Cancer: Integrated Naturopathic Support

Cancer: Integrated Naturopathic Support

DIAGNOSTIC SUMMARY

Cancer is a group of more than 200 individual diseases characterized by uncontrolled growth, proliferation, and spread of abnormal cells. Diagnosis and treatment vary depending on type of cancer cells and location, extent of total tumor burden, health and performance status of the patient, prior treatments administered, and which conventional treatment regimens are currently considered standard of care.

GENERAL CONSIDERATIONS

Prevention should take precedence over treatment. Occurrence involves two compounding factors: genetic susceptibility and environmental exposure to carcinogens. Environmental factors contribute more than half of risk for the 11 most common cancers. Naturopathy reduces lifestyle-based risk factors and counteracts some genetic factors.

Sensitive screening and diagnostic testing are needed to diagnose in early, more curable stages. Roles of naturopathy include the following:

• Preventing disease and screening for pathology

• Testing and evaluating suspicious lesions

• Reducing side effects of conventional therapies

• Improving tumor kill from conventional therapies

• Improving environment that allowed malignancy

• Supporting patient metabolically while starving tumor

• Slowing or stopping abnormal cell division

• Promoting normal cell differentiation and apoptosis

• Reducing metastasis and angiogenesis

• Enhancing cell-to-cell communication

• Using natural antitumor agents

• Blocking hormonal stimulation of tumors by normalizing hepatic clearance

• Supporting healthy immune response

• Supporting secondary prevention for patient after treatment

• Dealing with death and dying for those who succumb

• Encouraging prevention and screening for family members of patient

Stages of Cancer Development

• Initiation: damage to cellular DNA leading to mutations and resulting in development of cancerous cell.

• Promotion: factors in cellular environment (free radicals, xenobiotic chemicals, hormones) “feed” cancerous cell growth into a tumor.

• Progression: tumor metastasizes to other parts of body.

Cell Cycle

The cell cycle is usually divided into the following four or five phases:

• G0 phase: resting state, or gap phase. Many cells spend most of their time in this phase either at rest or performing assigned duties. Generally resistant to chemotherapy.

• G1 phase: gap 1 phase, or interphase. Cells synthesize RNA and prepare for cell division.

• S phase: synthesis phase. Cells duplicate DNA to create daughter cells.

• G2 phase: gap 2 phase. DNA synthesis completed. Microtubules of mitotic spindles produced.

• M phase: mitosis. Division of DNA and cellular proteins into two daughter cells. Return to G0 or resting phase.

Chemotherapy Agent Efficacy According to Cell Cycle Phase

Certain chemotherapeutic agents work best in particular phases of cell cycle:

• G1: asparaginase

• S phase: antimetabolites, procarbazine, topotecan, topoisomerase I inhibitors

• G2 phase: etoposide, bleomycin, paclitaxel, and topoisomerase II inhibitors

• M phase: vinca alkaloids

Types of cancer

• Sarcomas: cells of mesenchymal origin (e.g., bone, muscle, fibrous tissue)

— Bone: e.g., osteosarcoma

— Soft tissues: e.g., leiomyosarcoma.

• Leukemia: white blood cell–producing tissues (bone marrow)

— Chronic lymphocytic leukemia

— Chronic myelogenous leukemia

— Acute lymphocytic leukemia

— Acute myelogenous leukemia

• Lymphoma: lymphatic system, especially lymph nodes

— Hodgkin’s disease

— Non-Hodgkin’s lymphoma

• Cell type: T cell or B cell

— Physical form: follicular, diffuse

— Degree of indolence or aggressiveness

Staging

Staging expresses extent of spread to make treatment decisions, evaluate responses, and make survival prognoses. Usually based on anatomic spread, but certain cancers have other pertinent characteristics (e.g., any breast cancer of inflammatory subtype is stage IV regardless of spread; in colon cancer depth of penetration through colon wall is critical).

Complete Staging Description

• Origin of tumor

• Histologic type and grade

• Extent of spread of tumor and locations of metastatic lesions

• Functional status of patient

• TNM score includes size of tumor (T), number of involved lymph nodes (N), and presence or absence of distant metastasis (M). For example, breast cancer with primary tumor 2.5 cm, positive lymph nodes in ipsilateral axilla, and no metastasis would be T2, N1, M0.

• Staging designation

— Stage 0: in situ or noninvasive

— Stage I: small localized disease

— Stage II: larger disease but localized; may involve small number of local lymph nodes

— Stage III: regionally advanced

— Stage IV: advanced metastasis

Tumor Markers

Tumor markers are tissue proteins in blood whose elevation indirectly reveals cancer progression. Caveats include the following:

• Most are not useful as screening tests. Noncancerous tissue can also secrete higher amounts of these markers in conditions such as inflammation and infection.

• Tumor may express different marker than typical for that tumor type.

• Most useful: monitoring response to treatment or disease progression.

• Raw number is less important than direction of change.

Common Tumor Markers

Tumor Marker	Typical Tumor Types
CEA	Colorectal, breast, small cell lung
PSA	Prostate (some breast)
CA-15-3	Breast
CA 19-9	Pancreas, hepatic, biliary, gastric, colon
CA27-29	Breast
CA-125	Ovarian
Beta-HCG	Testis, trophoblastic neoplasia
Beta₂ microglobulin	Multiple myeloma, lymphoma
Thyroglobulin	Thyroid

Performance Indexes

Indicate level of health of patient. Most commonly used are Karnofsky score and Eastern Cooperative Oncology Group (ECOG) score. Based on patient’s ability to perform daily activities, need for assistance, and need for medical treatment. Reflect patient vitality and ability to withstand and respond to further treatment. Patients with similar stages of disease but radically different performance indexes may have quite different outcomes.

Comparison of Karnofsky and ECOG scoring

Karnofsky Score	Description	ECOG Score
100	Asymptomatic	0
90	Normal activity, minor disease signs	1
80	Some disease signs with exertion	1
70	Cares for self; unable to do active work	2
60	Requires occasional assistance; in bed less than 50% of day	2
50	Requires considerable assistance and medical care	3
40	Disabled; requires special assistance; in bed more than 50% of day	3
30	Severely disabled; hospital indicated	4
20	Quite ill; requires active supportive treatment; bedridden	4
10	Moribund	4
0	Deceased	5

Tumor Response Criteria and Terminology

Tumor response does not always mean cure or even an improvement in survivability. Cytotoxic therapy selects for resistant clones of tumor cells, which will over time no longer respond to treatment.

• Cure: treatment that allows patient to live as long as an age-matched cohort or die of other causes, even if some disease remains.

• Remission: complete disappearance of all detectable tumors. Millions of tumor cells may remain. Remission is a better term than “cure.”

• Complete response: complete disappearance of all evidence of disease for at least 2 measurement periods at least 4 weeks apart.

• Partial response: decrease of at least 50% in diameter of all measurable lesions with no new lesions for at least 4 weeks.

• Stable disease: less than 50% up to an increase of 25% in measurable lesions.

• Progression: increase of more than 25% or appearance of new lesions.

• Palliation: treatment not aimed at cure, simply reduction of symptoms or transient extension of life for brief period.

THERAPEUTIC CONSIDERATIONS

When making therapeutic decisions, results must be at least as good as those of conventional therapies to justify declining those therapies. This advice may determine whether a patient lives or dies. Make recommendations based on hard data, not on theory, anecdote, or opinion.

span id=”p126″ epub:type=”pagebreak” title=”126″/>Goals of Naturopathic Oncology Support

• Improve nutrition

• Selectively starve tumor

• Inhibit metastasis

• Reduce side effects of treatment

• Maximize tumor kill from conventional therapies

• Support normal cell division

• Remove tumor promoters

• Use antitumor herbs and nutrients (avoid waste of money on worthless products)

• Support immune function

• Support positive attitude and healthy lifestyle

• Regular secondary cancer screening after completion of treatment

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Tags: The Clinicians Handbook of Natural Medicine

Apr 3, 2017 | Posted by admin in GENERAL & FAMILY MEDICINE | Comments Off

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