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Colon cancer

Related Terms

Abdominal distension, adenocarcinoma, adenomatous, anti-diarrheal, barium enema, biopsy, calcium, carcinoembryonic antigen, CEA, chemotherapy, chemotherapy, colectomy, colonoscope, colonoscopy, colostomy, Crohn's disease, diarrhea, digital exam, diverticulitis, diverticulosis, dysplasia, fecal occult test, folic acid, hemicolectomy, IBD, IBS, inflammatory bowel disease, irritable bowel syndrome, laparoscopic, lymphadenectomy, magnesium, magnetic resonance imaging, metastasis, MRI, neoadjuvant, neutropenia, perforation, PET, polyps, positron emission tomography, postpolypectomy coagulation syndrome, prostate cancer, pyridoxine, secretory, sigmoidoscopy, vitamin B6.

Background

The colon and rectum are part of the digestive tract. They comprise the large intestine, or large bowel, which is located in the abdomen between the small intestine and the anus.

Colon cancer is cancer of the large intestine (colon), which is the lower part of the digestive system. Rectal cancer occurs on the last eight to ten inches of the colon. They are often referred to together as colorectal cancers, and are the second-leading cause of cancer-related deaths in the United States.

The incidence is slightly higher in men than women, and is highest in African American men. The incidence of colorectal cancer is highest in developed countries such as the United States and Japan, and lowest in developing countries such as Africa and Asia. Ashkenazi Jewish individuals have a higher incidence of a specific genetic mutation (called I1307K) that increases the risk for colorectal cancer.

Most colon cancers are adenocarcinomas (cancer in the glands or secretory cells) that develop when a change occurs in cells that line the wall of the colon or rectum. The disease often begins as an intestinal polyp, also called an adenoma, which is an abnormal growth of tissue. Polyps can gradually become precancerous and then cancerous.

The American Cancer Society's estimated number of new cases from colon and rectal cancer in the United States in 2012 are as follows: new cases: 103,170 (colon); 40,290 (rectal).

Signs and symptoms

There may be no symptoms in the early stages of the disease. When symptoms appear, they'll likely vary, depending on the cancer's size and location in the large intestine. In some cases, symptoms may result from a condition other than cancer, such as inflammatory bowel disease (IBD), irritable bowel syndrome (IBS), Crohn's disease, and sometimes diverticulosis or diverticulitis (conditions in which pouches form in the colon wall, weakening it and causing inflammation). Like colorectal cancer, these conditions are treatable.

Signs and symptoms to be aware of include a change in bowel habits including: diarrhea, constipation, a change in the consistency of the stool for more than a couple of weeks, narrow stools, rectal bleeding or blood in the stool, persistent abdominal discomfort such as cramps, gas or pain, abdominal pain with a bowel movement, a feeling that the bowel is not emptying completely, and/or an unexplained weight loss.

Blood in the stool may be a sign of cancer, but it can also indicate other conditions. Bright red blood on bathroom tissue or in the toilet may come from hemorrhoids or minor tears (fissures) in the anus, or from certain foods such as beets, spinach, red cabbage, or food dyes. Iron supplements and some anti-diarrheal medications may make stools appear black.

Diagnosis

Detection of early colon cancer is difficult due to a lack of symptoms. Most colon cancers develop from adenomatous polyps, which is why screening is extremely important for detecting polyps early. Symptoms usually appear with a more advanced disease.

Digital rectal exam: Digital rectal exams are performed in a doctor's office. A gloved finger is used to check the first few inches of the rectum for large polyps and cancers. Although safe and painless, the exam is limited to the lower rectum and cannot detect problems with the upper rectum and colon. In addition, it's difficult for a doctor to feel small polyps.

Fecal occult (hidden) blood test: This test checks a sample of the stool for blood. It can be performed in the doctor's office, or a kit may be given to the patient that explains how to take the sample at home. In colorectal cancer most polyps don't bleed, which can result in a negative stool test result, even though an individual may have cancer. Blood may also be the result of hemorrhoids or minor tears, so it can only aide in the diagnosis of colorectal cancer.

Flexible sigmoidoscopy: The doctor uses a flexible, slender and lighted tube to examine the rectum and sigmoid colon (approximately the last two feet of the colon). The test is fast but can sometimes be uncomfortable. If a polyp or colon cancer is found during this exam, the doctor will recommend a colonoscopy to look at the entire colon and remove any polyps for further examination under a microscope.

Barium enema: This diagnostic test allows the doctor to evaluate the entire large intestine with an X-ray. Barium, a contrast dye, is placed into the bowel using an enema, and air may also be added. The barium fills and coats the lining of the bowel, creating a clear outline of the rectum, colon, and occasionally a small portion of the small intestine. A flexible sigmoidoscopy is often done in addition to the barium enema to aid in detecting small polyps that a barium enema X-ray may miss. This commonly occurs in the lower bowel and rectum.

Colonoscopy: This procedure is the most sensitive test for colon cancer, rectal cancer, and polyps. Colonoscopies are similar to flexible sigmoidoscopies, but the instrument used is a colonoscope, a long, flexible, and slender tube attached to a video camera and monitor. This allows the doctor to view the entire colon and rectum. If any polyps are found during the exam, the doctor may remove them immediately or take tissue samples (biopsies) for analysis. This is done through the colonoscope and is virtually painless, but the patient may receive a mild sedative for comfort. Preparation for the procedure involves drinking a large amount of fluid containing a laxative to clean out the colon.

Genetic testing: If there is a family history of colorectal cancer, the individual may be a candidate for genetic testing.

Blood tests: Blood tests may include a test for anemia (if bleeding occurs). A newer test checks a stool sample for DNA of abnormal cells. It is called the carcinoembryonic antigen (CEA) assay. It is useful because CEA is released into the bloodstream from both cancer cells and normal cells, and has been found in colon cancer.

Biopsy: For a biopsy, the doctor removes a small piece of tissue that is sent to the lab and examined under the microscope to see if any cancer is present.

Ultrasound: Ultrasound uses sound waves to produce a picture of the inside of the body. Two special types of ultrasound may be useful for people with colon or rectal cancer. In one, the instrument that gives off sound waves is placed into the rectum. In the other test, the instrument is used during surgery and is placed against the surface of the liver to see if the cancer has spread there.

CT scan (computed tomography): A CT scan uses x-rays to take many pictures of the body and then combines the pictures by computer which provides a detailed picture. A CT scan can often show whether the cancer has spread to the liver, lungs, or other organs. CT scans can also be used to help guide a biopsy needle into a tumor. A newer way to use a CT scan is to perform a "virtual colonoscopy." Once the colon is cleaned and filled with air, a computer puts together a picture of the inside of the colon. The same preparation for a colonoscopy is used and there may be some discomfort from the bowel being filled with air. If anything abnormal is detected, a follow-up colonoscopy will be needed.

MRI (magnetic resonance imaging): Similar to CT scans, MRI's display a cross-section of the body using radio waves and strong magnets instead of radiation. A contrast dye may be injected, although it is used less often with MRI's. An MRI scan is most helpful when looking at the brain and spinal cord. They may take longer than CT scans, and the patient is placed inside a confining tube.

Chest x-ray: This test may be done to see whether colorectal cancer has spread to the lungs.

PET scan (positron emission tomography): PET scans for colon cancer use a type of radioactive sugar, because cancer cells absorb high amounts of sugar. A special camera is used to visualize where the cancerous cells may reside.

Angiography: A dye is injected and a series of x-ray pictures are taken during this procedure. Surgeons may use this method to find blood vessels near cancers that have spread to the liver.

American Cancer Society Colorectal Cancer Screening Guidelines state that beginning at age 50, both men and women with an average risk should follow one of the five screening options including: yearly stool blood tests, flexible sigmoidoscopy every five years, yearly stool blood test plus flexible sigmoidoscopy every five years, a double contrast barium enema every five years, or a colonoscopy every ten years.

Despite its high incidence, colorectal cancer is one of the most detectable and, if found early enough, most treatable forms of cancer. Over 90% of those diagnosed when the cancer remains localized survive more than five years. However, currently only 37% of colorectal cancers are detected while still localized.

Staging colon cancer: Once diagnosed with colorectal cancer, a doctor will determine the "stage" of the cancer. Staging helps determine how well the individual will do and what treatments are most appropriate.

Stage 0: Stage 0 cancer is the earliest stage. The cancer hasn't grown beyond the inner layer (mucosa) of the colon or rectum. This stage is also known as carcinoma in situ.

Stage I: In stage I, the cancer has grown through the mucosa, but hasn't spread beyond the colon wall or rectum.

Stage II: In stage II, the cancer has grown through the wall of the colon or rectum, but hasn't spread to nearby lymph nodes.

Stage III: In stage III, the cancer has invaded nearby lymph nodes, but isn't affecting other parts of the body.

Stage IV: In stage IV, the cancer has spread to distant sites such as the liver, lung, membrane lining of the abdominal cavity, or to the ovaries.

Recurrent: Recurrent colon cancer may happen following treatment occurring in the colon, rectum, or other parts of the body.

Complications

Metastasis (spreading) to other organs, such as the liver, pancreas, lungs, and lymph nodes may occur causing an increase chance of death.

Colonoscopy procedures may cause complications including perforation (a hole), bleeding, infection, abdominal distension (bloating), postpolypectomy coagulation syndrome (damage to the colon wall from a snare loop or hot forceps used in diagnostic procedures), splenic rupture, and small bowel obstruction.

Treatment

Surgery: Surgery is the treatment of choice for colorectal cancer. Treatment depends on the stage of the disease and the overall health of the patient. Chemotherapy and radiation therapy may be used as adjuvant treatment (in addition to surgery).

Radical bowel resection, also called partial colectomy and hemicolectomy, is used to treat 80 to 90% of colorectal cancer patients. This procedure may be performed through a large incision in the abdomen (open surgery) or through several small incisions (laparoscopic surgery). If the cancer has spread, the lymph nodes will be removed. Removal of the lymph nodes is called lymphadenectomy.

Recovery from surgery varies depending on the patient's age, overall health, and the extent of the surgery. After surgery, patients may experience pain, weakness, fatigue, and loss of appetite. Dietary modifications may be necessary until the digestive tract heals. Complications that may occur include allergic reaction to anesthesia, formation of a blockage of the intestine, formation of blood clots or bleeding, wound infection, and leakage at the reconnection site.

If the colon cannot be reconnected, a temporary or permanent colostomy is performed, which allows feces from the colon to pass into a collection vessel outside the body. Approximately 15% of patients require a permanent colostomy.

Chemotherapy: Chemotherapy is used to reduce the likelihood of metastasis (spreading), shrink tumor size, or slow tumor growth. Chemotherapy is often used after surgery (adjuvant), before surgery (neo-adjuvant), or as the primary therapy if surgery is not indicated (palliative). It may be combined with biological therapy (also called immunotherapy) and radiation therapy.

Adjuvant (after surgery) chemotherapy: The most commonly used intravenous regimen is called FOLFOX, and includes 5-fluorouracil (5-FU) or capecitabine (Xeloda?), leucovorin (folinic acid), and oxaliplatin (Eloxatin?).

Chemotherapy for metastatic disease: Commonly used first line chemotherapy regimens involve the combination of 5-fluorouracil, leucovorin, and oxaliplatin (FOLFOX) with bevacizumab (Avastin?), or 5-fluorouracil, leucovorin, and irinotecan (Camptosar?) (called FOLFIRI) with cetuximab (Erbitux?).

Other chemotherapy combinations and agents: Chemotherapy combinations used to prevent recurrence following surgery or used to shrink the tumors prior to surgery include FOLFOX (5-FU, leucovorin, and oxaliplatin) and FOFIRI (5-FU, leucovorin, and irinotecan). Colorectal cancer with liver metastasis also may be treated using floxuridine (FUDR?) administered through an artery. Other agents for metastatic colon cancer include bortezomib (Velcade?), panitumumab (Vectibix?), oblimersen (Genasense?, G3139), gefitinib and erlotinib (Tarceva?), topotecan (Hycamtin?), Bacillus Calmette-Gu?rin (BCG), and levamisole (Ergamisol?).

Chemotherapy side effects: Side effects of chemotherapy include nausea, vomiting, inflammation of the intestine (enteritis), diarrhea, mouth irritation (mucositis), low white blood cell count (neutropenia), and hair loss (alopecia). Biological therapy may cause flu-like side effects such as chills, diarrhea, fever, loss of appetite, muscle aches, weakness, and nausea/vomiting.

Radiation Therapy: Radiation therapy uses X-rays to kill any cancer cells that might remain after surgery, to shrink large tumors before operations so that they can be removed easily, or to relieve symptoms of colon cancer and rectal cancer. The goal of therapy is to damage the tumor without harming the surrounding tissue. If the cancer has spread through the wall of the rectum, radiation treatments in combination with chemotherapy after surgery may be used. This may help prevent cancer from reappearing in the same place. Side effects of radiation therapy may include diarrhea, rectal bleeding, fatigue, reddened and swollen skin, loss of appetite and nausea /vomiting.

Vaccine: A new vaccine, called TroVax?, works by using the patient's own immune system to fight the disease. TroVax? is in clinical trials and has reported positive results for colon cancer therapy.

Follow-up Treatment: Follow-up care is recommended for colorectal cancer patients to ensure that recurrent or metastatic disease is detected as soon as possible. Patients will generally undergo regular physical examinations, fecal occult blood tests, colonoscopies, CT scans, and chest x-rays.

Prognosis: Prognosis depends on the stage of the disease and the overall health of the patient. Overall, colorectal cancer patients have a 5-year survival rate of about 61%. The 5-year survival rate is about 92% when the disease is treated before it has spread (metastasized); 64% when the cancer has spread to nearby organs or lymph nodes; and 7% when it has spread to other parts of the body (e.g. liver, lungs).

Integrative therapies

Good scientific evidence:

Greater celandine: UkrainT, a semisynthetic drug derived from greater celandine (Chelidonium majus), has been studied in clinical trials of various types of cancer with consistently positive outcomes. However, the quality of the research performed to date is inadequate, and higher quality studies are needed.

Use cautiously in patients taking amphetamines, morphine, hexobarbital, MAOIs, or dopaminergic or serotonergic drugs, or in patients undergoing radiation therapy. Avoid in patients with liver disease or in pregnant and lactating women.

Meditation: There is good evidence that various types of meditation may help improve quality of life in cancer patients. Studies have shown benefits for mood, sleep quality, and the stresses of treatment. The specific effects of meditation are not fully understood. Additional research is needed in this area.

Use cautiously with underlying mental illnesses. People with psychiatric disorders should consult with their primary mental healthcare professional(s) before starting a program of meditation, and should explore how meditation may or may not fit in with their current treatment plan. Avoid with risk of seizures. The practice of meditation should not delay the time to diagnosis or treatment with more proven techniques or therapies, and should not be used as the sole approach to illnesses.

Psychotherapy: Psychotherapy is an interactive process between a person and a qualified mental health care professional (psychiatrist, psychologist, clinical social worker, licensed counselor, or other trained practitioner). There is good evidence that psychotherapy may enhance quality of life in cancer patients by reducing emotional distress and aiding in coping with the stresses and challenges of cancer. Therapy may be supportive-expressive therapy, cognitive therapy or group therapy. While some patients seek psychotherapy in hopes of extending survival, there conclusive evidence of effects on medical prognosis is currently lacking. Psychotherapy may help people come to terms with the fact that they may die of cancer, which is the 4th stage of dealing with a terminal illness, including denial, anger, bargaining, and acceptance.

Psychotherapy is not always sufficient to resolve mental or emotional conditions. Psychiatric medication is sometimes needed. The reluctance to seek and use appropriate medication may contribute to worsening of symptoms or increased risk for poor outcomes. In order to be successful, psychotherapy requires considerable personal motivation and investment in the process. This includes consistent attendance and attention to treatment recommendations provided by the practitioner. Not all therapists are sufficiently qualified to work with all problems. The client or patient should seek referrals from trusted sources and should also inquire of the practitioner's training and background before committing to work with a particular therapist. Some forms of psychotherapy evoke strong emotional feelings and expression. This can be disturbing for people with serious mental illness or some medical conditions. Psychotherapy may help with post-partum depression, but is not a substitute for medication, which may be needed in severe cases.

Unclear or conflicting scientific evidence:

Acupuncture: Acupuncture, or the use of needles to manipulate the "chi" or body energy, originated in China over 5,000 years ago. There has been limited research on acupuncture for cancer pain, and the research that was done was shown to have mixed results. More studies are needed to determine potential benefits. Evidence from several small studies supports use of acupuncture at a specific point on the wrist (P6) to help chemotherapy patients reduce nausea and vomiting. Acupuncture may also reduce the pain associated with cancer.

Needles must be sterile in order to avoid disease transmission. Avoid with valvular heart disease, infections, bleeding disorders or with drugs that increase the risk of bleeding (anticoagulants), medical conditions of unknown origin, or neurological disorders. Avoid on areas that have received radiation therapy and during pregnancy. Use cautiously with pulmonary disease (like asthma or emphysema). Use cautiously in elderly or medically compromised patients, diabetics or with history of seizures. Avoid electroacupuncture with arrhythmia (irregular heartbeat) or in patients with pacemakers.

Aloe: Transparent gel from the pulp of the meaty leaves of Aloe vera has been used on the skin for thousands of years to treat wounds, skin infections, burns, and numerous other skin conditions. Dried latex from the inner lining of the leaf has traditionally been used as an oral laxative. Preliminary research suggests that aloe may help in the area of cancer prevention or may aid in the regression of cancerous tumors. Additional research is needed in this area.

Caution is advised when taking aloe supplements as numerous adverse effects including a laxative effect, cramping, dehydration and drug interactions are possible. Aloe should not be used if pregnant or breast-feeding, unless otherwise directed by a doctor.

American pawpaw: Evidence supporting the use of the American pawpaw (Asimina triloba) tree for cancer treatment in humans is largely anecdotal and subjective. However, use in humans has reported minimal side effects, and evidence from animal and test tube studies suggest that American pawpaw extract does have some anticancer activity. Pawpaw standardized extract has been used for 18 months in patients with various forms of cancer. Well-designed studies on the long-term effects of pawpaw extracts are currently lacking. Pawpaw should not be used if pregnant or breast-feeding, unless otherwise directed by a doctor.

Antineoplastons: Antineoplastons are a group of naturally occurring peptide fractions, which were observed by Stanislaw Burzynski, MD, PhD in the late 1970s to be absent in the urine of cancer patients. There is inconclusive scientific evidence regarding the effectiveness of antineoplastons in the treatment of cancer. Several preliminary human studies (case series, phase I/II trials) have examined antineoplaston types A2, A5, A10, AS2-1, and AS2-5 for a variety of cancer types. It remains unclear if antineoplastons are effective, or what doses may be safe. Until better research is available, no clear conclusion can be drawn.

Avoid if allergic or hypersensitive to antineoplastons. Use cautiously with high medical or psychiatric risk, an active infection due to a possible decrease in white blood cells, high blood pressure, heart conditions, chronic obstructive pulmonary disease, liver disease or damage, or kidney disease or damage. Avoid if pregnant or breastfeeding.

Arabinoxylan: Arabinoxylan is made by altering the outer shell of rice bran using enzymes from Hyphomycetes mycelia mushroom extract. Arabinoxylan has been found to improve immune reactions in patients with diabetes and cancer of various types. Arabinoxylan products may contain high calcium and phosphorus levels, which may be harmful for patients with compromised renal (kidney) function. Caution is advised when taking arabinoxylan supplements, as numerous adverse effects including drug interactions are possible. Arabinoxylan should not be used if pregnant or breast-feeding, unless otherwise directed by a doctor.

Aromatherapy: Healing with fragrant oils has been used for thousands of years. Aromatherapy is often used in people with chronic illnesses (frequently in combination with massage), with the intention to improve quality of life or well-being. There is currently not enough scientific evidence to form a firm conclusion about the effectiveness of aromatherapy for quality of life in cancer.

Essential oils should only be used on the skin in areas without irritation. Essential oils should be administered in a carrier oil to avoid toxicity. Avoid with a history of allergic dermatitis. Use cautiously if driving or operating heavy machinery. Avoid consuming essential oils. Avoid direct contact of undiluted oils with mucous membranes. Use cautiously if pregnant.

Art therapy: Art therapy involves the application of a variety of art modalities including drawing, painting, clay and sculpture. Art therapy enables the expression of inner thoughts or feelings when verbalization is difficult or not possible. Limited evidence suggests that art therapy may be of benefit in cancer caregiving for families of cancer patients. Possible benefits include reduced stress, lowered anxiety, increased positive emotions and increased positive communication with cancer patients and health care professionals. Art therapy may also reduce pain and other symptoms in cancer patients. More studies are needed to determine how best to use this form of intervention with this population. Art therapy may also benefit children hospitalized with leukemia during and after painful procedures. Limited available study suggests that art therapy improves cooperation with treatment. Children requested art therapy again when procedures were repeated, and parents reported that children were more manageable after art therapy.

Art therapy may evoke distressing thoughts or feelings. Use under the guidance of a qualified art therapist or other mental health professional. Some forms of art therapy use potentially harmful materials. Only materials known to be safe should be used. Related clean-up materials (like turpentine or mineral spirits) that release potentially toxic fumes should only be used with good ventilation.

Astragalus: Astragalus (Astragalus membranaceus) has been used in Chinese medicine for centuries for its immune enhancing properties. Although early laboratory and animal studies report immune stimulation and reduced cancer cell growth associated with the use of astragalus, reliable human evidence in these areas is currently lacking. In Chinese medicine, astragalus-containing herbal mixtures are also sometimes used with the intention to reduce side effects of chemotherapy and other cancer treatments. Astragalus-containing herbal combination formulas may also have beneficial effects in aplastic anemia. Due to a lack of well-designed research, a firm conclusion cannot be drawn.

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

Baikal skullcap: Although the outcomes of early studies using baikal skullcap for cancer are promising, high-quality clinical studies are needed in this area before a conclusion can be made. Avoid if allergic or hypersensitive to Baikal skullcap (Scutellaria barbata), its constituents, or members of the Lamiaceae family. Use cautiously if taking sedatives and/or operating heavy machinery. Use cautiously if taking antineoplastic (anticancer) agents or agents metabolized by cytochrome P450 enzymes. Avoid if pregnant or breastfeeding. Baikal skullcap is an ingredient in PC-SPES, a product that has been recalled from the U.S. market and should not be used.

Bee pollen: Bee pollen is considered a highly nutritious food because it contains a balance of vitamins, minerals, proteins, carbohydrates, fats, enzymes, and essential amino acids. Research has found that bee pollen may reduce some adverse effects of cancer treatment side effects. Additional study is needed before a firm recommendation can be made. Caution is advised when taking bee pollen supplements as allergic reactions may occur in sensitive individuals. Bee pollen should not be used if pregnant or breast-feeding, unless otherwise directed by a doctor.

Beta-glucan: Treatment with a beta-glucan, called lentinan, plus chemotherapy (S-1) may help prolong the lives of patients with cancer that has returned or cannot be operated on. More research is needed in this area. Avoid if allergic or hypersensitive to beta-glucan. When taken by mouth, beta-glucan is generally considered safe. Use cautiously with AIDS or AIDS-related complex (ARC). Avoid using particulate beta-glucan. Avoid if pregnant or breastfeeding.

Bitter melon: Bitter melon (Momordica charantia) is used in Avurvedic medicine from India to lower blood sugar levels. Research has also found that bitter melon extracts may be beneficial in cancer therapies. MAP30, a protein isolated from bitter melon extract, is reported to possess anti-cancer effects in laboratory studies. Potential anti-cancer effects have not been studied appropriately in humans. Caution is advised when taking bitter melon supplements, as numerous adverse effects including blood sugar lowering and drug interactions are possible. Bitter melon should not be used if pregnant or breast-feeding, unless otherwise directed by a doctor.

Black tea: Black tea (Camellia sinensis) is from the same plant as green tea, but the leaves are processed differently. Black tea usually contains more caffeine than green tea. Several studies have explored a possible association between regular consumption of black tea and rates of cancer in several populations. This research has yielded conflicting results, with some studies suggesting benefits, and others reporting no effects. Laboratory and animal studies report that components of tea, such as polyphenols, have antioxidant properties and effects against tumors. However, effects in humans remain unclear, and these components may be more common in green tea rather than in black tea. Some animal and laboratory research suggests that components of black tea may actually be carcinogenic, or cancer causing, although effects in humans are not clear. Overall, the relationship of black tea consumption and human cancer prevention remains undetermined. Additionally, although there is evidence from animal and laboratory studies that black tea may help prevent colorectal cancer, human studies are limited in this area as well. Additional research is needed.

Avoid if allergic or hypersensitive to caffeine or tannins. Skin rash and hives have been reported with caffeine ingestion. Use caution with diabetes. Use cautiously if pregnant. Heavy caffeine intake during pregnancy may increase the risk of SIDS (sudden infant death syndrome). Very high doses of caffeine have been linked with birth defects. Caffeine is transferred into breast milk. Caffeine ingestion by infants can lead to sleep disturbances/insomnia. Infants nursing from mothers consuming greater than 500 milligrams of caffeine daily have been reported to experience tremors and heart rhythm abnormalities. Tea consumption by infants has been linked to anemia, decreased iron metabolism, and irritability.

Bovine cartilage: In early study, bovine tracheal cartilage (preparations such as Catrix? and VitaCarte?) has been studied for the treatment of cancer with encouraging results. High quality clinical research is needed to better determine the effectiveness of bovine tracheal cartilage preparations for cancer treatment.

Avoid if allergic or hypersensitive to bovine cartilage or any of its constituents. Use cautiously with cancer, renal (kidney) failure, or hepatic (liver) failure. Avoid if pregnant or breastfeeding.

Bromelain: Bromelain is a sulfur-containing digestive enzyme (proteins which help with digestion) that is extracted from the stem and the fruit of the pineapple plant (Ananas comosus). There is not enough information to recommend for or against the use of bromelain in the treatment of cancer, either alone or in addition to other therapies. One small study found that a bromelain supplement decreased tumor size in 12 breast cancer patients. Patients took the supplements for different periods of time, lasting from months to years. Caution is advised when taking bromelain supplements, as numerous adverse effects including blood thinning and drug interactions are possible. Bromelain should not be used if pregnant or breast-feeding, unless otherwise directed by a doctor.

Cat's claw: Originally found in Peru, the use of cat's claw (Uncaria tomentosa) has been said to date back to the Inca civilization, possibly as far back as 2,000 years. Cat's claw has anti-inflammatory properties, and several low-quality studies suggest that cat's claw may slow tumor growth. However, this research is early and has not identified specific types of cancer that may benefit; thus, the results are not clear. A few studies suggest that cat's claw may also boost the immune system. Caution is advised when taking cat's claw supplements, as numerous adverse effects including blood thinning and drug interactions are possible. Cat's claw should not be used if pregnant or breast-feeding, unless otherwise directed by a doctor.

Chaparral: Chaparral was used by the Native Americans for various health conditions. The chaparral component nordihydroguaiaretic acid (NDGA) has been evaluated as a treatment for cancer but due to risk of toxicity is considered unsafe and not recommended for use. Chaparral and NDGA have been associated with cases of kidney and liver failure, liver cirrhosis, kidney cysts, and kidney cancer in humans. In response to these reports, the U.S. Food and Drug Administration (FDA) removed chaparral from its "generally recognized as safe" (GRAS) list in 1970. Chaparral and NDGA are generally considered unsafe and are not recommended for use.

Avoid if allergic to chaparral or any of its components, including nordihydroguaiaretic acid. Use cautiously if taking blood thinners (anticoagulants), blood sugar medication, or drugs that are broken down by the liver (like amiodarone, phenobarbital, valproic acid). Stop use two weeks before surgery/dental/diagnostic procedures with bleeding risk, and do not use immediately after these procedures. Use cautiously if driving or operating heavy machinery. Avoid if pregnant or breastfeeding.

Chlorophyll: Preliminary evidence in suggest that chlorophyll may aid in the reduction of side effects associated with photodynamic therapies, such as those used in management of malignant tumors. Further research is required to support the use of chlorophyll as a laser therapy adjunct for cancer treatment.

Avoid if allergic or hypersensitive to chlorophyll or any of its metabolites. Use cautiously with photosensitivity, compromised liver function, diabetes or gastrointestinal conditions or obstructions. Use cautiously if taking immunosuppressant agents or antidiabetes agents. Avoid if pregnant or breastfeeding.

Chrysanthemum: Early study indicates that hua-sheng-ping (includes Chrysanthemum morifolium, Glycyrrhiza uralensis, and Panax notoginseng) may be beneficial for patients with precancerous lesions. However, more research is needed.

Avoid if allergic or hypersensitive to Chrysanthemum, its constituents, or members of the Asteraceae/Compositae family, such as dandelion, goldenrod, ragweed, sunflower, and daisies. Use cautiously if taking medication for gout, cancer, or HIV. Use cautiously with compromised immune systems or if taking immunomodulators. Avoid with photosensitivity or if taking photosensitizers. Avoid large acute or chronic doses of ingested pyrethrin. Avoid pyrethrin with compromised liver function, epilepsy, or asthma. Avoid ocular exposure to pyrethrin. Avoid if pregnant or breastfeeding.

Coenzyme Q10: Further research is needed to determine if coenzyme Q10 (CoQ10) may be of benefit for cancer when used with other therapies.

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

Copper: Copper is a mineral that occurs naturally in many foods, including vegetables, legumes, nuts, grains and fruits, as well as shellfish, avocado, and beef (organs such as liver). Preliminary research reports that lowering copper levels theoretically may arrest the progression of cancer by inhibiting blood vessel growth (angiogenesis). Copper intake has not been identified as a risk factor for the development or progression of cancer.

Copper is potentially unsafe when used orally in higher doses than the RDA. Copper supplements should not be used if pregnant or breast-feeding, unless otherwise directed by a doctor.

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

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

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

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

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

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

Essiac?: Essiac? contains a combination of herbs, including burdock root (Arctium lappa), sheep sorrel (Rumex acetosella), slippery elm inner bark (Ulmus fulva), and Turkish rhubarb (Rheum palmatum). The original formula was developed by the Canadian nurse Rene Caisse (1888-1978) and is thought to be effective in cancer therapies, although currently there is not enough evidence to recommend for or against the use of this herbal mixture as a therapy for any type of cancer. Different brands may contain variable ingredients, and the comparative effectiveness of these formulas is not known. None of the individual herbs used in Essiac? has been tested in rigorous human cancer trials, although some components have anti-tumor activity in laboratory studies. Numerous individual patient testimonials and reports from manufacturers are available on the Internet, although these cannot be considered scientifically viable as evidence. Individuals with cancer are advised not to delay treatment with more proven therapies. Caution is advised when taking Essiac? supplements, as numerous adverse effects including drug interactions are possible. Essiac? should not be used if pregnant or breast-feeding, unless otherwise directed by a doctor.

Fermented wheat germ extract (FWGE): Preliminary data suggest that fermented wheat germ extract (FWGE) may improve the overall survival rate of patients with colorectal cancer. Additional well-designed studies are required before a conclusion can be made.

Fermented wheat germ should not be used as a substitute for clinical cancer treatment or medications. Caution is advised in patients with diabetes or hypoglycemia and in those taking drugs, herbs, or supplements that affect blood sugar. Caution is advised in patients with bleeding gastrointestinal erosions and other bleeding disorders or those taking drugs, herbs, or supplements that may increase the risk of bleeding. Use cautiously in patients with organ and tissue transplants, colitis, enteritis, or malabsorption syndrome. Use cautiously in patients using immunosuppressants. Use cautiously in children. Use cautiously in pregnant or breastfeeding women. Avoid in patients with chronic disease or sensitivity to gluten and fructose. Avoid with known allergy or hypersensitivity to fermented wheat germ, its constituents, or wheat products.

Focusing: Focusing (experiential therapy) is a method of psychotherapy that involves being aware of one's feelings surrounding a particular issue and understanding the meaning behind words or images conveyed by those feelings. Early evidence suggests focusing may improve mood and attitude in cancer patients. Firm recommendations cannot be made until well-designed clinical trials are available.

Side effect reporting is rare, but patients should consult with a qualified healthcare practitioner before making decisions about medical conditions and practices. Individuals with severe emotional difficulties should not abandon proven medical and psychological therapies but rather choose focusing as a possible adjunct.

Gamma linolenic acid (GLA): GLA is an omega-6 essential fatty acid. Some laboratory and human studies indicate that GLA may have anti-tumor activity and may be used as a cancer treatment adjunct. Additional research is needed in this area.

Caution is advised when taking GLA supplements, as numerous adverse effects including an increased risk of bleeding and drug interactions are possible. GLA should not be used if pregnant or breast-feeding, unless otherwise directed by a doctor.

Garlic: Preliminary human studies suggest that regular consumption of garlic (Allium sativum) supplements may reduce the risk of developing several types of cancer. Some studies use multi-ingredient products so it is difficult to determine if garlic alone may play a beneficial role in cancer prevention. Further well-designed human clinical trials are needed to conclude whether eating garlic or taking garlic supplements may prevent or treat cancer.

Caution is advised when taking garlic supplements, as numerous adverse effects including an increased risk of bleeding and drug interactions are possible. Garlic should not be used if pregnant or breast-feeding, unless otherwise directed by a doctor.

Ginseng: Early studies report that ginseng taken by mouth may be of benefit in cancer prevention, especially if ginseng powder or extract is used. Weak studies suggest that ginseng in combination with other herbs may improve cell activity, immune function, and red and white blood cell counts in patients with aplastic anemia; however, other studies have found decreases in blood cell counts. Early studies suggest that ginseng may decrease radiation therapy side effects and may be used as a chemotherapy adjunct to improve body weight, quality of life, and the immune response. There is currently not enough evidence to recommend the use of Panax ginseng or American ginseng for these indications. Study results are unclear, and more research is needed before a clear conclusion can be reached.

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

Goji: Polysaccharide constituents, such as alpha- and beta-glucans from a variety of plants, are reported to have immune system enhancing properties. In clinical study, Lycium barbarum polysaccharides (LBP) demonstrated a synergistic effect in various cancer treatments, when administered in conjunction with powerful immune stimulating drugs.

Use cautiously in patients who are taking blood-thinning medications, such as warfarin. Use cautiously in asthma patients and in patients with sulfite sensitivities. The New York Department of Agriculture has detected the presence of undeclared sulfites, a food additive, in two dried goji berry products from China. Avoid in patients who are allergic to goji, any of its constituents, or to members of the Solanaceae family.

Grape seed: There is currently 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 or hypersensitive to grapes or other grape compounds. Use cautiously with bleeding disorders or if taking blood thinners such as warfarin, aspirin, non-steroidal anti-inflammatory drugs (NSAIDS), or anti-platelet agents. Use cautiously with drugs processed using the liver's cytochrome P450 enzyme system. Use cautiously with blood pressure disorders or if taking ACE inhibitors. Avoid if pregnant or breastfeeding.

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 in general remains inconclusive. Evidence from well-designed clinical trials is needed before a firm conclusion can be made in this area.

Caution is advised when taking green tea supplements, as numerous adverse effects including an increased risk of drug interactions are possible. Green tea should not be used if pregnant or breast-feeding, unless otherwise directed by a doctor.

Healing touch: Preliminary data suggests that healing touch (HT) may increase quality of life in cancer. 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, but rather is a therapeutic regimen consisting of an oral tonic, topical (on the skin) preparations, and supportive therapy. The tonic is individualized for cancer patients based on general condition, location of cancer, and previous history of treatment. An ingredient that usually remains constant for every patient is potassium iodide. Other ingredients are then added and may include licorice, red clover, burdock, stillingia root, berberis root, pokeroot, cascara, Aromatic USP 14, prickly ash bark, and buckthorn bark. A red paste may be used, which tends to be caustic (irritating), and contains antimony trisulfide, zinc chloride, and bloodroot. A topical yellow powder may be used, and contains arsenic sulfide, talc, sulfur, and a "yellow precipitate." A clear solution may also be administered, and contains trichloroacetic acid.

Well-designed human studies available evaluating the safety or effectiveness of Hoxsey formula are currently lacking. Caution is advised when taking the Hoxsey formula supplements, as numerous adverse effects including an increased risk of drug interactions are possible. Hoxsey formula should not be used if pregnant or breast-feeding, unless otherwise directed by a doctor.

Iodine: Iodine is an element (atomic number 53), which is required by humans for the synthesis of thyroid hormones (triiodothyronine/T3 and thyroxine/T4). The potential role of non-radioactive iodine in cancer care remains unknown. Antioxidant and anti-tumor effects have been proposed based on laboratory research. In contrast, some scientists have asserted that tumors may uptake more iodine than normal tissues. It has been suggested that high rates of gastric (stomach) cancer or low rates of breast cancer in coastal Japan may be due to high iodine intake, although this has not been demonstrated scientifically. Povidone-iodine solutions have been used as a part of alternative cancer regimens, such as the Hoxsey formula. Preliminary study has also indicated povidone-iodone solution as a potential rectal washout for rectal cancer. Overall, no clear conclusion can be drawn based on the currently available evidence.

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 hyperkalemia (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.

Isoflavones: Preliminary findings on the effects of isoflavones on colorectal cancer risk are inconsistent and inconclusive. Results vary between studies and suggest a need for additional research in this area.

Use isolated soy and red clover isoflavones cautiously. Various sources suggest limiting the consumption of isolated isoflavones to no more than 50 milligrams daily. Use cautiously in patients with bleeding disorders, diabetes or hypoglycemia, low or high blood pressure, or thyroid disorders, and in those taking agents to treat any of these conditions. Use cautiously in those taking hormonal agents (such as estrogens, or estrogen-like agents) or cholesterol-lowering agents. Avoid in patients with breast and other estrogen-associated cancers. Avoid higher than dietary amounts in children and pregnant or breastfeeding women. Avoid with known allergy or hypersensitivity to soy, soy-based products, or isoflavone products.

Jiaogulan: Preliminary evidence indicates that gypenosides extracted from Gynostemma pentaphyllum may 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 blood disorders or taking anticoagulants or anti-platelet drugs (blood thinners). Use cautiously with diabetes. Avoid if pregnant or breastfeeding.

Lavender: Perillyl alcohol (POH), derived from lavender (Lavendula officinalis), may be beneficial in the treatment of some types of cancer. Preliminary small studies in humans, involving the use of POH suggest safety and tolerability, but effectiveness has not been established.

Avoid if allergic or hypersensitive to lavender. Avoid with a history of seizures, bleeding disorders, eating disorders (anorexia, bulimia), or anemia (low levels of iron). Avoid if pregnant or breastfeeding.

Lignans: Limited evidence suggests that increased dietary lignan intake is correlated with a reduced colorectal cancer risk. Further research is needed.

Use cautiously in patients with bleeding disorders, deficient immune systems, diabetes, low blood sugar, prostate disorders, or those taking agents to treat these conditions. Use cautiously in patients taking antibiotics, estrogens, sedatives, diuretics, agents that lower blood pressure, or agents that are broken down by the liver. Use cautiously in pregnant or breastfeeding women. Avoid in patients with known allergy or sensitivity to lignans, flaxseed, sesame seeds, or any plants that produce them.

Lutein: 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 cardiovascular disease or cancer. Avoid if pregnant or breastfeeding.

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. Multiple studies have investigated whether intake of tomatoes or tomato-based products helps prevent digestive tract cancers, including colon cancer and rectal cancer. Results have been inconsistent with some studies reporting significant benefits and others finding no effects. Research that specifically studies lycopene supplements is limited, and more research is needed before a firm conclusion can be drawn on the effectiveness of lycopene for colorectal cancer prevention.

Avoid if allergic to tomatoes or to lycopene. Due to a lack of conclusive data, avoid if pregnant or breastfeeding.

Maitake mushroom: Maitake is the Japanese name for the edible mushroom Grifola frondosa. Maitake has been used traditionally both as a food and for medicinal purposes. Early studies in the laboratory as well as in humans suggest that beta-glucan extracts from maitake may increase the body's ability to fight cancer. However, these studies have not been well designed, and better research is needed before the use of maitake for cancer can be recommended.

Caution is advised when taking maitake supplements, as numerous adverse effects including an increased risk of bleeding and drug interactions are possible. Maitake should not be used if pregnant or breast-feeding, unless otherwise directed by a doctor.

Meditation: Not enough research has shown meditation to be of benefit in cancer prevention. More studies are needed.

Melatonin: There are several early-phase and controlled human trials of melatonin in patients with various advanced stage malignancies. There is currently not enough definitive scientific evidence to discern if melatonin is beneficial as a cancer treatment, whether it increases (or decreases) the effectiveness of other cancer therapies, or if it safely reduces chemotherapy side effects.

Melatonin is not to be used for extended periods of time. Caution is advised when taking melatonin supplements, as numerous adverse effects including drug interactions are possible. Melatonin is not recommended during pregnancy or breastfeeding unless otherwise advised by a doctor.

Milk thistle: Milk thistle (Silybum marianum) has been used medicinally in China for over 2,000 years, most commonly for the treatment of liver and gallbladder disorders. There are early reports from laboratory experiments that the components silymarin and silibinin found in milk thistle may reduce the growth of human cancer cells. However, effects have not been shown in high-quality human trials.

Caution is advised when taking milk thistle supplements, as numerous adverse effects including an increased risk of bleeding and drug interactions are possible. Milk thistle should not be used if pregnant or breast-feeding, unless otherwise directed by a doctor.

Mistletoe: Mistletoe is one of the most widely used unconventional cancer treatments in Europe. Mistletoe extracts have been studied for a variety of human cancers as well as melanoma and leukemia. However, efficacy has not been conclusively proven for any one condition. In fact, some studies have shown lack of efficacy of certain preparations for a variety of cancers. Larger, well-designed clinical trials are needed.

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

Moxibustion: Moxibustion is a healing technique employed across the diverse traditions of acupuncture and oriental medicine for over 2,000 years. Moxibustion uses the principle of heat to stimulate circulation and break up congestion or stagnation of blood and chi. Moxibustion is closely related to acupuncture as it is applied to specific acupuncture points. Preliminary evidence suggests that moxibustion may reduce side effects of chemotherapy or radiation therapy. More studies are needed.

Use cautiously over large blood vessels and thin or weak skin. Avoid with aneurysms, any kind of "heat syndrome," cardiac disease, convulsions or cramps, diabetic neuropathy, extreme fatigue and/or anemia, fever, inflammatory conditions, over allergic skin conditions or ulcerated sores, or skin adhesions. Avoid if pregnant or breastfeeding. Avoid areas with an inflamed organ, contraindicated acupuncture points, face, genitals, head, inflamed areas in general, nipples, and skin adhesions. Avoid in patients who have just finished exercising or taking a hot bath or shower. Use cautiously with elderly people with large vessels. It is considered not advisable to bathe or shower for up to 24 hours after a moxibustion treatment.

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 several types of cancer. More research is needed.

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

Omega-3 fatty acids: Omega-3 fatty acids are essential fatty acids found in some plants and fish. A balance of omega-6 and omega-3 fatty acids is advised for health. Several population studies report that dietary omega-3 fatty acids or fish oil may reduce the risk of developing several different types of cancer. Well conducted clinical trials are necessary before a clear conclusion can be drawn regarding the use of omega-3 fatty acids for cancer prevention.

Caution is advised when taking omega-3 fatty acid supplements, as numerous adverse effects including an increase in bleeding and drug interactions are possible. Omega-3 fatty acid supplements should not be used if pregnant or breast-feeding, unless otherwise directed by a doctor.

Para-aminobenzoic acid: N-butyl-p-aminobenzoate (BAB) has been shown to be a lipid-soluble local anesthetic. Early study found significant pain relief in patients with intractable cancer pain after an epidural injection of BAB suspension. Larger scale clinical study is needed to confirm these findings.

Avoid with known hypersensitivity to PABA or its derivatives. Avoid oral use in children and pregnant or nursing women. Use cautiously in patients with renal disease, bleeding disorders or taking anticoagulants, diabetics or patients at risk for hypoglycemia. Discontinue use if rash, nausea, or anorexia occurs. Pharmaceutical doses of PABA and its derivatives should only be taken under appropriate medical supervision. PABA should not be given concurrently with sulfonamides.

Perillyl alcohol: Perillyl alcohol has been used to treat cancer. However, high quality scientific studies are lacking. Further research 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: Initial studies of prayer 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 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. In clinical study, patients certain that they were receiving intercessory prayer had a higher incidence of complications following cardiac bypass surgery than those who did not know they were being prayed for.

Probiotics: Probiotics are beneficial bacteria (sometimes referred to as "friendly germs") that help maintain the health of the intestinal tract and aid in digestion. There is recent evidence that supplementation with a synbiotic preparation (oligofructose-enriched insulin, Lactobacillus rhamnosus GG (LGG), Bifidobacterium lactis Bb12 (BB12)) may help reduce the risk of colon cancer. More studies with probiotics as a monotherapy are needed.

Probiotics are generally considered safe and well-tolerated. Use cautiously in patients prone to infections or those with compromised immune systems, such as those with HIV/AIDS, or in infants born prematurely or those with immune deficiency. Use cautiously in patients with gastrointestinal disorders or in those sensitive or intolerant to dairy products containing probiotics or to lactose. Avoid with known allergy or sensitivity to probiotics.

PSK: Protein-bound polysaccharide (PSK) is obtained from cultured mycelia of Coriolus versicolor, a mushroom thought to have antimicrobial, antiviral, antitumor, and immune stimulating properties. PSK, in addition to chemotherapy and surgery, has been associated with increased disease-free survival rate for patients with colorectal cancer in various clinical trials as opposed to these pharmaceutical drugs alone. Well-designed clinical trials are needed to confirm these results along with optimal dosing regimens and optimal pharmaceutical combinations. PSK does not seem to affect the cure rate of colon cancer.

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

Psyllium: Psyllium, also referred to as ispaghula, is derived from the husks of the seeds of Plantago ovata. Psyllium contains a high level of soluble dietary fiber, and is the chief ingredient in many commonly used bulk laxatives. According to early research, diets that include psyllium may reduce the risk for colon cancer. More studies are needed to determine whether psyllium can help prevent colon cancer.

Prescription drugs should be taken one hour before or two hours after psyllium. Adequate fluid intake is required when taking psyllium-containing products. Use cautiously with blood thinners, antidiabetic agents, carbamazepine, lithium, potassium-sparing diuretics, salicylates, tetracyclines, nitrofurantoin, calcium, iron, vitamin B12, other laxatives, tricyclic antidepressants (amitriptyline, doxepin, and imipramine), antigout agents, anti-inflammatory agents, hydrophilic agents, and chitosan. Use cautiously with diabetes and kidney dysfunction. Use cautiously if pregnant or breastfeeding. Avoid if allergic or hypersensitive to psyllium, ispaghula, or English plantains (Plantago lanceolata). Avoid in patients with esophageal disorders, gastrointestinal atony, fecal impaction, gastrointestinal tract narrowing, swallowing difficulties, and previous bowel surgery. Avoid ingestion of psyllium-containing products in individuals with repeated or prolonged psyllium exposure who have not manifested allergic or hypersensitive symptoms.

Reiki: Reiki may contribute to reduced perception of pain, improved quality of life, and reduced fatigue in cancer patients. More studies are needed.

Reiki 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. Use cautiously with psychiatric illnesses.

Reishi mushroom: Reishi (Ganoderma lucidum) has been shown to have antineoplastic and immunomodulatory effects in animal studies. Human studies exist of advanced cancer patients using Ganopoly?, a Ganoderma lucidum polysaccharide extract. Results show improved quality of life and enhanced immune responses, which are typically reduced or damaged in cancer patients receiving chemotherapy and/or radiation therapy. Well-designed long-term studies are needed confirm these results and to determine potential side effects.

Caution is advised when taking reishi supplements, as numerous adverse effects including an increased risk of bleeding and drug interactions are possible. Reishi should not be used if pregnant or breast-feeding, unless otherwise directed by a doctor.

Seaweed: Bladderwrack (Fucus vesiculosus) is a brown seaweed that grows on the northern coasts of the Atlantic and Pacific oceans, and the North and Baltic seas. Bladderwrack appears to suppress the growth of various cancer cells in animal and laboratory studies. However, reliable human studies to support a recommendation for use in cancer are currently lacking.

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

Selenium: Selenium is a trace mineral found in soil, water, and some foods. It is an essential element in several metabolic pathways. Several studies suggest that low levels of selenium (measured in the blood or in tissues such as toenail clippings), may be a risk factor for developing cancer. 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 currently remains unclear if selenium is beneficial for cancer prevention or cancer treatment.

Avoid if allergic or sensitive to products containing selenium. Avoid with a history of nonmelanoma 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: 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 and have not included reliable comparisons to accepted treatments. Many studies have been supported by shark cartilage product manufacturers, which may influence the results. In the United States, shark cartilage products cannot claim to cure cancer, and the U.S. Food and Drug Administration (FDA) has sent warning letters to companies not to promote products in this way. Without further evidence from well-designed human trials, it remains unclear if shark cartilage is of any benefit in cancer and patients are advised to check with their doctor and pharmacist before taking shark cartilage.

Shark cartilage available in Asian grocery stores and restaurants should not be eaten due to declining populations of sharks. Caution is advised when taking shark cartilage supplements, as numerous adverse effects including an increased risk of drug interactions are possible. Shark cartilage should not be used by patients who are pregnant or breast-feeding, unless otherwise directed by a doctor.

Shiitake mushroom: Shiitake (Lentinus edodes) has been taken by mouth for boosting the immune system, decreasing cholesterol levels, and for anti-aging. Lentinan, derived from shiitake, has been injected as an adjunct treatment for cancer and HIV infection. Laboratory, animal and human studies of lentinan have shown positive results in cancer patients when used as a chemotherapy adjunct. Further well-designed clinical trials on all types of cancer are required to confirm these results.

Caution is advised when taking shiitake supplements, as numerous adverse effects including an increased risk of bleeding and drug interactions are possible. Shiitake should not be used if pregnant or breast-feeding, unless otherwise directed by a doctor.

Slippery elm: 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: Early evidence suggests that herbal formulations containing sorrel, such as Essiac?, do not shrink tumor size or increase life expectancy in patients with cancer. However, currently there is a lack of studies evaluating sorrel as the sole treatment for cancer. A conclusion cannot be made without further research.

Avoid with a known allergy or hypersensitivity to sorrel. Avoid large doses due to reports of toxicity and death, possibly because of the oxalate found in sorrel. Many tinctures contain high levels of alcohol and should be avoided when driving or operating heavy machinery. Sorrel formulations may cause nausea or vomiting when taken with the prescription drugs metronidazole (Flagyl?) or disulfiram (Antabuse?). Avoid if pregnant or breastfeeding.

Soy: Soy (Glycine max) contains compounds which have been reported to be effective as a cancer treatment. Genistein, an isoflavone found in soy, has been found in laboratory and animal studies to possess anti-cancer effects, such as blocking new blood vessel growth (anti-angiogenesis), acting as a tyrosine kinase inhibitor (a mechanism of many new cancer treatments), or causing cancer cell death (apoptosis). In contrast, genistein has also been reported to increase the growth of pancreas tumor cells in laboratory research. Until reliable human research is available, it remains unclear if dietary soy or soy isoflavone supplements are beneficial, harmful, or neutral in people with various types of cancer. There is currently not enough scientific evidence to determine if dietary intake of soy may be effective for colon cancer prevention. More research is needed before a conclusion can be made.

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

Spiritual healing: Cancer patients, especially those who fear recurrence or are unhappy with their physicians, commonly use prayer and spiritual healing. More research is needed to address the effects of spiritual healing on anxiety, depression, and quality of life in patients with cancer.

Spiritual healing should not be used as the only treatment approach for medical or psychiatric conditions, and should not delay the time it takes to consider more proven therapies.

Strawberry: Limited research suggests that strawberry may reduce the risk of colorectal adenoma (noncancerous tumor) with mild dysplasia (abnormal growths) in women. However, additional studies are needed to better determine strawberry's effects on colon cancer risk.

Avoid if allergic or hypersensitive to strawberry or members of the Rosaceae family. Use cautiously with hematological (blood) disorders or if taking anticoagulants or blood thinners. Use cautiously with iron-absorption disorder. Use cautiously if pregnant or breastfeeding.

Sweet annie: Certain constituents found in sweet annie show promise for use in cancer 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 or hypersensitive to sweet annie (Artemisia annua), its constituents, or members of the Asteraceae/Compositae family such dandelion, goldenrod, ragweed, sunflower, and 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.

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 cancer pain, there is not enough reliable evidence to draw a firm conclusion in this area. TENS is often used in combination with acupuncture.

Avoid with implantable devices, like defibrillators, pacemakers, intravenous infusion pumps, or hepatic artery infusion pumps. Use cautiously with decreased sensation, like neuropathy, and with seizure disorders. Avoid if pregnant or breastfeeding.

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.

Thiamin is generally considered safe and relatively nontoxic. Avoid if allergic or hypersensitive to thiamin. Rare hypersensitivity/allergic reactions have occurred with thiamin supplementation. Skin irritation, burning, or itching may rarely occur at injection sites. Large doses may cause drowsiness or muscle relaxation. Use cautiously if pregnant or breastfeeding.

Thymus extract: Preliminary evidence suggests that thymus extract may increase disease-free survival and immunological improvement in several types of cancer. Additional study is needed in this area.

Avoid if allergic or hypersensitive to thymus extracts. Use bovine thymus extract supplements cautiously due to potential for exposure to the virus that causes "mad cow disease." Avoid with an organ transplant or other forms of allografts or xenografts. Avoid if receiving immunosuppressive therapy, with thymic tumors, myasthenia gravis (neuromuscular disorder), untreated hypothyroidism, or if taking hormonal therapy. Avoid if pregnant or breastfeeding.

Traditional Chinese Medicine (TCM): The ancient Chinese philosophy of Taoism provided the basis for the development of Chinese medical theory. TCM uses over 120 different herbs in cancer treatment, depending on the type of cancer and its cause according to Chinese medical theory. Studies have reported significant benefits include reducing tumors, reducing treatment side effects and improved response to treatment. More studies of stronger design are needed before TCM can be recommended with confidence as an adjunct to cancer treatment, although centuries of traditional use in cancer cannot be discounted.

Chinese herbs can be potent and may interact with other herbs, foods or drugs. Consult a qualified healthcare professional before taking. There have been reports of manufactured or processed Chinese herbal products being tainted with toxins or heavy metal or not containing the listed ingredients. Herbal products should be purchased from reliable sources. Avoid ma huang, which is the active ingredient in ephedra. Avoid ginseng if pregnant or breastfeeding.

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 cancer. There are several ongoing studies in this area.

Caution is advised when taking turmeric supplements, as numerous adverse effects including an increased risk of bleeding and drug interactions are possible. Turmeric should not be used if pregnant or breast-feeding, unless otherwise directed by a doctor.

Vitamin A: Alpha-carotene and vitamin A may protect against recurrence of colorectal cancer in nonsmokers and nondrinkers or be indicative of compliance or another healthy lifestyle factor that reduces risk. Further research is needed before a conclusion can be drawn.

Vitamin A toxicity can occur if taken at high dosages. Vitamin A appears to be safe in pregnant women if taken at recommended doses. However, vitamin A excess, as well as deficiency, has been associated with birth defects. Vitamin A is excreted in human breast milk. The benefits or dangers to nursing infants are not clearly established. Use cautiously in children and infants. Use cautiously in patients using alcohol, bile acid sequestrants, birth control pills, chemotherapeutic agents (such as busulfan), mineral oil, neomycin, or orlistat. Avoid if allergic or hypersensitive to vitamin A. Avoid with agents toxic to the liver, blood thinners (such as warfarin (Coumadin?)), retinoids, or tetracycline antibiotics. Avoid in patients with liver disease, intestinal infections, fat malabsorption syndromes, severe protein energy malnutrition, or type V hyperlipoproteinemia (a genetic disorder). Avoid high-dose vitamin A and beta-carotene in patients at high risk of lung cancer.

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, including colon cancer, in population studies. However, it is not clear that it is specifically the vitamin C in these foods that is beneficial, and in available human research, vitamin C did not decrease total colorectal cancer incidence or colorectal cancer mortality. Additional studies are needed before a conclusion can be made.

Vitamin C is generally considered safe in amounts normally found in foods. Vitamin C supplements are also generally considered safe in most individuals if taken in recommended doses. Vitamin C intake from food is generally considered safe if pregnant or breastfeeding. It is not clear if vitamin C supplements in doses higher than Dietary Reference Intake recommendations are safe for pregnant or breastfeeding women. Vitamin C is naturally found in breast milk. High doses of vitamin C have been associated with multiple adverse effects. Caution is advised in patients with bleeding disorders or those taking drugs that affect bleeding. Caution is advised in patients with diabetes or hypoglycemia, and in those taking drugs, herbs, or supplements that affect blood sugar. Use with caution in patients with cancer, glucose-6-phosphate dehydrogenase deficiency, anemia and related conditions, kidney stones, or sickle cell disease, or after angioplasty. Use with caution in patients taking antibiotics, anticancer agents, HIV medications, barbiturates, estrogens, fluphenazine, or iron supplements. Use parenteral (injected) vitamin C cautiously. Avoid in patients with known allergy or sensitivity to any vitamin C product ingredients. Avoid high doses of vitamin C in patients with cirrhosis, gout, renal tubular acidosis, paroxysmal nocturnal hemoglobinuria, or kidney failure, or in those taking agents that may damage the kidneys.

Vitamin D: Studies have suggested an inverse association between vitamin D intake (with or without calcium) and colorectal cancer. More research is needed in this area. According to clinical review, greater vitamin D exposure may reduce the risk of colorectal adenoma, and it may do so more strongly in combination with anti-inflammatory agents.

Vitamin D is generally well tolerated in recommended doses; doses higher than those recommended may cause toxic effects. Vitamin D is considered safe in pregnant and breastfeeding women when taken in recommended doses. Use cautiously with hyperparathyroidism (overactive parathyroid), diabetes, low blood pressure, kidney disease, liver disease, or granulomatous disorders (a type of immune disorder), or in mothers who are receiving vitamin D supplements and who are breastfeeding. Avoid if allergic or hypersensitive to vitamin D or any of its components or with vitamin D hypersensitivity syndromes. Avoid in patients with hypercalcemia (high blood calcium levels).

Vitamin E: Sufficient scientific evidence is lacking to determine if vitamin E prevents colon cancer. In patients with previous colon cancer, a combination of vitamins A, C, and E has been reported to reduce the risk of developing a new colon cancer, while this effect was not observed in another trial. Preventive benefits have also been suggested in those with no prior colon cancer when vitamin E is used in a multivitamin, but not when used alone. Recent results of the Women's Health Study have reported no overall reduction in cancer risk with daily use of vitamin E, although this study was not large enough to look at colon cancer specifically. Additional research is warranted.

Use long-term vitamin E cautiously. Use cautiously in patients with heart conditions, skin conditions, kidney impairment, Alzheimer's disease, cognitive decline, retinitis pigmentosa (loss of peripheral vision), or in patients who smoke, or in preterm infants. Avoid high doses of vitamin E. Avoid above the recommended daily level in pregnant women and breastfeeding women. Avoid in patients with bleeding disorders or in those taking drugs that may increase the risk of bleeding. Avoid if allergic or hypersensitive to vitamin E.

Fair negative scientific evidence:

Apricot: Available clinical trials on the use of whole apricots for cancer are currently lacking. However, some research has been conducted on "LaetrileT," an alternative cancer drug marketed in Mexico and other countries outside of the U.S. LaetrileT is derived from amygdalin found in apricot pits and nuts such as bitter almond. There are multiple animal studies and initial human evidence to suggest that LaetrileT is not beneficial in the treatment of cancer. Based on a phase II trial in 1982, the U.S. National Cancer Institute concluded that LaetrileT is not an effective chemotherapeutic agent. Nonetheless, many people still travel to use this therapy outside the U.S.

Multiple cases of cyanide poisoning, including deaths, have been associated with LaetrileT therapy. 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 ten kernels daily). 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: While diets high in fruits and vegetables rich in beta-carotene have been shown to potentially reduce certain cancer incidences, 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.

Bitter almond: "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. Early evidence suggests that laetrile is not beneficial in the treatment of cancer. In 1982, the U.S. National Cancer Institute 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.

Hydrazine sulfate: 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.

Hydrazine sulfate may cause cancer. Avoid if allergic or hypersensitive to hydrazine sulfate or any of its constituents. Use cautiously with liver or kidney problems, psychosis, diabetes or seizure disorders. Avoid if pregnant or breastfeeding. Side effects have been reported, including dizziness, nausea, and vomiting.

Hypnotherapy, hypnosis: Hypnosis did not reduce radiotherapy side effects such as anxiety and did not improve quality of life in patients undergoing curative radiotherapy in early high-quality studies.

Use cautiously with mental illnesses like psychosis/schizophrenia, manic depression, multiple personality disorder or dissociative disorders, or with seizure disorders.

Iridology: There is currently limited available data supporting iridology as a tool for cancer diagnosis. Additional study is needed.

Iridology should not be used alone to diagnose disease. Studies of iridology have reported incorrect diagnoses, and thus, potentially severe medical problems may go undiagnosed. In addition, research suggests that iridology may lead to inappropriate treatment. Iridology is therefore not recommended as a sole method of diagnosis or treatment for any condition.

Strong negative scientific evidence:

Folate: Folic acid or folate is a form of a water-soluble B vitamin needed for human health. Evidence suggests that increased dietary folate intakes or folate status is associated with decreased risk of colorectal or colon cancer. However, folate supplementation studies in general indicate a lack of protective effect for colorectal cancer with increased risk found in one meta-analysis. Currently there is insufficient evidence available to suggest folate supplementation for any type of cancer prevention or treatment.

Avoid if allergic or hypersensitive to folate or any of the product ingredients. Use cautiously if receiving coronary stents and with anemia and seizure disorders. It is suggested that pregnant women consume 400 micrograms daily in order to reduce the risk of the fetus developing a defect. Folate is likely safe if breastfeeding.

Prevention

Fruits, vegetables and whole grains: Fruits, vegetables and whole grains contain vitamins, minerals, fiber and antioxidants, which may help protect from developing 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 patient's diet such as kale, chard, spinach, dark green lettuce, peppers, and squash.

Fat intake reduction: People who eat high-fat diets may have a higher rate of colorectal 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.

Vitamins and minerals: Calcium, magnesium, pyridoxine (vitamin B6), and folic acid may help reduce the risk of colorectal cancer. 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.

Alcohol consumption avoidance: 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 colon cancer. 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 colorectal and other cancers.

Exercise and weight control: Controlling weight and exercising regularly can reduce the risk of developing colorectal cancer. Exercise, including light walking, stimulates movement through the bowel and reduces the time the colon is exposed to harmful substances (carcinogens) that may cause 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.

Screening tests: It is best to follow the early detection screening guidelines to help find colon or rectal cancer. When these cancers are found and treated early, they can often be cured. Screening can also find polyps, and their removal helps prevent some cancers.

Anti-inflammatory drugs: Aspirin and other anti-inflammatory drugs, such as ibuprofen and celecoxib (Celebrex?), appear to help prevent the growth of polyps. They may also help reduce polyps for some people whose family members tend to develop polyps.

Statin drugs: Statin drugs are commonly used to lower blood cholesterol levels. The regular use of these drugs has recently been found to decrease the risk of developing colon cancer. However, another study found no benefit between taking stains and colon cancer prevention, but the use of statins did seem to reduce the risk of stage IV cancer.

Author information

This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography

American Cancer Society. .

American Society of Colon and Rectal Surgeons. .

Center for Disease Control and Prevention (CDC). .

Colon Cancer Alliance. .

Coogan PF, Smith J, Rosenberg L. Statin use and risk of colorectal cancer. J Natl Cancer Inst. 2007;99(1):32-40.

Fernandez E, Gallus S, La Vecchia C. Nutrition and cancer risk: an overview. J Br Menopause Soc. 2006;12(4):139-42.

Frezza EE, Wachtel MS, Chiriva-Internati M. Influence of obesity on the risk of developing colon cancer. Gut. 2006;55(2):285-91.

National Cancer Institute. .

Natural Standard: The Authority on Integrative Medicine. .

Wakai K, Hirose K, Matsuo K, et al. Dietary risk factors for colon and rectal cancers: a comparative case-control study. J Epidemiol. 2006;16(3):125-35.

Causes

The risk factors mentioned above leave the individual susceptible to developing colon or rectal cancers.

In the colon and rectum, the exaggerated growth of cells may cause precancerous polyps (adenomas, or adenomatous polyps), which form in the lining of the intestine. Over a period of time some of these polyps may become cancerous. In the later stages of the disease, these cancerous polyps may penetrate the colon walls and metastasize (spread) to nearby lymph nodes and other organs.

Risk factors

Age: The chances of having colorectal cancer increases after the age of 50. According to the American Cancer Society, more than 9 out of 10 people with colorectal cancer are older than 50.

Previous colorectal cancer: Although the colorectal cancer has been completely removed, there is a risk that new cancers could grow in other areas of the colon and rectum.

History of polyps: An increased risk for colorectal cancer may depend on a larger size or greater number of polyps.

Inflammatory intestinal conditions: Inflammatory bowel diseases such as ulcerative colitis and Crohn's disease increase the risk of colon cancer. In these conditions, the colon is inflamed over a long period of time and there may be ulcers in the lining.

Genetics: If an individual has close relatives (such as a parent or sibling) that have had colon cancer, their risk is increased. This is especially true if the family member had cancer before the age of 60. Individuals with a family history of colorectal cancer should talk to their doctors about how often screening tests should be performed.

An estimated 25% of colon cancer cases may be linked to genetics. Some mutations are inherited, while others occur randomly during a person's life. Mutations in three main types of genes have been linked to colon cancer. These include tumor-suppressor genes, proto-oncogenes, and stability genes.

Tumor-suppressor genes help prevent cancer by regulating cell growth. They prevent cells from dividing too rapidly or uncontrollably. When tumor-suppressor genes are mutated, they do not function properly. As a result, cells may grow uncontrollably and possibly lead to cancerous tumors. Mutations in several different tumor-suppressor genes, including the APC, DCC, DPC4 (also known as SMAD4), LKB1, MSH2, and MLH1 genes, have been linked to colon cancer or colorectal cancer. Some tumor-suppressor genes, such as the TP53 (p53) gene, are associated with many different types of cancers, including colon cancer.

Proto-oncogenes also help regulate cell division. When a proto-oncogene is mutated, it is called an oncogene. Mutations in several proto-oncogenes, including C-MYC and MYB, have been linked to colon cancer. Researchers have recently discovered that the CDK8 oncogene may also increase a person's susceptibility to colon cancer.

Stability genes repair DNA damage or abnormalities that occur during cellular division. When these genes are mutated, it may cause genetic mutations that can lead to cancer. Examples of stability genes associated with colon cancer include hMLH1hMSH2, hMSH6, PMS2, MYH (MutYH), and BLM.

Ethnic background: Jewish individuals of Eastern European descent (Ashkenazi) have a higher rate of colon cancer.

Diet: A diet high in fat, especially from animal sources, may increase the risk of colorectal cancer. Poor food choices may result in a deficiency of nutrients, such as calcium, magnesium, pyridoxine (vitamin B6) and folic acid, and these nutrients may be helpful in reducing the risk of colorectal cancer.

Lack of exercise: People who are inactive have a higher risk of colorectal cancer.

Obesity: Obesity increases an individual's risk for colorectal cancer.

Smoking: Recent studies have shown that smokers are 30-40% more likely than nonsmokers to die of colorectal cancer.

Alcohol: Heavy and chronic use of alcohol has been linked to colorectal cancer.

Diabetes: Individuals with diabetes have as a high as a 40% increased risk of developing colorectal cancer.

Other cancers and their treatment: A recent report on testicular cancer survivors found that men with this condition had a higher rate of colorectal cancer. Men who receive radiation therapy for prostate cancer have also been reported to have a higher risk of rectal cancer.

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