often receive chemotherapy and/or radiation therapy to kill any cancer cells that may still be in the body.
Amputations were commonly performed in the past in bone cancer patients. However, this procedure is less common today because of the advancements in medical treatment. Surgical amputations are generally only performed when the bone cannot be saved. Limb-preserving procedures are preferred because the patient is able to maintain his/her mobility. However, if the affected bone is not amputated, there is a risk that some cancerous cells were not destroyed and can grow back.
Recovery time depends on the size and location of the tumor(s). In general, recovery typically takes several weeks to months. After surgery, a doctor may recommend rehabilitation, physical therapy, and/or occupational therapy. The main risks associated with surgery include infection, recurrence of the cancer, and injury to the surrounding tissues. Other complications may include muscle weakness (if muscle was removed), decreased sensation (if nerves were removed), and an increased risk of fractures.
Chemotherapy: Chemotherapy is a drug therapy that kills rapidly dividing cells, including cancer cells. Because these drugs are poisonous (toxic) to cells that multiply quickly, they kill some healthy cells in addition to cancer cells. This includes cells in the bone marrow, gastrointestinal tract, reproductive system, and hair follicles. However, healthy cells usually recover shortly after treatment is completed.
Chemotherapy may be used to kill cancer cells that have spread to other parts of the body. Ewing's sarcoma is especially aggressive. Therefore, patients with this type of cancer are likely to undergo chemotherapy. However, in bone cancer patients, chemotherapy is more commonly used in combination with surgery and/or radiation to shrink tumors, which helps make surgery safer and easier on the patient. Chemotherapy may also be used to prolong a person's life by managing the cancer growth. Not all people respond the same way to chemotherapy treatments. The effectiveness of treatment varies significantly based on many factors, such as the type of cancer, size and location of the tumor, as well as the person's age and overall health.
Chemotherapy drugs can be given by mouth, injected through a syringe into a vein, artery, or muscle; given intravenously though an IV drip device; placed into a catheter (tube) that goes into the bladder, chest cavity, brain, spinal cord, liver, or abdomen; or they can be applied to the skin. The decision on which way to deliver these drugs depends on several factors, mainly the type of cancer and the type of drug being used. At the same time, people may be given other medications, including steroids, allergy medications (anti-histamines), anti-nausea medications, sedatives, and antibiotics, to reduce side effects of chemotherapy.
Because healthy cells are also killed during chemotherapy, there are many potential side effects of treatment. Side effects of chemotherapy depend on the type of drugs, the amounts taken, and the length of treatment. The most common side effects include hair loss, nausea, vomiting, weakened immune system (which may lead to an increase in infections), fatigue, and loss of appetite. These side effects start to go away once treatment is completed. Because adequate nutrition is essential during chemotherapy, a doctor may recommend a nutritionist, especially if the patient experiences nausea and loss of appetite.
Radiation therapy: Radiation therapy uses high-energy rays to kill cancer cells. It is considered a local therapy, meaning that it is used to target specific areas of the body that have tumors. A radiation oncologist plans and supervises therapy. As with chemotherapy, healthy cells are also killed during radiation therapy. However, there is less damage with radiation therapy than chemotherapy. This is because only a localized area receives radiation therapy.
Bone cancer patients may undergo radiation therapy before surgery to shrink cancerous tumors or after surgery to help kill any cancer cells that may still be in the body. It may also be used in combination with chemotherapy or to help shrink tumors in order to decrease symptoms of pain and pressure.
Radiation therapy is usually given on an outpatient basis, with the patient visiting the hospital up to five times per week. Before each treatment, the patient is carefully positioned, usually lying on a treatment table. Parts of the body that are not being treated may be covered. It is important to remain completely still during the treatment. Each treatment usually lasts only a few minutes and causes no immediate discomfort. Although the patient is left alone during the actual treatment, the radiotherapy technician watches from an observation room, and the patient is able to talk to the technician with a microphone. A course of radiotherapy typically lasts between two and six weeks, depending on the patient's individual circumstances. The length of radiation treatment varies depending on the stage of the disease. Radiation therapy may be used alone, but is commonly used in combination with chemotherapy.
Common side effects include fatigue, loss of appetite, the suppression of the blood counts, and damage to the surrounding skin and soft tissues. Undergoing radiation before surgery may increase the risk of postoperative wound or healing problems.
Integrative therapies
Good scientific evidence:Greater celandine: Greater celandine has been used historically in Europe for the treatment of many diseases. Although celendine is considered somewhat toxic, German doctors have used its extracts extensively for decades. Ukrain™, a semisynthetic drug derived from Chelidonium majus, has been studied in clinical trials as a possible treatment for various cancers. These trials have resulted in consistently positive outcomes, with Ukrain™ demonstrating immune system modulating and stimulating properties, cytotoxic effects on malignant cells, and improvements in the clinical course of the disease. A systematic review of the randomized clinical trials on Ukrain™ found that this medicine has promise as an anticancer agent for many types of cancer. However, the quality of the research performed to date is inadequate, and higher methodological quality studies are called for.
Avoid if allergic to greater celandine, its constituents, or members of the Papaveraceae family. Avoid with liver disease. Use cautiously if taking amphetamines, morphine, hexobarbital, monoamine oxidase inhibitors (MAOIs), dopaminergic, or serotonergic drugs. Use cautiously if undergoing radiation therapy. Avoid if pregnant or breastfeeding, due to a lack of safety evidence.
Psychotherapy: Psychotherapy is an interactive process between a person and a qualified mental health professional. The patient explores thoughts, feelings, and behaviors to help with problem solving. There is good evidence that psychotherapy can enhance cancer patients' quality of life by reducing emotional distress and helping them cope with the stresses and challenges of cancer. Therapy may involve 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 cannot always fix mental or emotional conditions. Psychiatric drugs are sometimes needed. In some cases, symptoms may worsen if the proper medication is not taken. Not all therapists are qualified to work with all problems. Use cautiously with serious mental illnesses or some medical conditions because some forms of psychotherapy may stir up strong emotional feelings and expressions.
Unclear or conflicting scientific evidence:
Acupuncture: Acupuncture is commonly used throughout the world. According to Chinese medicine theory, the human body contains a network of energy pathways through which vital energy, called "chi," circulates. These pathways contain specific points that function like gates, allowing chi to flow through the body. Needles are inserted into these points to regulate the flow of chi. 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.
Needles must be sterile in order to avoid disease transmission. Avoid with valvular heart disease, medical conditions of unknown origins, or infections. Acupuncture should not be applied to the chest in patients with lung diseases or on any area that may rely on muscle tone to provide stability. Avoid use in infants, young children, or in patients with needle phobias. Use cautiously with bleeding disorders, neurological disorders, seizure disorders, or diabetes. Use cautiously in elderly or medically compromised patients. Use cautiously in patients who will drive or operate heavy machinery after acupuncture. Use cautiously if taking anticoagulants. Avoid if pregnant.
American pawpaw: American pawpaw (Asimina triloba) is a fruiting tree native to North America. However, the tree is also cultivated in Asia, Australia, and Europe. Pawpaw extract may have some anticancer activity, but additional study is needed to make a firm recommendation.
No well-designed studies on the long-term effects of pawpaw extracts have been conducted. The constituents in pawpaw extract are cytotoxic. Therefore, oral use of pawpaw extract is not recommended without the supervision of a doctor. Avoid if allergic to Asimina triloba or any other members of the Annonaceae plant family (including other species of Asimina, and those in the genera Annona, Deeringothamnus, Disepalum, Goniothalanus, Rollinia, Uvaria, or Xylopia). Use cautiously with gastrointestinal problems or with a history of dermatological reactions. Avoid if pregnant or breastfeeding.
Antineoplastons: Antineoplastons are substances found in normal human blood and urine. In the late 1970s, Dr. Stanislaw Burzynski found that they were not in the urine of cancer patients, and so researchers began studying antineoplastons as a possible treatment for cancer. 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 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/damage, or kidney disease/damage. Avoid if pregnant or breastfeeding.
Arabinoxylan: Arabinoxylan, made from rice bran and mushroom extract, has been used to support individuals with low white blood cell counts caused by chemotherapy. Arabinoxylan has been studied as a possible treatment for various types of cancer. Additional research is needed in this area.
Use cautiously if elderly or with kidney dysfunction, due to potentially high calcium and phosphorus content. Use cautiously with diabetes. Avoid if pregnant or breastfeeding. Users of MGN-3 (BioBranâ) should be aware of other constituents (cornstarch, dextrin, tricalcium phosphate, silicon dioxide). Patients with allergies to other constituents should not take MGN-3. It is not a proven treatment for cancer, diabetes, or HIV.
Aromatherapy: Aromatherapy refers to many different therapies that use essential oils. The oils are sprayed in the air, inhaled, or applied to the skin. Essential oils are usually mixed with a carrier oil (usually a vegetable oil) or alcohol. Aromatherapy is often used in people with chronic illnesses, including cancer, with the intention to improve quality of life or well-being. It is often used in combination with massage. There is not enough scientific evidence in this area to form a firm conclusion about the effectiveness of aromatherapy.
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. Sage, rosemary, and juniper oils should be avoided if pregnant or breastfeeding.
Art therapy: Art therapy involves many forms of art to treat anxiety, depression, and other mental and emotional problems. Art therapy became a mental health profession in the 1930s. Today, it is practiced in hospitals, clinics, public and community agencies, wellness centers, educational institutions, businesses, and private practices. 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 healthcare 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.
Because art therapy may stir up distressing thoughts or feelings, it should be used under the guidance of a qualified art therapist or mental health professional. Related materials, such as turpentine or mineral spirits, should be used in areas with good ventilation because they release potentially toxic fumes.
Astragalus: In traditional Chinese medicine (TCM), astragalus is commonly found in mixtures with other herbs. Western herbalists began using astragalus in the 1800s as an ingredient in various tonics. 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 the effectiveness of platinum-based chemotherapy (anti-cancer drugs that contain platinum) when combined with chemotherapy. Due to a lack of well-designed research, a firm conclusion cannot be drawn.
Avoid if allergic to astragalus, peas, or any related plants. Avoid with a history of Quillaja bark-induced asthma. Avoid if taking aspirin, aspirin products, or herbs or supplements with similar effects. Avoid with inflammation, fever, stroke, organ transplant, or autoimmune diseases. Stop use two weeks before and immediately after surgery/dental/diagnostic procedures with bleeding risks. Use cautiously with bleeding disorders, diabetes, high blood pressure, lipid disorders, or kidney disorders. Use cautiously if taking blood-thinners, blood sugar drugs, or diuretics or herbs and supplements with similar effects. Avoid if pregnant or breastfeeding.
Bee pollen: Bee pollen may reduce some adverse effects of cancer treatment. Additional study is needed before a firm recommendation can be made.
Avoid if allergic or hypersensitive to bee pollen or other bee products. Avoid with liver disease or bleeding disorders. Use cautiously because bee pollen may contain mycotoxins like ochratoxin A. Avoid if pregnant or breastfeeding due to a lack of scientific data.
Bitter melon: MAP30, a protein isolated from bitter melon extract, has been reported to possess anti-neoplastic effects in vitro. These effects have been attributed to the reduced expression of growth factor receptors, such as the transmembrane tyrosine kinase receptor HER2 (also known as neu or c-erb-2), which has been implicated in breast cancer. MAP30 was originally identified as a single chain ribosome inactivating protein (SCRIP), but its in vitro antineoplastic activities appear to be unrelated to its effect on ribosomes. The MAP30 gene has been cloned and expressed, and the recombinant protein re-MAP30 possesses similar properties in vitro as native MAP30. However, the antineoplastic effects of MAP30 (or bitter melon) have not been studied in humans.
Avoid if allergic to bitter melon or members of the Curcurbitaceae (gourd or melon) family, including Persian melon, honeydew, casaba, muskmelon, and cantaloupe. Avoid consuming the bitter melon seeds or outer rind, due to toxic lectins. Avoid with glucose-6-phosphate dehydrogenase deficiency. Use cautiously with diabetes, glucose intolerance, or if taking hypoglycemic agents. Avoid if pregnant or breastfeeding.
Black tea: Black tea is made from the dried leaves of Camellia sinensis, a perennial evergreen shrub. 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 than in black tea. Some animal and laboratory research suggests that components of black tea may be carcinogenic, although effects in humans are not clear. Overall, the relationship of black tea consumption and human cancer remains undetermined.
Avoid if allergic or hypersensitive to caffeine or tannin. Skin rash and hives have been reported after caffeine ingestion. Use cautiously 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. If breastfeeding mothers consume black tea, it may lead to anemia, decreased iron metabolism, and irritability in their infants
Bovine cartilage: Bovine cartilage, as a dietary supplement, is usually a preparation of bovine tracheal cartilage. The dietary supplement, VitaCarte®, is the commercially available preparation of Catrix®, the experimental powdered preparation taken in capsules in a case series by Prudden on the use of bovine tracheal cartilage as a potential cancer treatment. It remains unclear if bovine cartilage is an effective treatment for cancer. Additional research is warranted.
Avoid if allergic to bovine cartilage or its constituents. Use cautiously with cancer, as there is uncertainty about the effectiveness of bovine cartilage as a treatment for cancer. Use cautiously with kidney or liver failure. Avoid if pregnant or breastfeeding due to a lack of safety evidence.
Bromelain: Classified as an herb, bromelain is a digestive enzyme that comes from the stem and the fruit of the pineapple plant. 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.
Avoid if allergic to bromelain, pineapple, honeybee, venom, latex, birch pollen, carrots, celery, fennel, cypress pollen, grass pollen, papain, rye flour, wheat flour, or other members of the Bromeliaceae family. Avoid with liver disease, kidney disease, or bleeding disorders. Use cautiously with stomach ulcers, high blood pressure, or acute genitourinary tract inflammation. Use cautiously before dental or surgical procedures or while driving or operating heavy machinery. Use cautiously in children younger than two years of age. Avoid if pregnant or breastfeeding due to a lack of safety evidence.
Cat's claw: Cat's claw is widely used in the United States and Europe, and it is one of the top herbal remedies sold despite a lack of high-quality human evidence. Preliminary evidence suggests that cat's claw may slow tumor growth. However, this research is very early and has not identified specific types of cancer that may benefit; the results are not clear. More studies are needed before a firm recommendation can be made.
Avoid if allergic to Cat's claw, Uncaria plants, or plants in the Rubiaceae family (such as gardenia, or quinine). Avoid with immune disorders (such as AIDS, HIV, some types of cancer, multiple sclerosis, tuberculosis, rheumatoid arthritis, or lupus). Use cautiously in patients taking iron, antihypertensive agents, diuretics, estrogens, progestins, or drugs that increase the risk of bleeding. Use cautiously with bleeding disorders, low blood pressure, irregular heartbeat, or kidney dysfunction. Stop use two weeks before and immediately after surgery/dental/diagnostic procedures with bleeding risks. Avoid if pregnant or breastfeeding. Cat's claw may be contaminated with other Uncaria species. Reports exist of the potentially toxic Texan grown plant Acacia gregii being substituted for cat's claw.
Chaparral: Native Americans have used chaparral leaves and stems to treat cancer, arthritis, and colds. Chaparral and one of its components called nordihydroguaiaretic acid (NDGA) have antioxidant ("free-radical scavenging") properties, and have been proposed as cancer treatments. However, 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.
Chlorophyll: Chlorophyll is a chemoprotein commonly known for its contribution to the green pigmentation in plants. It is related to protoheme, the red pigment of blood. Preliminary evidence suggests 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 its use for reducing photosensitivity symptoms.
Avoid if allergic to chlorophyll or any of its metabolites. Use cautiously with photosensitivity, compromised liver function, diabetes, or gastrointestinal conditions or obstructions. Use cautiously if taking immunosuppressants or antidiabetic agents. Avoid if pregnant or breastfeeding.
Copper: Copper is a mineral that occurs naturally in many foods, including vegetables, legumes, nuts, grains, fruits, shellfish, avocado, beef, and animal organs (e.g. liver and kidney). Preliminary research reports that lowering copper levels may theoretically 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.
Avoid if allergic to copper. Avoid copper supplements during the early phase of recovery from diarrhea. Avoid with hypercupremia. Avoid with genetic disorders affecting copper metabolism (e.g. Wilson's disease, Indian childhood cirrhosis, or idiopathic copper toxicosis). Avoid with HIV/AIDS. Use cautiously with water containing copper concentrations greater than 6 milligrams/liter. Use cautiously with anemia, arthralgias, or myalgias. Use cautiously if taking birth control pills. Use cautiously if at risk for selenium deficiency. Doses that do not exceed the recommended dietary allowance appear to be safe during pregnancy and breastfeeding.
Cranberry: Cranberries come from small evergreen shrubs with tart, red, edible berries. The berries are used in sauces, jellies, and drinks. 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.
Avoid if allergic to cranberries, blueberries, or other plants of the Vaccinium species. Sweetened cranberry juice may affect 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: Dandelion is a member of the Asteraceae/Compositae family closely related to chicory. Limited animal research does not provide a clear assessment of the effects of dandelion on tumor growth. There is a lack of well-conducted human studies currently available in this area.
Avoid if allergic to chamomile, feverfew, dandelion, honey, yarrow, or any related plants, such as aster, daisies, sunflower, chrysanthemum, mugwort, ragweed, or ragwort. Avoid if taking aspirin, anti-inflammatories, blood thinners, diuretics, or lithium. Use cautiously with diabetes, bleeding disorders, gastroesophageal reflux disease (GERD), kidney or liver diseases, or with a history of stroke or electrolyte disorders. Monitor potassium blood levels. Stop use two weeks before and immediately after surgery/dental/diagnostic procedures with bleeding risks. Avoid if pregnant or breastfeeding.
Echinacea: Echinacea is a perennial herb that has been used to treat a variety of medical conditions. There is no clear human evidence of the effects of echinacea on any type of cancer.
Avoid if allergic to plants in the Asteraceae or Compositae family (such as ragweed, chrysanthemums, marigolds, or daisies). Avoid echinacea injections. Avoid with a history of liver disease or if taking amoxicillin. Avoid in transplant patients. Use cautiously if driving or operating heavy machinery. Use cautiously with a history of asthma, diabetes, conditions affecting the immune systems (such as lupus, TB, AIDS-HIV), or rheumatologic conditions (such as rheumatoid arthritis). Avoid if pregnant or breastfeeding. Tinctures may contain large amounts of alcohol.
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). 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 (rhubarb has shown some anti-tumor properties in animal experiments; slippery elm inner bark has not; sheep sorrel and burdock have been used traditionally in cancer remedies). 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.
Safety concerns are based on reactions associated with the herbal components of Essiac®: burdock root (Arctium lappa), sheep sorrel (Rumex acetosella), slippery elm bark (Ulmus fulva), and Turkish rhubarb (Rheum palmatum). However, the safety and toxicities of these individual herbs are also not well studied. Various Essiac®-like products may contain different or additional ingredients, and patients are advised to carefully review product labels. There are no reports of allergy to Essiac® in the published scientific literature, but reactions can potentially occur due to any of the included herbs. Anaphylaxis has been reported after rhubarb leaf ingestion, and there are reports of allergic reactions to sorrel products taken by mouth. Contact dermatitis has been reported with exposure to burdock, slippery elm bark, and rhubarb leaves. Cross-sensitivity to burdock may occur in individuals with allergy to members of the Asteraceae/Compositae family, such as ragweed, chrysanthemums, marigolds, and daisies. Use cautiously with diabetes or hypoglycemia. Use cautiously if taking drugs, herbs, or supplements that affect blood sugar. Avoid if pregnant or breastfeeding.
Focusing: Focusing (also called 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.
Side effect reporting is rare, but patients should consult with their qualified healthcare practitioners before making decisions about medical conditions and practices. People with severe emotional difficulties should not abandon proven medical and psychological therapies but rather choose focusing as a possible adjunct.
Gamma linolenic acid: Gamma linolenic acid (GLA) is a dietary fatty acid that is found in many plant oil extracts. Preliminary research has indicated that GLA may act as a cytotoxic agent or at least as an adjunct agent to a chemotherapy regimen. However, human studies are conflicting and more study is needed before a strong conclusion can be made.
Use cautiously with drugs that increase the risk of bleeding like anticoagulants and anti-platelet drugs. Avoid if pregnant or breastfeeding.
Garlic: The Garlic bulb is made of many cloves that are wrapped in a paper-thin, white skin. It is used both medicinally and as a spice in food. Preliminary human studies suggest that regular consumption of garlic (particularly unprocessed garlic) 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.
Avoid if allergic or hypersensitive to garlic or other members of the Lilaceae (lily) family (such as hyacinth, tulip, onion, leek, and chive). Avoid topical use in infants or young children and use cautiously in adults. Use cautiously with bleeding disorders or peptic ulcer disease. Use cautiously if taking any drugs (prescription or over-the-counter), herbs, or supplements that may increase the risk of bleeding. Stop using supplemental garlic two weeks before and immediately after dental/surgical/diagnostic procedures with bleeding risks. Avoid in supplemental doses if pregnant or breastfeeding.
Goji: Goji berries have been consumed as a food and as medicine in Asia for at least 2,000 years. Polysaccharide constituents, such as the alpha- and beta-glucans from a variety of plants, are reported to have immune system enhancing properties. Early human research has shown that Lycium barbarum polysaccharides (LBP) have a synergistic effect in the treatment of various cancers when administered in conjunction with powerful immune stimulating drugs. However, additional research is needed to confirm these findings.
Avoid if allergic to goji, any of its constituents, or to members of the Solanaceae family. Use cautiously if taking blood-thinning medications. Use cautiously with asthma. Avoid if pregnant or breastfeeding due to a lack of safety evidence.
Grape seed: Grape leaves, sap, and fruit have been used medicinally since the Greek empire. There is little information available on the use of grape seed extract in the treatment of human cancer. Further research is needed before a recommendation can be made.
Avoid if allergic to grapes. Use cautiously if taking anticoagulants. Use cautiously with blood pressure disorders or if taking ACE inhibitors. Grape seed may interfere with the way the body processes certain drugs that use the liver's "cytochrome P450" enzyme system. Avoid if pregnant or breastfeeding.
Green tea: Green tea is made from the dried leaves of Camellia sinensis, an evergreen shrub. Overall, 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.
Avoid if allergic or hypersensitive to caffeine or tannin. Use cautiously with diabetes or liver disease.
Healing touch: Healing touch (HT) is a combination of hands-on and off-body techniques to influence the flow of energy through a person's biofield. Early evidence suggests that HT 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.
HT should not be regarded as a substitute for established medical treatments. Use cautiously if pregnant or breastfeeding.
Hoxsey formula: "Hoxsey formula" is a misleading name because it is not a single formula. It is a therapeutic regimen made 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. Different preparations contain multiple herbs and other ingredients. The original "Hoxsey formula" was developed in the mid-1800s when a horse belonging to John Hoxsey was observed to recover from cancer after feeding in a field of wild plants. These plants were collected and used to create a remedy that was initially given to ill animals. Different historical accounts state various herbs included in the original formula. The formula was passed down in the Hoxsey family, and John Hoxsey's great-grandson Harry Hoxsey, an Illinois coal miner, marketed an herbal mixture for cancer and promoted himself as an herbal healer. The first Hoxsey clinic opened in the 1920s in Illinois, and Hoxsey therapy became popular for cancer in the United States during the 1940s and 1950s, with clinics operating in multiple states. The Hoxsey clinic in Dallas was one of the largest privately owned cancer hospitals in the world. However, after legal conflicts with the American Medical Association and U.S. Food and Drug Administration (FDA), the last U.S. clinic closed in the 1950s. The formula was passed to Mildred Nelson, a nurse in the clinic, who used the formula to open and operate a Hoxsey clinic in Tijuana, Mexico. There are no well-designed human studies available evaluating the safety or effectiveness of Hoxsey formula.
Avoid if allergic to burdock root, potassium iodide, licorice, red clover, stillingia root, berberis root, pokeroot, cascara, prickly ash bark, or buckthorn bark (all of which may be contained in the oral Hoxsey tonic). Avoid if pregnant or breastfeeding.
Hydrazine sulfate: Hydrazine is an industrial chemical marketed as having the potential to repress weight loss and cachexia associated with cancer, and to improve general appetite status. 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.
Although hydrazine sulfate has been considered to have antineoplastic properties, the FDA and the U.S. Department of Health and Human Services have determined that hydrazine sulfate has carcinogenic effects. Use cautiously with liver or kidney problems, psychosis, seizures, or diabetes. Avoid if pregnant or breastfeeding due to a lack of safety evidence. Avoid in children.
Iodine: Iodine is an element that the human body needs to make thyroid hormones. 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.
Reactions can be severe, and deaths have occurred with exposure to iodine. Avoid iodine-based products if allergic or hypersensitive to iodine. Do no use for more than 14 days. Avoid Lugol solution and saturated solution of potassium iodide (SSKI, PIMA) with high amounts of potassium in the blood, pulmonary edema (fluid in the lungs), bronchitis, or tuberculosis. Use cautiously when applying to the skin because it may irritate/burn tissues. Use sodium iodide cautiously with kidney failure. Avoid sodium iodide with gastrointestinal obstruction. Iodine is safe in recommended doses for pregnant or breastfeeding women. Avoid povidone-iodine for perianal preparation during delivery or postpartum antisepsis.
Jiaogulan: Jiaogulan (Gynostemma pentaphyllum) is best known as a traditional Chinese medicine (TCM) herb. Preliminary evidence indicates that gypenosides extracted from Gynostemma pentaphyllum decrease cancer cell viability, arrest the cell cycle, and induce apoptosis (cell death) in human cancer cells. Immune function in cancer patients has also been studied. Additional study is needed in this area.
Avoid if allergic or hypersensitive to jiaogulan (Gynostemma pentaphyllum), its constituents, or members of the Cucurbitaceae family. Use cautiously with hematologic (of the blood) conditions or if taking anticoagulants or anti-platelet drugs (blood thinners). Use cautiously with diabetes. Avoid if pregnant or breastfeeding.
Lutein: Lutein and zeaxanthin are found in high levels in foods, such as green vegetables, egg yolk, kiwi fruit, grapes, orange juice, zucchini, squash, and corn. Currently, there is insufficient available evidence to recommend for or against the use of lutein for cancer. Available evidence in humans is conflicting.
Avoid if allergic or hypersensitive to lutein or zeaxanthin. Use cautiously if at risk for heart disease or cancer. Avoid if pregnant or breastfeeding.
Maitake mushroom: Maitake mushrooms (Grifola frondosa) are fungi that can be eaten. The mushroom has a large fruiting body and overlapping caps. Maitake has been used both as a food and for medical conditions. 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.
Maitake has not been studied thoroughly in humans, and its effects are not well known. Because it has been used historically as a food, it is thought that low doses may be safe. Avoid if allergic to Grifola frondosa (maitake). Use cautiously with a history of low blood pressure, diabetes, or if taking drugs, herbs, or supplements that treat such conditions. Avoid if pregnant or breastfeeding.
Melatonin: Melatonin is a neurohormone produced in the brain. Levels of melatonin in the blood are highest before bedtime. 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.
There are rare reports of allergic skin reactions after taking melatonin by mouth. Avoid with bleeding disorders or if taking blood thinners. Use cautiously with seizures disorders, major depression, psychotic disorders, diabetes, low blood sugar levels, glaucoma, high cholesterol, atherosclerosis, or if at risk of heart disease. Use cautiously if driving or operating heavy machinery.
Oleander: Oleander is an evergreen shrub native to the Mediterranean. Laboratory studies of 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 before a recommendation can be made.
All parts of the oleander plant, including flowers, leaves, and nectar, are considered toxic and may cause death. Avoid if allergic to oleander or other cardiac glycosides, such as digoxin. Avoid with a history of irregular heartbeat (arrhythmia), seizures, liver or kidney disease, depression, or asthma. Avoid if pregnant or breastfeeding.
Para-aminobenzoic acid (PABA): Para-aminobenzoic acid (PABA) is a naturally occurring non-protein amino acid. It was previously thought to be a B vitamin, but it is now known that it is neither a vitamin, nor an essential nutrient in humans. Limited scientific evidence suggests that PABA may help reduce pain caused by cancer. Additional study is warranted.
Avoid if allergic to PABA or its derivatives. Avoid oral use in children and pregnant or breastfeeding women. Avoid if taking sulfonamides. Use cautiously with kidney disease, liver disease, diabetes, hypoglycemia, or bleeding disorders. Use cautiously if taking anticoagulants. Blood sugar monitoring may be warranted in diabetics or patients at risk for hypoglycemia who are taking PABA systemically. Discontinue use if rash, nausea, or anorexia occurs.
Perillyl alcohol: Perillyl alcohol is a monoterpene, isolated from essential oils of several plants including cherries, lavender, peppermint, spearmint, celery seeds, sage, cranberries, lemongrass, ginger grass, savin juniper, Conyza newii, caraway, Perilla frutescens, and wild bergamont. Perillyl alcohol is primarily used to treat cancer. However, no high-quality, advanced studies are currently available to determine its effectiveness. Further information is required before recommendations can be made.
Avoid if allergic/hypersensitive to perillyl alcohol. Avoid use in the absence of medical supervision. Use cautiously in patients under medical supervision. Avoid if pregnant or breastfeeding.
Prayer, distant healing: Prayer can be defined as a "reverent petition," the act of asking for something while aiming to connect with God or another object of worship. Initial studies in patients with cancer 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.
Prayer is not recommended as the sole treatment approach for potentially serious medical conditions and should not delay the time it takes to consult with a healthcare professional or receive established therapies. Sometimes religious beliefs come into conflict with standard medical approaches and require an open dialog between patients and caregivers.
Reishi mushroom: Reishi mushroom (Ganoderma lucidum), also known as Ling Zhi in China, grows wild on decaying logs and tree stumps. Reishi 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. It is important to note that this data was published by the same group of authors who are affiliated with the manufacturer of Ganopoly®. Well-designed long-term studies are needed confirm these results and potential side effects.
Avoid if allergic to reishi mushroom, any of its constituents, or any member of its family. Use cautiously with diabetes, blood disorders (including hemophilia), low blood pressure, or ulcers. Avoid if pregnant or breastfeeding.
Seaweed, kelp, bladderwrack: Bladderwrack (Fucus vesiculosus) is a brown seaweed found along the northern coasts of the Atlantic and Pacific oceans and North and Baltic seas. Ascophyllum nodosum is another seaweed that grows alongside bladderwrack and is often combined with bladderwrack in kelp preparations. Several brown algae, including bladderwrack (Fucus vesiculosus), appear 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.
Avoid if allergic or hypersensitive to Fucus vesiculosus or iodine. Avoid with a history of thyroid disease, bleeding, acne, kidney disease, blood clots, nerve disorders, high blood pressure, stroke, or diabetes. Avoid if pregnant or breastfeeding.
Selenium: Selenium is a mineral found in soil, water, and some foods. 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. 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.
Avoid if allergic to products containing selenium. Avoid with a history of non-melanoma skin cancer. Selenium is generally regarded as safe for pregnant or breastfeeding women. However, animal research reports that large doses of selenium may lead to birth defects.
Shark cartilage: Shark cartilage is one of the most popular supplements in the United States with over 40 brand-name products sold. 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.
Avoid if allergic to shark cartilage or any of its ingredients (such as chondroitin sulfate or glucosamine). Use cautiously if allergic to sulfur. Use cautiously with coronary artery disease, peripheral vascular disease, liver disorders, diabetes, or kidney disorders. Avoid in children or if pregnant or breastfeeding.
Shiitake: Shiitake mushrooms were originally grown on natural oak logs found in Japan. Today, they are available in the United States. Laboratory, animal, and human studies of lentinan, a constituent of shiitake mushrooms, 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. Shiitake mushroom extract (SME) used alone did not show benefit in prostate cancer patients in one study. Please check with a medical oncologist and pharmacist before taking any therapies.
Avoid if allergic or hypersensitive to shiitake mushrooms. Avoid if pregnant or breastfeeding.
Slippery elm: Slippery elm is native to eastern Canada, and the eastern and central United States. Its name refers its slippery consistency when the inner bark is chewed or mixed with water. Slippery elm is found as a common ingredient in a purported herbal anticancer product called Essiac® and a number of Essiac®-like products. These products contain other herbs such as rhubarb, sorrel, and burdock root. 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.
Avoid if allergic or hypersensitive to slippery elm. Avoid if pregnant or breastfeeding.
Sorrel: Sorrel has been used as a salad green, spring tonic, diarrhea remedy, weak diuretic (to help eliminate water from the body), and a soothing agent for sore noses. There is no reliable human evidence evaluating sorrel monotherapy as a cancer treatment. Sorrel is included as an ingredient in the combination herbal formula Essiac® and in several Essiac®-like products that are used in the management of cancer. However, there is limited reliable research of these formulas, and it remains unclear if there are any health benefits of Essiac® or Essiac®-like products.
Avoid if allergic to sorrel or any member of the Polygonaceae plant family. Avoid large doses of sorrel because there have been reports of toxicity and death, possibly caused by oxalate found in sorrel. Fatal oxalic acid poisoning has been reported from sorrel soup. Be aware that many tinctures contain high levels of alcohol and should be avoided when driving or operating heavy machinery. These sorrel formulations may cause nausea or vomiting when taken with the prescription drugs metronidazole (Flagyl®) or disulfiram (Antabuse®). Avoid if pregnant or breastfeeding.
Sweet annie: Sweet annie (Artemisia annua) is also known as Chinese wormwood or sweet wormwood. Certain constituents found in sweet annie show promise when used in combination with standard chemotherapy. However, currently there is not enough scientific evidence in humans to make a strong recommendation for this use.
Avoid if allergic to sweet annie (Artemisia annua), its constituents, or members of the Asteraceae/Compositae family (e.g. dandelion, goldenrod, ragweed, sunflower, or daisies). Use cautiously in patients who are pregnant, taking angiogenic agents, or recovering from surgery or other wounds. Use cautiously if taking cardiotoxic or neurotoxic agents or with compromised cardiac or neural function. Use cautiously if taking immunostimulants or quinolines. Avoid if pregnant or breastfeeding.
TENS (transcutaneous electrical nerve stimulation): 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. There is not enough scientific evidence to determine if TENS is a safe treatment to reduce cancer pain.
Avoid with implantable devices (e.g. defibrillators, pacemakers, intravenous infusion pumps, or hepatic artery infusion pumps). Use cautiously with decreased sensation (e.g. neuropathy) or seizure disorders. Avoid if pregnant or breastfeeding.
Thiamin: Thiamin (also spelled "thiamine") is a water-soluble B-complex vitamin. It is also known as vitamin B1 or aneurine. 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 adaptive (beneficial). Currently, it remains unclear if thiamin supplementation plays a role in the management of any particular type(s) of cancer
Thiamin is generally considered safe and relatively nontoxic, even at high doses. Avoid if allergic or hypersensitive to thiamin. Thiamin appears safe if pregnant or breastfeeding when taken in the recommended dosages.
Thymus extract: Thymus extracts for nutritional supplements are usually derived from young calves (bovine). Preliminary evidence suggests that thymus extract may increase disease-free survival and immunological improvement. Early studies have investigated thymus extract for the treatment of hematopoietic cancer, histiocytosis X, larynx and oropharnygeal cancer, and skin cancer, among others. Additional study is needed to determine if it is an effective treatment for bone cancer.
Avoid if allergic to thymus extracts. Use bovine thymus extract supplements cautiously due to potential for exposure to the virus that causes "mad cow disease." Avoid use with an organ transplant or other forms of allografts or xenografts. Avoid with thymic tumors, myasthenia gravis (neuromuscular disorder), or untreated hypothyroidism. Avoid if taking hormonal therapy or immunosuppressants. Avoid if pregnant or breastfeeding; thymic extract increases human sperm motility and progression.
Traditional Chinese medicine (TCM): The term traditional Chinese medicine (TCM) is a recent development. In the 1940s and 1950s the Chinese government blended many forms of Chinese medicine into a unified health system. TCM practitioners use a wide range of treatments, ranging from meditation and acupuncture to herbal therapy and martial arts. TCM uses more than 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.
Chinese herbs can be potent and may interact with other herbs, foods, or drugs. Consult a qualified healthcare professional before taking.
Turmeric: Turmeric (Curcuma longa) is a perennial plant native to India and Indonesia, and it is often used as a spice in cooking. The rhizome (root) of turmeric has long been used in traditional Asian medicine to treat gastrointestinal upset, arthritis pain, and fatigue. Several early animal and laboratory studies report anti-cancer 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.
Avoid if allergic to turmeric (curcumin), yellow food colorings, or plants belonging to the Curcuma and Zingiberaceae (ginger) families. Use cautiously with a history of bleeding disorders, immune system deficiencies, liver disease, or gallstones. Use cautiously if taking blood-thinners, such as warfarin (like Coumadin®). Historically, turmeric has been considered safe when used as a spice in foods during pregnancy and breastfeeding. However, turmeric has been found to cause uterine stimulation and to stimulate menstrual flow, and caution is therefore warranted during pregnancy.
Vitamin C: Vitamin C (ascorbic acid) is a vitamin that the body needs to form collagen in bones, cartilage, muscle, and blood vessels. It is unknown is vitamin C can help prevent various types of cancers. 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. 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.
It is also unclear if vitamin C is an effective treatment for various cancers. 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. More well-designed studies are needed before a firm recommendation can be made.
Vitamin C is generally considered safe in amounts found in foods. Vitamin C supplements are also generally considered safe in most individuals if taken in recommended doses. Avoid high doses of vitamin C with glucose 6-phosphate dehydrogenase deficiency, kidney disorders or stones, cirrhosis (inflammation of the liver), gout, or paroxysmal nocturnal hemoglobinuria (bleeding disorder). Vitamin C intake from food is generally considered safe if pregnant or breastfeeding.
Vitamin D: Vitamin D is found in many foods, including fish, eggs, fortified milk, and cod liver oil. The sun also helps the body produce vitamin D. Limited research suggests that synthetic vitamin D analogs may play a role in the treatment of human cancers. However, it remains unclear if vitamin D deficiency raises cancer risk, or if an increased intake of vitamin D is protective against some cancers. Until additional trials are conducted, it is premature to advise the use of regular vitamin D supplementation to prevent cancer.
Avoid if allergic or hypersensitive to vitamin D or any of its components. Vitamin D is generally well-tolerated in recommended doses. Doses higher than recommended may cause toxic effects. Individuals with overactive thyroids, kidney disease, sarcoidosis, tuberculosis, or histoplasmosis have a higher risk of experiencing toxic effects. Vitamin D is generally considered safe for pregnant women. It may be necessary to give infants vitamin D supplements along with breast milk in order to prevent vitamin deficiencies.
Vitamin E: Vitamin E exists in eight different forms ("isomers"): alpha, beta, gamma, and delta tocopherol; and alpha, beta, gamma, and delta tocotrienol. Alpha-tocopherol is the most active form in humans. 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.
Avoid if allergic to vitamin E. For short periods of time, and in the recommended doses, vitamin E supplementation is generally considered safe. Avoid doses higher than 1,000 milligrams a day. Avoid with Retinitis pigmentosa (loss of peripheral vision). Use cautiously with bleeding disorders.
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.
Yoga is generally considered to be safe in healthy individuals when practiced appropriately. However, patients with bone cancer should be extremely cautious when practicing yoga because their bones are weaker than normal. As a result, they have an increased risk of experiencing bone fractures. Avoid some inverted poses with disc disease of the spine, fragile or atherosclerotic neck arteries, extremely high or low blood pressure, glaucoma, detachment of the retina, ear problems, severe osteoporosis, cervical spondylitis, or if at risk for blood clots. Certain yoga breathing techniques should be avoided 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. However, poses that put pressure on the uterus, such as abdominal twists, should be avoided in pregnancy.
Fair negative scientific evidence:
Apricot: Apricot is a natural fruit that grows in the northern Himalayas. Evidence suggests that apricot is not an effective treatment for cancer.
Avoid if allergic to apricot, its constituents, or members of the Rosaceae family, especially the Prunoideae subfamily of plants. Avoid eating excessive amounts of apricot kernels (about 7 grams daily, or more than 10 kernels daily). Avoid using Laetrile(tm), a drug that contains amygdalin, which is found in the pits of many fruits, raw nuts, and plants, including apricot. Use cautiously with diabetes. Use cautiously when taking supplements containing beta-carotene, iron, niacin, potassium, thiamine, or vitamin C. Use cautiously when taking products that may lower blood pressure. Avoid if pregnant or breastfeeding.
Beta-carotene: Beta-carotene is a member of the carotenoids, which are very colorful (red, orange, yellow), fat-soluble compounds. They are naturally found in many fruits, grains, oil, and vegetables, including green plants, carrots, sweet potatoes, squash, spinach, apricots, and green peppers. While diets high in fruits and vegetables rich in beta-carotene have been shown to potentially reduce the incidence of certain cancers, results from randomized controlled trials with oral supplements do not support this claim. There is some concern that beta-carotene metabolites with pharmacological activity can accumulate and potentially have cancer causing (carcinogenic) effects. A higher, statistically significant incidence of lung cancer in male smokers who took beta-carotene supplements has been discovered. Beta-carotene/vitamin A supplements may have an adverse effect on the incidence of lung cancer and on the risk of death in smokers and asbestos exposed people or in those who ingest significant amounts of alcohol. In addition, high-dose antioxidants theoretically may interfere with the activity of some chemotherapy drugs or radiation therapy. Therefore, individuals undergoing cancer treatment should speak with their oncologist if they are taking or considering the use of high-dose antioxidants. Beta-carotene in the amounts normally found in food does not appear to have this adverse effect.
Avoid if sensitive to beta-carotene, vitamin A, or any other ingredients in beta-carotene products. Avoid large oral doses in pregnant or breastfeeding women due to a lack of safety evidence.
Bitter almond: The bitter almond is not edible but contains oil used in making flavoring extracts and some sedatives. Laetrile, a drug that contains amygdalin (found in the pits of many fruits, raw nuts, and plants, including bitter almond) may be toxic to humans. Laetrile™ is an alternative cancer drug marketed in Mexico and other countries outside of the United States. Laetrile™ is derived from amygdalin, found in the pits of fruits and nuts such as the bitter almond. There are multiple animal studies and initial human evidence to suggest that Laetrile™ is not beneficial in the treatment of cancer. In 1982, the U.S. National Cancer Institute (NCI) concluded that Laetrile™ was not effective for cancer therapy. Nonetheless, many people still travel to use this therapy outside the United States. Multiple cases of cyanide poisoning, including deaths, have been associated with Laetrile™ therapy.
Avoid if allergic to almonds or other nuts. Use cautiously if driving or operating machinery. Avoid if pregnant or breastfeeding because of the risk of birth defects.
Hypnotherapy, hypnosis: Hypnosis is a trance-like state in which a person becomes more aware and focused and is more open to suggestion. Hypnotherapy has been used to treat health conditions and to change behaviors. There are several studies of hypnosis for cancer-related conditions, including pain, anxiety, and quality-of-life. Limited research reports mixed effects of hypnotherapy on chemotherapy-related nausea/vomiting or mouth sores, and additional research is necessary before a conclusion can be drawn.
Use cautiously with mental illnesses (e.g. psychosis/schizophrenia, manic depression, multiple personality disorder, or dissociative disorders) or seizure disorders.
Iridology: Iridology is the study of the iris for diagnostic purposes that developed more than 100 years ago. It is based on the idea that all bodily organs are represented on the surface of the iris via intricate neural connections. There is currently limited available data supporting iridology as a diagnostic tool in cancer. Additional study is needed.
Iridology should not be used alone to diagnose disease. Studies of iridology have reported incorrect diagnoses, and potentially severe medical problems may thus go undiagnosed. In addition, research suggests that iridology may lead to inappropriate treatment.
Vitamin E: Although it is unclear if vitamin E is an effective treatment for cancer, evidence has shown that it does not prevent cancer. Recent evidence from a well-conducted randomized controlled trial (the Women's Health Study) reports no reduction in the development of cancer with the use of natural-source vitamin E taken daily. Previously, there have been laboratory, population, and other human trials examining whether vitamin E is beneficial in preventing various types of cancer. Results of these prior studies have been variable. At this time, based on the best available scientific evidence, and recent concerns about the safety of vitamin E supplementation, vitamin E cannot be recommended for this use.
Avoid if allergic to vitamin E. For short periods of time, and in the recommended doses, vitamin E supplementation is generally considered safe. Avoid doses higher than 1,000 milligrams a day. Avoid with Retinitis pigmentosa (loss of peripheral vision). Use cautiously with bleeding disorders.
Prevention
General: Currently there is no known method of prevention against bone cancer.Preventing cancer in general: Exposure to certain chemicals have been shown to increase the risk of cancer. People, such as hairdressers and painters, should follow all safety instructions to avoid or minimize exposure. People who have wells for water are encouraged to have it tested for contaminants, such as lead and arsenic. Local health departments can be a source of water testing.
Controlling weight and exercising regularly may reduce the risk of developing cancer. The American Cancer Society recommends at least 30 minutes of physical activity five or more days a week if the individual can tolerate it.
Fruits, vegetables, and whole grains contain vitamins, minerals, fiber, and antioxidants that 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 squash.
Consuming moderate to heavy amounts of alcohol, such as more than one drink a day for women and two for men, may increase the risk of developing certain cancers, such as colon and breast cancer. This is particularly true if a person has a close relative, such as a parent, child, or sibling, with cancer.
People who eat high-fat diets may have a higher rate of cancer, such as colon cancer. It is important to limit saturated fats from animal sources such as red meat. Other foods that contain saturated fat include milk, cheese, ice cream, coconut, and palm oils. It is best to restrict the total fat intake to about 30% of the daily calories, with no more than 10% coming from saturated fats.
It is best to follow the early detection screening guidelines to help find colon, breast, prostate, and other cancers.
Preventing complications: Patients who are diagnosed with other types of cancers are encouraged to seek prompt treatment. This helps reduce the risk of cancer spreading to others parts of the body, including the bones. Cancer that has spread may damage vital organs and can potentially lead to death.
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 Cancer Society (ACS). www.cancer.org. Accessed December 11, 2007.
Bijwaard H, Dekkers F. Bone cancer risk of (239)pu in humans derived from animal models. Radiat Res. 2007 Nov;168(5):582-92. View Abstract
Blum RH, Novetsky D, Shasha D, et al. The multidisciplinary approach to bone metastases. Oncology (Williston Park). 2003 Jun;17(6):845-57; discussion 862-3, 867. View Abstract
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Matsuda S, Iwamoto Y. [Osteosarcoma and pain] [Article in Japanese] Clin Calcium. 2007 Oct;17(10):1614-7. View Abstract
National Cancer Institute (NCI). www.cancer.gov. Accessed December 11, 2007.
Natural Standard: The Authority on Integrative Medicine. www.naturalstandard.com. Copyright © 2007. Accessed December 11, 2007.
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Related Terms
Amputation, biopsy, bone fractures, bone pain, bone scan, bone tumor, chemotherapy, chondrosarcoma, Ewing's sarcoma, metastasized bone cancer, needle biopsy, osteosarcoma, primary bone cancer, radiation, radiation therapy, radiotherapy, sarcoma, secondary bone cancer, surgical biopsy.
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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