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Background |
Types of leukemia |
Causes and risk factors |
Signs and symptoms |
Complications |
Diagnosis |
Treatment |
Integrative therapies |
Prevention |
Bibliography
Leukemia
Leukemia is cancer of the bone marrow and blood. The bone marrow is the soft, inner part of the bones that makes red and white blood cells. Leukemia is characterized by the uncontrolled accumulation of white blood cells (leucocytes).Under normal circumstances, the blood-forming (hematopoietic) cells of the bone marrow make leukocytes to defend the body against infectious organisms, such as viruses and bacteria. Leukocytes fight infection through a process known as phagocytosis. During phagocytosis, the leukocytes surround and destroy foreign organisms. White blood cells also produce, transport, and distribute antibodies as part of the body's immune response. If some leukocytes are damaged and remain in an immature form, they become poor infection fighters that multiply excessively and do not die off as they should. Immature leukocytes are those that have just been formed in the bone marrow.
These damaged leukemic cells accumulate and lessen the production of oxygen-carrying red blood cells (erythrocytes), blood-clotting cells (platelets), and normal leukocytes. If untreated, the surplus leukemic cells overwhelm the bone marrow, enter the bloodstream, and eventually invade other parts of the body, such as the lymph nodes, spleen, liver, and central nervous system (brain, spinal cord). In this way, the behavior of leukemia is different than that of other cancers, which usually begin in major organs and ultimately spread to the bone marrow.
Leukemia can be acute (fast growing) or chronic (slow growing).
The four major types of leukemia are: acute lymphocytic leukemia (ALL); chronic lymphocytic leukemia (CLL); acute myelogenous leukemia (AML); and chronic myelogenous leukemia (CML).
Leukemia is often thought to be a childhood disease, but statistically, leukemia strikes 10 times more adults than children. The American Cancer Society (ACS) predicts that about 35,070 new leukemia cases will be diagnosed in the United States in 2006. Acute myelogenous leukemia (AML) is the most frequently reported form of leukemia in adults, and approximately 11,930 new cases are anticipated in 2006.
The relative five-year survival rate has more than tripled in the past 47 years for patients with leukemia due to advances in treatment. The overall relative survival rate is nearly 50%. The relative survival rates differ according to the age of the patient at diagnosis, gender, race, and type of leukemia.
It is anticipated that approximately 21,790 deaths in the United States will be attributed to leukemia in 2007 (12,320 males and 9,470 females).
The goal of treatment for leukemia is to bring about a complete remission. Complete remission means that there is no evidence of the disease and the individual returns to good health with normal blood and marrow cells. The cancer is not detectable in remission. Relapse indicates a return of the cancer cells and return of other signs and symptoms of the disease. Treatment centers report increasing numbers of patients with leukemia who are in complete remission at least five years after the diagnosis of their disease.
Background
Leukemia is cancer of the bone marrow and blood. The bone marrow is the soft, inner part of the bones that makes red and white blood cells. Leukemia is characterized by the uncontrolled accumulation of white blood cells (leucocytes).Under normal circumstances, the blood-forming (hematopoietic) cells of the bone marrow make leukocytes to defend the body against infectious organisms, such as viruses and bacteria. Leukocytes fight infection through a process known as phagocytosis. During phagocytosis, the leukocytes surround and destroy foreign organisms. White blood cells also produce, transport, and distribute antibodies as part of the body's immune response. If some leukocytes are damaged and remain in an immature form, they become poor infection fighters that multiply excessively and do not die off as they should. Immature leukocytes are those that have just been formed in the bone marrow.
These damaged leukemic cells accumulate and lessen the production of oxygen-carrying red blood cells (erythrocytes), blood-clotting cells (platelets), and normal leukocytes. If untreated, the surplus leukemic cells overwhelm the bone marrow, enter the bloodstream, and eventually invade other parts of the body, such as the lymph nodes, spleen, liver, and central nervous system (brain, spinal cord). In this way, the behavior of leukemia is different than that of other cancers, which usually begin in major organs and ultimately spread to the bone marrow.
Leukemia can be acute (fast growing) or chronic (slow growing).
The four major types of leukemia are: acute lymphocytic leukemia (ALL); chronic lymphocytic leukemia (CLL); acute myelogenous leukemia (AML); and chronic myelogenous leukemia (CML).
Leukemia is often thought to be a childhood disease, but statistically, leukemia strikes 10 times more adults than children. The American Cancer Society (ACS) predicts that about 35,070 new leukemia cases will be diagnosed in the United States in 2006. Acute myelogenous leukemia (AML) is the most frequently reported form of leukemia in adults, and approximately 11,930 new cases are anticipated in 2006.
The relative five-year survival rate has more than tripled in the past 47 years for patients with leukemia due to advances in treatment. The overall relative survival rate is nearly 50%. The relative survival rates differ according to the age of the patient at diagnosis, gender, race, and type of leukemia.
It is anticipated that approximately 21,790 deaths in the United States will be attributed to leukemia in 2007 (12,320 males and 9,470 females).
The goal of treatment for leukemia is to bring about a complete remission. Complete remission means that there is no evidence of the disease and the individual returns to good health with normal blood and marrow cells. The cancer is not detectable in remission. Relapse indicates a return of the cancer cells and return of other signs and symptoms of the disease. Treatment centers report increasing numbers of patients with leukemia who are in complete remission at least five years after the diagnosis of their disease.
Types of leukemia
Leukemia is divided into four categories. It can be myelogenous or lymphocytic and acute (fast growing) or chronic (slow growing). Acute leukemia is fast-growing and can overrun the body within a few weeks or months. By contrast, chronic leukemia is slow-growing and progressively worsens over years. The terms myelogenous or lymphocytic denote which type of while blood cell is involved.Acute myelogenous leukemia (AML): Acute myelogenous leukemia (AML), also called acute nonlymphocytic leukemia, is the most common type of leukemia. AML occurs in children and adults. AML is fast growing and requires aggressive treatment.
Acute lymphocytic leukemia (ALL): Acute lymphocytic leukemia (ALL) is the most common type of leukemia in young children. ALL accounts for 80% of all childhood leukemias. ALL is also fast growing and requires aggressive treatment.
Chronic lymphocytic leukemia (CLL): Chronic lymphocytic leukemia (CLL) is a common adult leukemia. CLL is more common in Jewish people of Russian or Eastern European descent. It almost never affects children. Individuals with CLL may be well for years without treatment.
Chronic myelogenous leukemia (CML): Chronic myelogenous leukemia (CML) is a type of leukemia that mainly affects adults. CML is associated with a chromosome abnormality called the Philadelphia chromosome, which creates an abnormal gene called BCR-ABL. The BCR-ABL gene produces an abnormal protein called tyrosine kinase that doctors and researchers believe causes leukemia cells to grow and develop. Before treatment, an individual with CML may have few or no symptoms for months or years before entering a phase in which the leukemia cells grow more quickly.
Other chronic myeloid disorders: Like CML, this group of diseases causes chronic leukemia by the creation of too few or too many myeloid cells (a type of white blood cell). Chronic myeloid disorders include myelodysplastic syndromes and myeloproliferative disorders such as essential thrombocythemia, polycythemia vera, and myelofibrosis. These conditions may cause fluctuations in white blood cell levels and lead to acute myeloid leukemia (AML).
Acute vs. chronic leukemia: Acute leukemia is a rapidly progressing disease that results in the accumulation of immature leukocytes (white blood cells) in the marrow and blood. The marrow often can no longer produce enough normal red blood cells, white blood cells, and platelets. Anemia, a deficiency of red cells, develops in virtually all leukemia patients. The lack of normal white cells impairs the body's ability to fight infections. A shortage of platelets results in bruising and easy bleeding.
Therefore, acute leukemia needs to be treated immediately; otherwise, the disease may be fatal within a few months. Fortunately, some subtypes of acute leukemia respond very well to available therapies and they are curable. Children often develop acute forms of leukemia, which are managed differently from leukemia in adults.
Chronic leukemia progresses more slowly and allows greater numbers of more mature, functional cells to be made. Unlike acute leukemia, chronic leukemia does not always require treatment. For older adults or people with early-stage CLL and few troublesome symptoms, the risks associated with the disease do not warrant the risks and discomfort associated with treatment, such as nausea, fatigue, and infection. If symptoms change or worsen, the individual can discuss treatment options with their doctor.
Causes and risk factors
Age: Approximately 60-70% of leukemia cases occur in individuals who are older than 50. The most common form of leukemia among children under 19 years of age is ALL. The incidence of ALL among one to four-year-old children is more than 9 times greater than the rate for young adults ages 20-24.Gender: Incidence rates for all types of leukemia are higher among males than among females. Males account for more than 56% of the cases of leukemia. This may be hormonally related.
Radiation exposure: The risk of chronic myelogenous leukemia (CML) is increased among individuals who have been exposed to high doses of radiation. Radiation damages bone cells and may cause cancerous cells to develop. Atomic bomb survivors in Japan, those who lived near the nuclear reactor accident in Chernobyl, and armed forces who participated in American nuclear detonations during the late 1950s are examples of groups exposed to high levels of radiation. It is important to note, however, that standard diagnostic X-rays pose little or no increase in leukemia risk.
Chemicals: The risk for acute leukemia is increased 20 times among workers with long-term exposure to benzene. Risk also is increased among workers exposed to some other solvents, herbicides, and pesticides. Agricultural chemicals, in particular, have been linked with an increased risk of chronic lymphocytic leukemia (CLL). In addition, some reports suggest that leukemia risk may be increased in workers in factories exposed to dioxin, styrenes, butadienes, or ethylene oxides.
Viruses: The human T-cell leukemia virus I (HTLV-I) is related to acute T-cell leukemia. This type of leukemia is well documented in parts of the Caribbean and Asia, but it is uncommon in the United States and Europe. Higher rates of leukemia have also been reported in workers who are exposed to animal viruses, such as butchers, slaughterhouse workers, and veterinarians.
Genetics: Studies have reported that in some types of leukemia, such as AML, genetics also may play a role in the risk for recurrence of the disease. Leukemia risk is increased 15 times among children with Down's syndrome, which is a genetically linked chromosomal abnormality (usually an extra copy of chromosome 21). Three rare inherited disorders, including Fanconi's anemia, Bloom's syndrome, and ataxia telangiectasia, also have an increased risk for leukemia.
Race: Leukemia varies among racial and ethnic groups with different genetic make-ups. For example, rates of lymphoma and leukemia, such as chronic lymphocytic leukemia (CLL), are especially high in some Jewish populations, whereas Asian populations rarely develop CLL. First-degree relatives, including parents, children, and siblings of CLL patients, have two to four times the risk for leukemia due to genetics.
Leukemia is one of the top 15 most frequently occurring cancers in minority groups.
Cigarette smoking: Cigarette smoking is a known lifestyle-related risk factor for leukemia. Potential leukemia-causing chemicals in tobacco smoke include benzene, polonium-210, and polycyclic aromatic hydrocarbons (PAHs). These carcinogens (cancer-causing substances) are absorbed by the lungs and are spread via the bloodstream. It is estimated that one in four cases of acute myelogenous leukemia (AML) is the result of cigarette smoking.
Cancer therapy: Individuals who have received chemotherapy and radiation therapy for previous cancers have a slightly greater chance of getting secondary leukemia (leukemia that arises after therapy). Acute myelogenous leukemia (AML) has been reported after chemotherapy and/or radiotherapy for various solid tumors (such as breast cancer and ovarian cancer), blood malignancies, and non-malignant conditions. The chemotherapeutic agents most often associated with secondary leukemias are procarbazine, chlorambucil, etoposide, mechlorethamine, teniposide, and cyclophosphamide. The risk is increased when these drugs are combined with radiation therapy. Many secondary leukemias are AMLs that develop within nine years after treatment of Hodgkin's disease, non-Hodgkin's lymphoma, or childhood CLL. Further chemotherapy often is ineffective in patients with secondary AML. Their prognosis is less favorable than that of typical AML patients.
Other causes: The use of the antibiotic chloramphenicol has been linked with the development of childhood leukemia. Chloramphenicol is rarely used today. Other medications, such as growth hormones and phenylbutazone, also have reportedly shown some associations with leukemia. Leukemias and lymphomas have been observed in recipients of organ transplants, and certain immunodeficiency syndromes are associated with leukemias.
Signs and symptoms
Leukemia cells are abnormal cells that cannot do what normal blood cells do. They cannot help the body fight infections. For this reason, individuals with leukemia often get infections and have fevers. Also, those with leukemia often have less than the normal amount of healthy red blood cells and platelets. As a result, there are not enough red blood cells to carry oxygen through the body. With this condition, called anemia, individuals may look pale and feel weak and tired. When there are not enough platelets, patients bleed and bruise easily.Like all blood cells, leukemia cells travel through the body. Depending on the number of abnormal cells and where these cells collect, patients with leukemia may have a number of symptoms. Some of the common symptoms of leukemia include: fever, chills, and other flu-like symptoms; weakness and fatigue; frequent infections; loss of appetite and/or weight; swollen or tender lymph nodes, liver, or spleen; easy bleeding or bruising; tiny red spots, called petechia, under the skin; swollen or bleeding gums; sweating, especially at night; and/or bone or joint pain.
In acute leukemia, symptoms appear and get worse quickly. In chronic leukemia, symptoms may not appear for a long time. When symptoms do appear, they generally are mild at first and get worse gradually. Doctors often find chronic leukemia during a routine checkup - before there are any symptoms - with blood tests revealing abnormal white blood cell counts.
In acute leukemia, the abnormal cells may collect in the brain or spinal cord. The result may be headaches, vomiting, confusion, loss of muscle control, and seizures. Leukemia cells can collect in the testicles and cause swelling. Some individuals develop sores in the eyes or on the skin. Leukemia also can affect the digestive tract, kidneys, lungs, or other parts of the body.
Chronic leukemia often goes undetected for many years until it is identified in a routine blood test. Nearly one in five chronic leukemia patients have no symptoms at the time of their diagnosis. In chronic leukemia, the abnormal blood cells may gradually collect in various parts of the body. Chronic leukemia may affect the skin, central nervous system, digestive tract, kidneys, and testicles.
Complications
Fatigue: Leukemia can cause individuals to have too few red blood cells, resulting in anemia. Anemia can make the individual feel tired by decreasing the number of red blood cells that can carry oxygen to tissues. Treatment for leukemia, such as with chemotherapy, can also cause a drop in red blood cells, leading to fatigue.Excess bleeding: Blood cells called platelets help control bleeding by prompting the blood to clot. A shortage of blood platelets (thrombocytopenia) can result in easy bleeding and bruising, including frequent or severe nosebleeds, bleeding from the gums, or tiny red marks caused by bleeding into the skin.
Pain: Leukemia can cause bone pain or joint pain as the bone marrow expands when excess white blood cells build up.
Enlarged spleen: Some of the extra blood cells produced when an individual has leukemia are stored in the spleen, causing the spleen to become swollen or enlarged. Rarely, the spleen becomes so large that it is at risk of bursting. More commonly, the swollen spleen takes up space in the abdomen and makes the individual feel full even after small meals or causes pain on the left side of the body below the ribs and difficulty breathing.
Stroke or excess clotting: Some individuals with CML produce too many platelets. Without treatment, this high platelet count, called thrombocytosis, can cause excessive clotting of the blood, which can lead to stroke. Stroke is neurological damage to the brain due to a lack of oxygen. An increase in blood clotting can lead to the blocking of blood vessels in the brain, decreasing the oxygen to the brain tissue and causing brain cell death.
Infection: White blood cells help the body fight off infection. Although individuals with leukemia have too many white blood cells, these cells are often leukemic (damaged) and do not function properly. As a result, they are not able to fight infection as well as healthy white cells can. In addition, treatment can cause the white cell count to drop too low (neutropenia), also making individuals vulnerable to infection.
Metastasis: Metastasis is the movement or spreading of cancer cells from one organ or tissue to another. Leukemic cells in the blood can deposit into organs and tissues, such as the brain and spine, causing further cancer development.
Death: If leukemia cannot be successfully treated, it ultimately is fatal.
Diagnosis
Once a doctor suspects that an individual's blood is abnormal, blood and bone marrow tests are performed to rule out leukemia. Additional tissue samples may be needed to confirm the diagnosis or to help plan treatment.If an individual has symptoms that suggest leukemia, the doctor may do a physical exam and ask about the personal and family medical history. The doctor also may order laboratory tests, including blood tests.
Bone marrow tests: The bone marrow is sampled by a technique known as bone marrow aspiration. During this procedure, a thin, hollow needle with a syringe attachment is used to suction up (aspirate) a teaspoon-sized sample of liquid bone marrow from the back of the hip bone. A larger needle is then employed to obtain a bone marrow biopsy ("core" biopsy), which removes roughly a 1/16 inch cylindrical piece of bone marrow from the hip site. After the bone marrow samples are obtained, they are examined by many physician specialists, including a pathologist (disease diagnosis specialist, who examines samples under a microscope), hematologist (blood specialist), and oncologist (cancer specialist). The individual is generally awake during the procedure, but local anesthetics (such as lidocaine) and sedatives (such as midazolam or Versed®) may be administered. There is usually no pain involved.
Cytogenetic analysis: Cytogenetic analysis detects changes in the chromosomes, including the presence of the Philadelphia chromosome (a genetic abnormality that can lead to leukemia). It can be done using a regular microscope or a more modern lab technology called fluorescence in situ hybridization (FISH). Blood will be drawn from the individual and analyzed for the genetic abnormality.
X-ray: X-rays are used to see whether there are enlarged lymph nodes in the chest, localized masses in the lungs, or evidence of spreading to the outer bones or joints.
Computerized tomography (CT): Computed tomography (CT) scan is a computer-assisted x-ray that produces cross-sectional images of the body. CT scans are not often used in leukemia patients unless the doctor suspects that the disease has spread to other organs. In such cases, CT scans may detect changes in the lymph nodes around the heart, trachea (windpipe), or abdomen. Lymph node enlargement is more common in patients with acute or chronic lymphocytic leukemia (ALL, CLL).
Magnetic resonance imaging (MRI): Magnetic resonance imaging (MRI) scan is a procedure that uses electromagnets and radio waves to create computer-generated pictures of the internal organs. MRI may be used if the doctor suspects that leukemia involves the brain or lungs.
Radionuclide scan: A radionuclide scan may be performed to rule out non-leukemic disorders in individuals who complain of bone pain. The radiologist injects the individual with a radioactive chemical (such as gallium-67), which will accumulate in areas of infection or malignancy and can be viewed with a special camera. This procedure is not used for individuals who already have been diagnosed with leukemia.
Treatment
Leukemia treatment falls into two categories: treatment to fight the cancer and treatment to relieve the symptoms of the disease and the side effects of the treatment (supportive care).The goal of treatment for leukemia is to bring about a complete remission. Unlike other types of cancer, leukemia is not a solid tumor that a doctor can surgically remove. The source of the problem is in the bone marrow, and bone marrow cannot be removed.
Treatment for leukemia is complex, depending on many factors including age and overall health, the type of leukemia, and whether it has spread to other parts of the body.
In general, there are five major approaches to the treatment of leukemia: chemotherapy to kill leukemia cells using strong anti-cancer drugs; interferon therapy to slow the reproduction of leukemia cells and promote the immune system's anti-leukemia activity; radiation therapy to kill cancer cells by exposure to high-energy radiation; stem cell transplantation (SCT) to enable treatment with high doses of chemotherapy and radiation therapy; and surgery to remove an enlarged spleen or to install a venous access device (large plastic tube) to give medications and withdraw blood samples.
Chemotherapy: Chemotherapy uses drugs to destroy cancer cells. These drugs can be given intravenously (IV, through a vein), orally (by mouth), subcutaneously (SubQ, or injected under the skin), intramuscularly (injected into muscle), or intrathecally (injected into cerebrospinal fluid).
Chemotherapy used to treat leukemia varies, because there are many different forms of this disease. In general, leukemia treatment combines chemotherapy with a number of different anticancer drugs, which destroy cancer cells by preventing them from growing and dividing rapidly. Unfortunately, a number of the body's normal, noncancerous cells (e.g., hair cells, red and white blood cells, blood-clotting platelets, cells that line the gastrointestinal tract) also divide rapidly, and are harmed by chemotherapy. Damage to these cells causes side effects, which depend upon the type and dose of the drugs, as well as the length of time that they are used.
If the leukemia does not respond to one or two courses of treatment, a different drug program may be used to achieve remission. A different drug program may also be used if a relapse occurs.
Chemotherapy side effects may include: temporary hair loss; mouth sores; anemia or a decreased number of red blood cells that may cause fatigue, dizziness, and shortness of breath; leukopenia or a decreased numbers of white blood cells that may lower resistance to infection; thrombocytopenia or a decreased number of platelets that may lead to easy bleeding or bruising; and gastrointestinal symptoms, including nausea, vomiting, and diarrhea.
Radiation therapy: Radiation therapy is used along with chemotherapy for some kinds of leukemia. Radiation therapy (also called radiotherapy) uses high-energy rays to damage cancer cells and stop them from growing.
Radiation therapy for leukemia may be given in two ways. For some individuals, the doctor may direct the radiation to one specific area of the body where there is a collection of leukemia cells, such as the spleen or testicles. Others may receive radiation that is directed to the whole body. This is called total-body irradiation. This type of radiation usually is given before a bone marrow transplant.
Depending on how and where the radiation is administered, it may cause certain side effects such as fatigue (extreme tiredness), loss of appetite, nausea, diarrhea, and skin problems. Radiation of lymph node areas may result in suppression of the immune system to varying degrees. Irradiation of the underlying bone and the marrow within the bone may result in suppression of the blood counts.
Interferon therapy: Interferons are a class of proteins that are released by virus-infected cells. They help normal cells to make antiviral proteins. Interferons also help the body to reduce leukemia cell growth and reproduction, while strengthening the body's immune response. Interferon-alpha (INFa) is a type of interferon that frequently is used to treat leukemia.
Interferon-alpha can be given by a number of methods. Subcutanous injection is the customary route. INF-a is usually offered to all newly diagnosed patients who are not candidates for stem cell transplantation. Possible IFN-a-related complaints include fevers, chills, muscle aches, bone pain, headaches, concentration difficulties, fatigue, nausea, vomiting, and general flu-like symptoms when starting the drug. Such symptoms usually last for one to two weeks, but may be lessened by drugs such as acetaminophen (Tylenol®). Side effects recur if the INF-a dosage is increased, but they are temporary and usually improve after INF-a therapy is completed.
Stem cell transplantation: Stem cell transplantation, or bone marrow transplant, is a treatment that allows use of very high doses of chemotherapy along with total body irradiation in order to kill the leukemic cells. At the completion of high-dose therapy, the individual's immune system is essentially depleted, and they are at high risk of developing serious life-threatening infections. These individuals are treated in specially designed, sterile, air-filtered marrow transplant rooms. Stem cell transplantation is a surgical procedure performed under general anesthesia.
Immediately upon completion of the high-dose therapy, stem cells from a healthy, complete blood cell matched donor, usually a sibling or, less commonly, a parent, are transplanted into a vein whereupon they migrate to the marrow where they grow and multiply before entering the circulation. This process may take two to three weeks to be completed. On rare occasions, when a donor is not available, one's own marrow cells, usually pretreated in order to remove residual, but otherwise unseen, leukemic cells, are infused. This approach is far less successful than the use of matched donor cells.
If an individual receives stem cells from a matched donor, the type of stem cell transplant is called allogeneic. If the individual's own stem cells are reintroduced back into the patient following high dose therapy, the infusion is called autologous. Side effects include fever and fatigue.
Surgery: A splenectomy is the surgical removal of the spleen. The spleen is located in the abdomen, on the left side. The spleen acts as a filtering system for blood cells. When an individual has chronic leukemia, the spleen tends to collect leukemia cells, transfused platelets (given during surgery), and red blood cells. Frequently, the spleen enlarges from storing these cells. This makes it difficult for the chemotherapy to reduce the quantity of diseased cells. If the spleen is not removed, it sometimes grows so large that it causes breathing difficulty and compresses other organs. In that case, a splenectomy may be needed. Splenectomy is used along with other treatments, such as chemotherapy and radiation.
Integrative therapies
Although there are few studies to support the use of integrative therapies in leukemia, many of the following therapies have been reported useful in the management of cancer in general.Strong scientific evidence:
Vitamin A: Vitamin A is a fat-soluble vitamin, which is derived from two sources: preformed retinoids and provitamin carotenoids. Retinoids, such as retinal and retinoic acid, are found in animal sources such as livers, kidneys, eggs, and dairy produce. Carotenoids like beta-carotene (which has the highest vitamin A activity) are found in plants such as dark or yellow vegetables and carrots. The prescription drug All-Trans-Retinoic Acid (ATRA, Vesanoid®) is a vitamin A derivative that is an established treatment for acute promyelocytic leukemia and improves median survival in this disease. Treatment should be under strict medical supervision. Vitamin A supplements should not be used simultaneously with ATRA due to a risk of increased toxicity.
Vitamin A toxicity, or hypervitaminosis A, is rare in the general population. Vitamin A toxicity can occur with excessive amounts of vitamin A taken over short or long periods of time. Consequently, toxicity can be acute or chronic. An infant with acute toxicity can develop a bulging fontalle (the soft spot on the head) and symptoms similar to a brain tumor. Adults experience less specific symptoms such as headache, dizziness, fatigue, malaise, blurry vision, bone pain and swelling, nausea, and/or vomiting. Severe toxicity can lead to eye damage, high levels of calcium, and liver damage. Persons with liver disease and high alcohol intake may be at risk for hepatotoxicity from vitamin A supplementation. Smokers who consume alcohol and beta-carotene may be at an increased risk for lung cancer or cardiovascular disease. At recommended doses, vitamin A is generally considered non-toxic.
Good scientific evidence:
Psychotherapy: Psychotherapy is an interactive process between a person and a qualified mental health 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.
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 the use of acupuncture at a specific point on the wrist (P6), which helps reduce the nausea and vomiting associated with chemotherapy.
Aloe: Transparent gel from the pulp of the meaty leaves of Aloe vera has been used topically for thousands of years to treat wounds, skin infections, burns, and numerous other dermatologic conditions. 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 the patient is pregnant or breastfeeding, 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. Use in humans has reported minimal side effects, and evidence from animal and in vitro studies suggests 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. No well-designed studies on the long-term effects of pawpaw extracts have been conducted. Pawpaw should not be used if the patient is pregnant or breastfeeding, unless otherwise directed by a doctor.
Antineoplastons: Antineoplastons are a group of naturally occurring peptide fractions isolated from human blood and urine. Antineoplastons were observed by Dr. Stanislaw Burzynski in the late 1970s and found 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.
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 are not for internal use.
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 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.
Art therapy may benefit children hospitalized with leukemia during and after painful procedures. One study suggests the therapy improves cooperation with treatment. Children requested art therapy again when procedures were repeated, and parents reported that children were more manageable after art therapy.
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 platinol or Cisplatin®) 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.
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, but additional studies are 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 the patient is pregnant or breastfeeding, unless otherwise directed by a doctor.
Bitter melon: Bitter melon (Momordica charantia) is used in the traditional Ayurvedic form of medicine from India for lowering 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 the patient is pregnant or breastfeeding, unless otherwise directed by a doctor.
Black tea: Black tea (Camellia sinensis) is from the same plant as green tea, but processed differently and 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. 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 proteolytic digestive enzyme 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. Caution is advised when taking bromelain supplements, as numerous adverse effects including blood thinning and drug interactions are possible.
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 it may slow tumor growth; however, this research is early and has not identified specific types of cancer that may benefit. 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 the patient is pregnant or breastfeeding, unless otherwise directed by a doctor.
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 recommended dietary allowance (RDA). Copper supplements should not be used if the patient is pregnant or breastfeeding, 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, but studies are 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.
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 there is currently no evidence 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® have been tested in rigorous human cancer trials, although some components have anti-tumor activity in laboratory studies. Caution is advised when taking Essiac® supplements, as numerous adverse effects, including drug interactions, are possible. Essiac® should not be used if the patient is pregnant or breastfeeding, 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 of cancer patients. Firm recommendations cannot be made until well-designed clinical trials are available.
Garlic: Preliminary human studies suggest that regular consumption of garlic (Allium sativum, particularly aged 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. Caution is advised when taking garlic supplements, as numerous adverse effects, including an increased risk of bleeding and drug interactions, are possible.
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 the patient is pregnant or breastfeeding, 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.
Healing touch (HT): Preliminary data suggests 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, the data is 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 it is a therapeutic regimen consisting of an oral tonic and topical (on the skin) preparations. 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 the patient is pregnant or breastfeeding, 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. In large randomized controlled trials, hydrazine has not been found 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 nausea, vomiting, stomach cramping, and diarrhea.
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 fungus 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. These studies have not been well designed, and better research is needed before the use of maitake for cancer can be recommended.
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.
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, CNS, colorectal, head and neck, liver, lung, lymphatic, ovarian, and renal (kidney) cancers as well as melanoma and leukemia. Efficacy has not been conclusively proven for any one condition, and in fact some studies have shown a lack of efficacy in 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 the patient is pregnant or breastfeeding, unless otherwise directed by a doctor.
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.
Omega-3 fatty acids: Omega-3 fatty acids are essential fatty acids found in some plants and fish. Experts recommend that there should be a balance of omega-6 and omega-3 fatty acids for health. Several population studies report that dietary omega-3 fatty acids or fish oil may reduce the risk of developing certain types of 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.
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. Prayer helps give individuals suffering from cancer a sense of hope.
PSK: PSK, or protein-bound polysaccharide, is obtained from cultured mycelia of the Coriolus versicolor, a mushroom thought to have antimicrobial, antiviral, and antitumor properties. One preliminary human trial in patients with acute leukemia suggests that adjunct PSK therapy may prolong duration of remission and survival time. In a second study in patients with acute nonlymphocytic leukemia, no significant increases in survival were found. Well-designed clinical trials are required in order to determine if PSK therapy may in fact prolong remission and increase survival time in individuals with acute leukemia.
PSK generally seems to have a low incidence of mild and tolerable side effects. In one report, three cases of toxicity were noted, and PSK was discontinued. PSK has been associated with side effects of gastrointestinal upset and darkening of the fingernails, but these effects have been limited and general safety has been demonstrated with daily oral doses for extended periods. Darkening of the fingernails and coughing have been reported during administration of powder drug.
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 to confirm these results and potential side effects.
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. Currently, there are no reliable human studies available to support a recommendation for use in cancer. Bladderwrack should not be used if the patient is pregnant or breastfeeding, or has hyperthyroidism (increased thyroid hormone), unless otherwise directed by a doctor.
Selenium: Selenium is a trace mineral found in soil, water, and some foods, and 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 that 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.
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.
Soy: Soy (Glycine max) contains compounds that have been 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). 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.
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.
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, dependent upon the type and cause of the cancer. 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.
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, and iridology.
Traditional or theoretical uses lacking sufficient 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
Chemical exposure avoidance: If the individual works with chemicals on a daily basis, such as in the case of hairdressers, printers, and painters, they should follow all safety instructions to avoid unsafe exposure. If an individual has their own well as their water source, they may wish to have it tested for contaminants such as lead and arsenic, which both may be linked to cancer. Local health departments can be a source of water testing.Exercise and weight control: Controlling weight and exercising regularly can 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 physically tolerate it.
Fruits, vegetables and whole grains: Fruits, vegetables and whole grains contain vitamins, minerals, fiber and antioxidants, which may help protect from developing various types of cancer. Eating five or more servings of fresh fruits and vegetables every day is important for good health. A variety of produce should be included in the individual's diet such as kale, chard, spinach, dark green lettuce, peppers, and squashes.
Limit alcohol consumption: 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. This is particularly true if the individual has a close relative, such as a parent, child or sibling with cancer.
Smoking cessation: Smoking can increase the risk of cancers such as lung and bladder.
Vitamins and minerals: Calcium, magnesium, pyridoxine (vitamin B6), and folic acid may help reduce the risk of certain cancers. Good food sources of calcium include skim or low-fat milk and other dairy products, shrimp, and soy products such as tofu and soy milk. Magnesium is found in leafy greens, nuts, peas and beans. Food sources of vitamin B6 include grains, legumes, peas, spinach, carrots, potatoes, dairy foods and meat. Folic acid is found in dark leafy greens such as spinach and lettuce, and in legumes, melons, bananas, broccoli and orange juice.
Bibliography
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Centers for Disease Control and Prevention (CDC). www.cdc.gov. Accessed June 20, 2007.
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Leukemia and Lymphoma Society. www.leukemia-lymphoma.org. Accessed June 20, 2007.
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National Cancer Institute. www.cancer.gov. Accessed June 20, 2007.
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Related Terms
Acute lymphocytic leukemia, acute myelogenous leukemia, acute nonlymphocytic leukemia, ALL, AML, anemia, ataxia telangiectasia, benzene, Bloom's syndrome, bone marrow, chemotherapy, chronic lymphocytic leukemia, chronic myelogenous leukemia, chronic myelomonocytic leukemia, CLL, CML, computed tomography, CT, cytogenetic analysis, erythrocytes, Fanconi's anemia, hairy cell leukemia, hematopoietic, HTLV-I, human T-cell leukemia virus I, leukemic, leukocytes, lymphocytic, lymphoid tissue, malignant, myelogenous, myeloid cells, oncogenes, petechia, platelets, radiation therapy, radionuclide scan, relapse, remission, spleen, splenectomy, thrombocytosis, tumor suppressor, ultrasound, white blood cells, 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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