Role of Nutrition in Cancer Treatment

Nutrition plays an important role in the prevention and treatment of cancer. Nutrients provide essential nourishment to the body for the maintenance of life. These can be divided into two groups, i.e. energy nutrients and protector nutrients. Certain vitamins (such as B vitamins) and minerals (such as magnesium), which help in the process of conversion of food into energy by activating specific enzymes are called energy nutrients, whereas the nutrients that protect the body from various toxins (such as environmental pollutants) are known as protector nutrients. The protector nutrients include beta-carotene, vitamin C, vitamin E, copper, manganese, selenium and zinc. Most of the protector nutrients act as antioxidants by eliminating free radicals (which are highly reactive, unstable molecules produced during the process of conversion of food into energy). Some nutrients are known to perform specific functions in the body, for example, vitamin C, vitamin E and selenium protect the body from environmental pollutants while B vitamins counteract emotional and physical stress. The nutritional deficiencies may lead to the genesis of cancer by suppressing the immune system of the body and inducing premature ageing.

A vegetarian diet is rich in fibre, micronutrients and antioxidants. A study conducted on 1200 persons, all above the age of 66 years, has shown that the vegetarians have a significantly lower incidence of cancer as compared to the non-vegetarians. Another study conducted at the Institute for Experimental Pathology, German Cancer Research Center, Heidelberg, Germany has revealed that the blood samples of vegetarians contain higher levels of cancer-preventing factors such as carotene and glutamine transferase. Moreover, the activity of the natural killer cells (NK cells) is found to be twofold higher in the vegetarians as compared to the non-vegetarians.

Amino acids play an important role in the prevention and treatment of cancer. N-acetyl cysteine is a sulphur-containing amino acid that inhibits angiogenesis, enhances the immunity of the body and reduces toxic side effects of radiotherapy & chemotherapy. N-acetyl cysteine plays an important role in the synthesis of DNA and protects DNA from the damaging effect of free radicals. L-arginine, an amino acid, enhances the anticancer activity of the natural killer cells (NK cells) and the cytotoxic T lymphocytes (CTL). Another sulphur-containing amino acid, methionine, increases survival period in the liver cancer patients.

Coenzyme Q10 (Ubiquinone) prevents the genesis of cancer by enhancing the activity of the macrophages. A study done on advanced cases of breast cancer has shown partially to complete regression of the tumours after administration of Coenzyme Q10. It also protects tissues of the liver, kidney and the heart from the damaging effect of free radicals. Soya bean, grape seed, sesame seed, pistachio, walnut and spinach contain rich contents of coenzyme Q10.

Gamma-linolenic acid inhibits the growth of cancer by producing good eicosanoids such as PGE-1. This function of gamma-linolenic acid is promoted by vitamin B3, vitamin B6, vitamin C and zinc. Studies have shown that a combination of gamma-linolenic acid and vitamin C increases the survival period in liver cancer patients. Black currant oil, evening primrose oil and mother’s milk contain rich contents of gamma-linolenic acid.

Chinese Medicine in Cancer Treatment

Panax ginseng (Ren Shen/Ginseng) is a forest herb that has been used by Chinese medical practitioners for more than 2000 years. It inhibits the growth of cancer by interfering with the DNA synthesis. Panax ginseng contains several active constituents, which include saponins, essential oils, phytosterols, amino acids, peptides, vitamins and minerals. Saponins enhance the activity of the natural killer cells (NK cells), stimulate the macrophages and promote the production of the antibodies. According to a report published in the Free Radical Biology and Medicine, the anticancer effect of Panax ginseng is mainly due to its ability to protect the body against free radicals. Studies have shown that Panax ginseng decreases the incidence of liver cancer by 75 per cent. Panax ginseng is used by the Chinese doctors to treat cancers of the ovary and the stomach. Two Korean researchers, T.K. Yun and S.Y. Choi, have reported that the incidence of cancer decreases significantly after administration of Panax ginseng. Studies have revealed that Panax ginseng regenerates the natural killer cells (NK cells), which are damaged by chemotherapy and radiotherapy.

Astragalus membranaceus (Huang Qi) is used by Chinese doctors to treat advanced cases of liver cancer. Swainsonine, a derivative of Astragalus membranaceus, is known to prevent metastases. A study conducted at the Peking Cancer Institute has recorded much higher survival rate in the patients of advanced-stage liver cancer after administration of Astragalus membranaceus along with conventional treatment as compared to those patients, who were given the conventional treatment alone. Astragalus membranaceus protects the liver from toxic effects of chemotherapy. Astragalus membranaceus is often used in combination with Panax ginseng. According to research done in Japan, the Ginseng-Astragalus combination (GAC) has a regulatory effect on the natural killer cells (NK cells). Studies have also shown that GAC protects the body from toxic side effects of chemotherapy and enhances the activity of the immune cells. GAC is found to regulate the secretion of the stress hormone, cortisol. Astragalus membranaceus is used in China along with another herb called Ligustrum lucidum. A study conducted at Loma Linda University in California has revealed that Astragalus membranaceus and Ligustrum lucidum, enhance the immune-stimulating effect of each other when given together.


Amygdalin (Laetrile) has been used by Chinese physicians for more than 3,500 years to treat various tumours. Ernest Krebs, a noted biochemist, has confirmed the anticancer activity of Amygdalin, which is derived from Fagopyrum esculentum, Panicum miliaceum and seeds of Prunasin family (including Prunus armenica, Prunus cerasus, Prunus persica and Prunus domestica). Amygdalin is one of the nitrilosides (natural cyanide-containing substances), which consists of two molecules, i.e. benzaldehyde and cyanide.  In the body, these two molecules split off in the liver by an enzyme, called beta-glucosidase to form glucuronic acid. Another enzyme known as glucuronidase that is present in higher concentrations in the cancerous cells breaks glucuronic acid to produce cyanide that kills the cancerous cells. It is worth mentioning that cancerous cells do not contain rhodanese (sulphur transferase), an enzyme, which is found in normal cells of the body. Rhodanase protects normal cells of the body from the killing effects of cyanide by converting free cyanide into a relatively harmless substance known as thiocyanate.

Carcinoma of the Salivary Gland

The salivary glands (the glands that secrete saliva) can be divided into two groups, i.e. major salivary glands and minor salivary glands. The major salivary glands include the parotid gland, submandibular gland and the sublingual gland. The minor salivary glands are tiny glands located on the oral mucosa, palate, uvula, floor of the mouth, posterior part of the tongue, retromolar and the peritonsillar areas. Carcinoma may arise from any of the major or the minor salivary glands. The exact cause of salivary gland carcinoma is not fully understood but smoking and exposure to radiotherapy of the head & neck area are considered as the major risk factors.

Carcinoma of the salivary gland usually presents as a slow-growing lump in the cheek along with dull but progressive pain. The tumour is usually fixed to the mandible and the adjacent muscles & the skin leading to restricted movements of the jaw. There may be anaesthesia of the overlying skin or the mucous membrane, resorption of the bone and enlarged lymph nodes in the neck. The parotid gland carcinoma usually presents as a rapidly growing tumour along with progressive facial nerve palsy and neuralgia.

Staging of salivary gland carcinoma is done as follows:

1. In stage I of the tumour is less than 4 cm in size.
2. In stage II, the tumour is 4 cm to 6 cm in size.
3. In stage III, the tumour is more than 6 cm in size; or there is involvement of a single group of lymph nodes on the same side of the neck.
4. In stage IV, the tumour is larger than 6 cm in size and invades adjacent tissues; or there is extensive involvement of the lymph nodes, or the tumour metastasises to distant parts of the body.
5. Recurrent salivary gland carcinoma is the one that reappears after an apparent recovery in response to the initial treatment.

Procedures used in diagnosis & evaluation of the salivary gland carcinoma include MRI, CT scan and biopsy.

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Carcinoma of Uterus

Carcinoma of the uterus (the uterine endometrium carcinoma) is the second most common cancer of the female genital tract. It usually occurs during 50 to 70 years of age. The exact cause of uterine endometrial carcinoma is not fully understood, but there are certain risk factors, which include obesity, hypertension, diabetes, polycystic ovaries (with prolonged anovulation), use of oral contraceptives and extended use of Tamoxifen. The nulliparous women and the women having late menopause possess higher risk of the uterine endometrium carcinoma. Positive family history is another major risk factor. Endometrial hyperplasia is a pre-cancerous stage of uterine endometrial carcinoma. There are various types of uterine endometrial carcinoma, which include adenocarcinoma, adenosquamous carcinoma, papillary serous carcinoma and clear cell carcinoma. The most common type is adenocarcinoma.

The uterine endometrial carcinoma usually presents with postmenopausal bleeding with abdominal or suprapubic pain, weight loss and vaginal discharge.

Staging of the uterine endometrial carcinoma is done as follows:

In stage 0 (carcinoma in situ) of the uterine endometrial carcinoma, there is atypical hyperplasia of the endometrium.

In stage I, the tumour is confined to body of the uterus.

In stage II, the tumour extends to the cervix.

In stage III, the uterine endometrial carcinoma spreads outside the uterus but remains within the true pelvis.

In stage IV, the uterine endometrium carcinoma extends beyond the true pelvis and metastasises to distant organs of the body.

Recurrent uterine endometrial carcinoma is the one that reappears after an apparent recovery in response to the initial treatment.

Conventional Treatment of Cancer

Conventional approach to treat cancer is to cut it (surgery), burn it (radiotherapy) and poison it (chemotherapy). When a cancer is localised, it can be removed by surgery. But in most of the cases, it is practically impossible to detect cancer in such an early stage. The cancerous cells do get killed by chemotherapy and radiotherapy, but both of these therapies also destroy some vital cells in the body, leading to serious side effects. It is extremely difficult for the scientists to prepare a drug that could kill the cancerous cells selectively without harming normal cells of the body. Another major drawback of chemotherapy is the drug resistance. Moreover, recurrences are commonly seen after chemotherapy and radiotherapy. Other conventional techniques used in the treatment of cancer including bone marrow transplantation, peripheral stem cell transplantation, hormone therapy, photodynamic therapy, immunotherapy and gene therapy have their own limitations.

Radiotherapy

In radiotherapy, therapeutic doses of radiation (which are many times higher than the diagnostic doses) are used to kill the cancerous cells. A single large dose of radiation may kill the cancerous cells, but it will also burn the adjoining healthy tissues. Therefore, the required doses of radiation are usually fractionated into smaller doses, however damage to the healthy tissue still occurs. Radiotherapy has proved more effective in the treatment of tumours of the food pipe, testes and the brain.

The history of radiotherapy goes back to 1895, when Wilhelm Conrad Roentgen discovered X-rays for diagnostic purposes. Two years later, in 1897, it was disclosed in a meeting of the Vienna Medical Society that a mole has disappeared after repeated exposures to the X-rays. Since then, X-rays have been used to treat various tumours. Later, during 1950s, an artificial radioactive isotope of cobalt was developed that delivered radiation deeper into the body as compared to the X-rays. These were named gamma rays, which were similar to X-rays except that these have a shorter wavelength. The X-rays and gamma rays are almost outdated now and their place has been taken up by the high-energy electron beam generated by linear accelerators. In the past, the doses of radiation were used to be measured in rad (radiation absorbed dose), but this unit has recently been replaced by gray (1 Gy = 100 rad). Radiotherapy can be given internally or externally.

In internal radiotherapy, the radioactive implant (a sealed container of radioactive substance) is placed directly into the tumour or in one of the body cavities. The radioactive implant is usually kept in the body for 1 to 7 days but sometimes it is implanted permanently. In the after loading technique of internal radiotherapy, an empty container is first placed in the body and then the radioactive substance is inserted into it. In some patients, the radioactive substance (in the liquid form) is administered orally or by injection. There are three different techniques of giving internal radiotherapy. These are intracavitary radiotherapy, interstitial radiotherapy and brachytherapy.

In external radiotherapy, the X-rays and the gamma rays have been used extensively to treat cancer. The X-rays generate extranuclear radiation, whereas the gamma rays generate intranuclear radiation but both of these are ionising radiations, which form highly reactive ions in the exposed cells. The use of X-rays and gamma rays in radiotherapy is now replaced by the high-energy electron beam  (generated by linear accelerators) that can be focused on a smaller area, thus minimising the damage to the adjoining tissues.

In the hyper fractionated technique of external radiotherapy, smaller doses of radiation are given throughout the day instead of a single large dose.

In the super fractionated technique of external radiotherapy, smaller doses of radiation are given many times in a day, but the total combined dose of radiotherapy is greater than that of the single daily dose.

The effect of radiotherapy can be enhanced by using the hyperbaric oxygen and the hyperthermia techniques.

Radioimmunotherapy is a new technique of radiotherapy that delivers radiation directly to the cancerous cells. In this technique, first of all, the specific antibodies produced in the patient’s body against some components of the cancerous cells are collected from the patient’s blood. Later, a radioactive isotope is attached to these antibodies in the laboratory. These antibodies carrying the radioactive isotope are then injected back to the patient, which travel through the bloodstream to reach the cancerous cells and get attached to them. By this technique, the radioactive isotope is directly delivered to the cancerous cells that kill them selectively, thus sparing normal cells of the body from the damaging effect of radiotherapy.

The cancerous cells exist in the body in three different forms, i.e. dividing cells, dying cells and dormant cells. Radiotherapy can kill the dividing cancerous cells. The dormant cells do survive even after exposure to the radiotherapy. These dormant cancerous cells may get back into the cell cycle after some time and multiply to produce many more cancerous cells that may form the cancerous growth again. Such a cancerous growth, which reappears at the same site (or any other site in the body), from where the original cancerous growth apparently disappeared after administration of radiotherapy, is known as recurrence. There are various side effects of radiotherapy such as nausea, vomiting, dryness of mouth, difficulty in swallowing, change or loss of taste, earache, cough, frequency of urination, diarrhoea, change in texture of the skin, loss of hair, sterility and decreased blood cell counts.