Purpose of This PDQ Summary
Overview
General Information
History
Laboratory/Animal/Preclinical Studies
Human/Clinical Studies
Adverse Effects
Overall Level of Evidence for Gerson Therapy
Changes to This Summary (01/11/2008)
More Information

Purpose of This PDQ Summary

This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about the use of Gerson therapy as a treatment for cancer. This summary is reviewed regularly and updated as necessary by the PDQ Cancer Complementary and Alternative Medicine Editorial Board ¹.

Information about the following is included in this summary:

• A brief history of Gerson therapy research.
• Possible side effects of Gerson therapy use.

This summary is intended as a resource to inform and assist clinicians and other health professionals who care for cancer patients. It does not provide formal guidelines or recommendations for making health care decisions.

Some of the reference citations in the summary are accompanied by a level of evidence designation. These designations are intended to help the readers assess the strength of the evidence supporting the use of specific interventions or treatment strategies. The PDQ Cancer Complementary and Alternative Medicine Editorial Board uses a formal evidence ranking system ² in developing its level of evidence designations. These designations should not be used as a basis for reimbursement determinations.

This summary is also available in a patient version ³, which is written in less technical language.

Overview

This complementary and alternative medicine (CAM) information summary provides an overview of the Gerson therapy as a treatment for patients with cancer. The summary includes a brief history of the development of the Gerson therapy; a review of laboratory, animal, and human studies; and possible side effects associated with the use of this treatment.

This summary contains the following key information:

• The Gerson therapy is advocated by its supporters as a method of treating cancer patients based on changes in diet and nutrient intake.
• An organic vegetarian diet plus nutritional and biological supplements, pancreatic enzymes, and coffee or other types of enemas are the main features of the Gerson therapy.
• The regimen is intended to “detoxify” the body while building up the immune system and raising the level of potassium in cells.
• The regimen is empirically based on observations made by Max Gerson, M.D., in his clinical practice and on his knowledge of research in cell biology at the time (1930s–1950s).
• No results of laboratory or animal studies are reported in the scientific literature contained in the MEDLINE (Medical Literature Analysis and Retrieval System Online) database.
• Few clinical studies of the Gerson therapy are found in the medical literature.

Many of the medical and scientific terms used in this summary are hypertext linked (at first use in each section) to the NCI Dictionary of Cancer Terms ⁴, which is oriented toward nonexperts. When a linked term is clicked, a definition will appear in a separate window. All linked terms and their corresponding definitions will appear in a glossary in the printable version of this summary.

Reference citations in some PDQ CAM information summaries may include links to external Web sites that are operated by individuals or organizations for the purpose of marketing or advocating the use of specific treatments or products. These reference citations are included for informational purposes only. Their inclusion should not be viewed as an endorsement of the content of Web sites, or of any treatment or product, by the PDQ Cancer CAM Editorial Board or NCI.

General Information

The Gerson therapy is a complex regimen advocated by its supporters to treat cancer and other degenerative diseases. It consists of a specialized diet to “detoxify” the body and rebuild the immune system, adding vitamin and mineral supplements to help in these processes. Coffee enemas are an essential part of the regimen. The therapy is named for its developer, Max Gerson, a German physician who emigrated to the United States and started a medical practice in New York City in 1938.[1,2]

The Gerson therapy is rooted in the belief that cancer is a disease of the whole organism, the tumor being only a symptom of a diseased body. Gerson considered cancer to be an accumulation of several damaging factors that combine to cause the deterioration of the entire metabolic system. The goal of the Gerson therapy is to bring the body back to its normal metabolic state, or as near to this state as possible, and to keep the metabolism in natural equilibrium.[1,2]

Gerson observed that cancer patients exhibited markedly degenerated organs, especially the liver, presumably caused by the clearing of toxic materials of an unknown type that the disease produced. He also noted that the situation became worse after chemotherapy, probably because of more toxic products entering the bloodstream. Gerson’s regimen focused on helping the liver rid the body of toxic substances while restoring and maintaining healthy liver function.[1,2]

According to Gerson, during the detoxification process that results from the Gerson diet, the liver becomes progressively overburdened as the body rids itself of toxic substances formed by the breakdown of cancer cells. Coffee enemas, pancreatic enzymes, and crude liver extract are used to help the liver deal with the burden of removing toxic substances.[1-5]

Total control of everything that enters and leaves the body is the governing principle of the Gerson regimen. Its three main components are strict diet, nutritional supplements, and regular enemas.

The diet is strictly vegetarian for at least 6 weeks and consists of specific fruits and vegetables, eaten either raw or stewed in their own juices. No animal protein is allowed. Some whole grains such as oatmeal are included. Flaxseed oil is allowed only because it aids in the body’s use of vitamin A.[2] No other fat such as cooking oil and no salt or spices of any kind are allowed. A glass of freshly prepared juice from vegetables and fruits must be consumed every hour for 13 hours throughout the day. The vegetables and fruits used on the diet are very high in potassium and very low in sodium.

Food preparation is also controlled. Food may be prepared only in cast-iron pots and pans; no aluminum cookware is allowed. Juices must be prepared using a specific type of juicer that crushes the fruit or vegetable rather than grinding it into pulp. Gerson advocated organically produced food, with all fruits, vegetables, and grains grown and raised in soil free of pesticides and contaminants and enriched only with natural fertilizers.[2]

The protein and dairy restriction may be lifted to include buttermilk; however, this restriction may continue through the entire course of the therapy, depending on the individual patient. Some changes in the original diet have occurred over time, but the initiation phase of the diet has always been a vegetarian diet.[2]

Taking specific vitamin and mineral supplements plus pancreatic enzymes is the second component of the regimen. Although there have been additions and substitutions to the basic list of supplements, there have been few changes since the 1940s. The typical range of supplements includes the following:

1. Potassium solution
2. Lugol’s solution (potassium iodide, iodine, water)
3. Injectable crude liver extract (no longer used) with vitamin B12 (substitution: coenzyme Q10 and vitamin B12)
4. Vitamins A, C, and B3 (niacin)
5. Flaxseed oil
6. Pancreatic enzymes
7. Pepsin

The potassium solution (potassium dissolved in water) is to help increase the ratio of potassium to sodium in the cells. Lugol’s solution, which consists of 5 g of iodine and 10 g of potassium iodide dissolved in water, is given to increase the body’s metabolic rate. The potassium solution and Lugol’s solution are both added to the hourly juice intake.[1-5]

Originally, Gerson thought that using crude liver extract and juice (made by processing fresh calf and veal livers) would help maintain liver function. The extract and juice were given to patients via injection with the vitamin B12. In 1989, the use of injectable crude liver extract was banned by the U.S. Food and Drug Administration because it was found to be contaminated with Campylobacter.[1,2] Desiccated liver capsules replaced the crude extract, but this has now been replaced by coenzyme Q10.[2] As mentioned above, flaxseed oil is used to help the body utilize vitamin A. Pancreatic enzymes are given to assist in the digestion and the elimination of the breakdown products in the colon.

Coffee (or chamomile) enemas are the third component of the Gerson therapy. Coffee enemas supposedly dilate the bile duct in the liver, thereby allowing the liver to release the breakdown products more easily and speed their removal to the intestine. At the beginning of therapy, a patient may take four or more coffee enemas per day. Literature suggests that coffee enemas help relieve the pain associated with gastrointestinal cancers; however, there is only anecdotal evidence to suggest that the enemas actually dilate the bile ducts.[6,7]

Central to the therapy is an abundance of potassium and the lack of sodium. Gerson had observed that as soon as his cancer patients started on the diet regimen, they released large amounts of sodium in their urine. He noticed that cells in the patients’ bodies that had been bloated with fluid started to shrink as the fluid was released.[1] After studying the research in cancer cell biology available to him at the time and noting the ratio of potassium to sodium in cancer cells versus healthy cells, he deduced that the reason for this sodium excretion was that the diet regimen was correcting generalized tissue damage caused by excess sodium. Healthy cells had a high ratio of potassium to sodium; diseased cells had a low ratio of potassium to sodium or an abundance of sodium.[1]

The implications of this observation led Gerson to believe that part of the process of recovery from cancer was the replacement of excess sodium by potassium in damaged tissues.[8] This belief is the theoretical basis for Gerson’s choice of high-potassium, low-sodium fruits and vegetables in his prescribed diet: a high intake of potassium was needed to restore a normal ratio of potassium to sodium in the cell.

The Gerson therapy is the basis for other CAM therapies that include cleansing enemas or special diets as part of their regimens, most notably the Gonzalez regimen. (Refer to the PDQ summary on the Gonzalez Regimen ⁵ for more information.)

References

1. Gerson M: A Cancer Therapy: Results of Fifty Cases and The Cure of Advanced Cancer by Diet Therapy. San Diego, Calif: The Gerson Institute, 2002. 
   
   
2. Gerson C, Walker M: The Gerson Therapy: The Amazing Nutritional Program for Cancer and Other Illnesses. New York, NY: Kensington Publishing Corp, 2001. 
   
   
3. Gerson M: Effects of a combined dietary regime on patients with malignant tumors. Exp Med Surg 7 (4): 299-317, illust, 1949.  [PUBMED Abstract]
   
   
4. Gerson M: Dietary considerations in malignant neoplastic disease: preliminary report. Rev Gastroenterol 12: 419-25, 1945. Also available online. ⁶ Last accessed September 4, 2007. 
   
   
5. Gerson M: The cure of advanced cancer by diet therapy: a summary of 30 years of clinical experimentation. Physiol Chem Phys 10 (5): 449-64, 1978.  [PUBMED Abstract]
   
   
6. Green S: A critique of the rationale for cancer treatment with coffee enemas and diet. JAMA 268 (22): 3224-7, 1992.  [PUBMED Abstract]
   
   
7. Brown BT: Treating cancer with coffee enemas and diet. JAMA 269 (13): 1635-6, 1993.  [PUBMED Abstract]
   
   
8. Cope FW: A medical application of the Ling association-induction hypothesis: the high potassium, low sodium diet of the Gerson cancer therapy. Physiol Chem Phys 10 (5): 465-8, 1978.  [PUBMED Abstract]
   
   

History

Max Gerson immigrated to the United States from Germany. In 1938, after passing the New York state medical board examinations, he started a practice in New York City. While in Germany, Gerson had suffered from severe migraine headaches and developed a vegetarian diet as a way to cure his migraines. The diet was based on his study of the history of medicine and his respect for the writings of Paracelsus (1490–1541), who said that diet must be the basis of medical therapy; however, Gerson noted that diet is only one part of a treatment regimen. [1] The special diet cured his migraines, and after seeing its success in one of his patients suffering from lupus vulgaris, he prescribed the diet for others suffering from the same disease. He conducted a successful clinical trial in Germany using the vegetarian diet.[1] His most noted patient was the wife of Albert Schweitzer, M.D., whom he reported curing. The accolades he received from Dr. Schweitzer may have persuaded the medical community to seriously consider the Gerson therapy and perhaps led to Gerson’s 1946 appearance with five of his patients before a congressional committee considering a bill to increase funding for cancer research.[2]

When Gerson began prescribing his regimen for patients, he did not consider his therapy a cure for cancer. At that time he wrote that there was no conclusive evidence from his work that cancer was influenced by diet; however, he did think that diet was a useful supportive measure.[3] In 1958, after treating patients with his regimen for more than 15 years, Gerson published his complete theory, including the results of 50 cases. He started referring to his regimen as an “effective treatment for cancer, even in advanced cases.”[1,4]

The practice of changing diet or fasting to cure or ameliorate the effects of disease has a long history, as does the practice of giving enemas to flush the body, thus keeping the body clear of toxins. [5] There are no reported results of clinical trials examining the efficacy of either of these practices in the treatment of cancer or how these practices would affect a treatment. Evolving evidence supports the idea that a plant-based diet plays a role in cancer prevention.

Gerson theorized that the use of pancreatic enzymes would reduce demands on the liver and pancreas, already in a weakened state, to manufacture the enzymes necessary to convert food into usable nutrients; this would help stabilize the nutritional needs of the body while it undergoes the detoxification process.[1,6] Gerson’s therapy was widely considered impossible because it was thought that pancreatic enzymes were reduced to their components in the intestinal tract. However, it has been reported that these enzymes are not broken down but are released into the bloodstream and used again in the digestive process[7,8]

Controversy about the efficacy of the Gerson therapy continued throughout Gerson’s life. In 1946 and 1949, two articles in the Journal of the American Medical Association concluded that the treatment was of no value.[9,10] The National Cancer Institute (NCI) reviewed Gerson’s data from 10 case histories in 1947 and 50 case histories in 1959. NCI concluded that in most cases, basic criteria for evaluating clinical benefit were not met. NCI concluded that the data demonstrated no benefit.[2] In 1972, the American Cancer Society (ACS) published a statement summarizing the negative assessments of Gerson’s treatment.[11] Another statement published by ACS in 1991 concerned various “ metabolic therapies” (defined as treatments that depend on changing metabolism through diet, enemas, and supplements given at clinics in Tijuana, Mexico) and reemphasized the lack of scientific evidence on the efficacy of the Gerson regimen.[12]

Gerson died in 1959, leaving behind no systematic way to continue offering his treatment. His malpractice insurance had been canceled in 1953, and in 1958 he was suspended for 2 years from the New York County Medical Society.[11] In 1977, his daughter, Charlotte Gerson Straus, who had continued to lecture widely about the Gerson therapy, cofounded the Gerson Institute with Norman Fritz. Located in San Diego, the Gerson Institute does not own or operate treatment facilities but maintains a licensing program for treatment centers such as the Centro Hospitalario Internacional Pacifico and Mexico’s Center for Integrative Medicine and the Gerson Hospital (CHIPSA) in Baja California, Mexico. CHIPSA refers to Max Gerson as the founder of “immunonutrition,” their term for Gerson’s idea of cleansing the body while building up the immune system through diet and supplementation.

References

1. Gerson M: A Cancer Therapy: Results of Fifty Cases and The Cure of Advanced Cancer by Diet Therapy. San Diego, Calif: The Gerson Institute, 2002. 
   
   
2. US Congress, Office of Technology Assessment.: Unconventional Cancer Treatments. Washington, DC: U.S. Government Printing Office, 1990. OTA-H-405. 
   
   
3. Gerson M: Dietary considerations in malignant neoplastic disease: preliminary report. Rev Gastroenterol 12: 419-25, 1945. Also available online. ⁶ Last accessed September 4, 2007. 
   
   
4. Gerson M: The cure of advanced cancer by diet therapy: a summary of 30 years of clinical experimentation. Physiol Chem Phys 10 (5): 449-64, 1978.  [PUBMED Abstract]
   
   
5. Ernst E: Colonic irrigation and the theory of autointoxication: a triumph of ignorance over science. J Clin Gastroenterol 24 (4): 196-8, 1997.  [PUBMED Abstract]
   
   
6. Gerson C, Walker M: The Gerson Therapy: The Amazing Nutritional Program for Cancer and Other Illnesses. New York, NY: Kensington Publishing Corp, 2001. 
   
   
7. Rothman S, Liebow C, Isenman L: Conservation of digestive enzymes. Physiol Rev 82 (1): 1-18, 2002.  [PUBMED Abstract]
   
   
8. Isenman L, Liebow C, Rothman S: Transport of proteins across membranes--a paradigm in transition. Biochim Biophys Acta 1241 (3): 341-70, 1995.  [PUBMED Abstract]
   
   
9. Gerson's cancer treatment. JAMA 132 (11): 645-6, 1946. 
   
   
10. Council on Pharmacy and Chemistry.: Report of the council: cancer and the need for facts. JAMA 139 (2): 93-8, 1949. 
    
    
11. Unproven methods of cancer management. Gerson method of treatment for cancer. CA Cancer J Clin 23 (5): 314-7, 1973 Sep-Oct.  [PUBMED Abstract]
    
    
12. Questionable cancer practices in Tijuana and other Mexican border clinics. CA Cancer J Clin 41 (5): 310-9, 1991 Sep-Oct.  [PUBMED Abstract]
    
    

Laboratory/Animal/Preclinical Studies

There are no in vivo studies in animal models of the Gerson diet in the scientific literature.

Human/Clinical Studies

Gerson’s book [1] and articles in English [2-4] are primarily reports of the details of the Gerson regimen, supplemented with case reports of patients seen in his clinical practice. His book presents an extended discourse on the empirical and scientific foundation for his treatment regimen and an expansive description of the treatment and diet followed by 50 patients selected from 30 years of clinical practice. Gerson’s published cases encompass a variety of cancer types. The reports are extended case notes, with occasional x-rays of the patients over time. Although some attempt at follow-up is made, it is not systematic and consists chiefly of anecdotal reports and conversations with patients by mail or phone.

Few published studies evaluate the Gerson therapy. The one study that was conducted by the Gerson Institute that looked at patients treated in the Gerson clinic is retrospective; while showing some survival advantage, this study has never been duplicated or followed with a prospective study.[5]

A preliminary study conducted between 1983 and 1984 attempted to collect any available retrospective data on three nonallopathic treatments offered in clinics in Tijuana, Mexico: Gerson, Hoxsey, and Contreras.[6] In general, this study was extremely limited and provided no scientifically useful information. The authors did not have access to medical records and relied on patient interviews for all information. The self-reporting was incomplete and inconsistent, lacking precise information in areas such as how far the disease had advanced. In the Gerson segment, only 18 of the 38 patients stayed in the study for 5 years or until they died; their mean survival was 9 months from the beginning of the study. The other 20 patients were lost to follow-up. At 5 years, 17 of the 18 had died, and 1 patient with advanced non-Hodgkin lymphoma was alive but not disease-free.

A 1990 noncontrolled, self-selected, matched-pairs study conducted in Austria used a diet regimen based on the Gerson therapy to evaluate diet as an adjuvant to surgery. This diet was ovolactovegetarian.[7] The Gerson regimen is basically strictly vegetarian (no eggs or milk) and does not introduce food other than buttermilk until 6 or 8 weeks into the regimen, if at all, depending on the patient.

Two groups of patients who had undergone surgery—18 patients with colorectal cancer with metastases to the liver and 38 with breast cancer —were treated. Each of the two groups was divided into a diet group and a nondiet group. All patients continued with whatever prescribed conventional regimen was required after their surgery. Results in the matched pairs with colorectal cancer showed an increased survival time in three of the nine patients in the diet group (28.6 months) as compared to four of the nine patients (16.2 months) in the nondiet group. In the breast cancer matched pairs, side effects of chemotherapy as well as pain and pleural effusion were lower in the diet group. No statistically significant information was generated in this small number of patients; however, the authors stated that the diet regimen appeared to have beneficial effects that required further study.[7]

A 1995 report of a retrospective study of patients at the Gerson Institute with melanoma, colorectal cancer, and ovarian cancer reported slightly higher survival rates than those found in the published literature. Statistics to substantiate this finding were not provided. When asked to publish statistics on these findings, the authors published another retrospective study of survival rates among melanoma patients alone.[5]

The study looked at records of 153 patients with stage I–IV melanoma treated with the Gerson diet. Of the 14 stage I–II patients, all were disease-free at 17 years posttreatment; however, this number was too small for a statistical comparison with other cohorts. For stage III patients, the 5-year survival rate was 71% compared to rates of 27% to 42% reported in the literature. The stage IV patients had the largest survival advantage. The 5-year survival rate for these 18 patients was 39%, compared to 6% in the published literature. The analysis did not include 53 patients who were lost to follow-up, which could have influenced the survival comparisons.

A small best-case series published in [8] suggests that the evidence presented supports the development and conduct of a more definite clinical study on the Gerson regimen.

No conclusions about the effectiveness of the Gerson therapy, either as an adjuvant to other cancer therapies or as a cure, can be drawn from any of the studies reported above.

References

1. Gerson M: A Cancer Therapy: Results of Fifty Cases and The Cure of Advanced Cancer by Diet Therapy. San Diego, Calif: The Gerson Institute, 2002. 
   
   
2. Gerson M: Effects of a combined dietary regime on patients with malignant tumors. Exp Med Surg 7 (4): 299-317, illust, 1949.  [PUBMED Abstract]
   
   
3. Gerson M: Dietary considerations in malignant neoplastic disease: preliminary report. Rev Gastroenterol 12: 419-25, 1945. Also available online. ⁶ Last accessed September 4, 2007. 
   
   
4. Gerson M: The cure of advanced cancer by diet therapy: a summary of 30 years of clinical experimentation. Physiol Chem Phys 10 (5): 449-64, 1978.  [PUBMED Abstract]
   
   
5. Hildenbrand GL, Hildenbrand LC, Bradford K, et al.: Five-year survival rates of melanoma patients treated by diet therapy after the manner of Gerson: a retrospective review. Altern Ther Health Med 1 (4): 29-37, 1995.  [PUBMED Abstract]
   
   
6. Austin S, Dale EB, DeKadt S: Long term follow-up of cancer patients using Contreras, Hoxsey and Gerson therapies. J Naturopathic Med 5 (1): 74-6, 1994. 
   
   
7. Lechner P, Kroneberger L Jr: Experiences with the use of diet therapy in surgical oncology. Aktuel Ernahrungsmed 2 (15): 72-8, 1990. 
   
   
8. Molassiotis A, Peat P: Surviving against all odds: analysis of 6 case studies of patients with cancer who followed the Gerson therapy. Integr Cancer Ther 6 (1): 80-8, 2007.  [PUBMED Abstract]
   
   

Adverse Effects

Coffee enemas have come under scrutiny because the concept of using enemas for body cleansing is not supported by scientific evidence. However, three deaths that seem related to coffee enemas have been reported in the literature. Salmonella enteridis group D and Campylobacter fetus intestinalis were cultured from stool and blood of one patient who died shortly after treatment at the Gerson Institute clinic. This death could not be directly linked to the practice of coffee enemas because more tests could not be performed.[1]

Case reports of two more deaths following treatment at the Gerson Institute were both attributed to electrolyte imbalance after autopsies were performed showing no active inflammation of the colon. [2]

A third case report of electrolyte imbalance that did not result in death describes a patient who developed hyperkalemia while undergoing Gerson therapy.[3] No other reports of adverse effects have been identified.

References

1. Margolin KA, Green MR: Polymicrobial enteric septicemia from coffee enemas. West J Med 140 (3): 460, 1984.  [PUBMED Abstract]
   
   
2. Eisele JW, Reay DT: Deaths related to coffee enemas. JAMA 244 (14): 1608-9, 1980.  [PUBMED Abstract]
   
   
3. Nagasaki A, Takamine W, Takasu N: Severe hyperkalemia associated with "alternative" nutritional cancer therapy. Clin Nutr 24 (5): 864-5, 2005.  [PUBMED Abstract]
   
   

Overall Level of Evidence for Gerson Therapy

To assist readers in evaluating the results of human studies of complementary and alternative medicine (CAM) treatments for cancer, the strength of the evidence (i.e., the “levels of evidence”) associated with each type of treatment is provided whenever possible. To qualify for a level of evidence analysis, a study must:

• Be published in a peer-reviewed scientific journal.
• Report on a therapeutic outcome or outcomes, such as tumor response, improvement in survival, or measured improvement in quality of life.
• Describe clinical findings in sufficient detail that a meaningful evaluation can be made.

Evidence from studies that do not meet these requirements is considered extremely weak. In addition to scoring individual studies, an overall level of evidence assessment is usually made.

Because no prospective, controlled study of the use of the Gerson therapy in cancer patients has been reported in a peer-reviewed scientific journal, no level of evidence analysis is possible for this approach. The data that are available are not sufficient to warrant claims that the Gerson therapy is effective as an adjuvant to other cancer therapies or as a cure. At this time, the use of the Gerson therapy in the treatment of cancer patients cannot be recommended outside the context of well-designed clinical trials.

Separate levels of evidence scores are assigned to qualifying human studies on the basis of statistical strength of the study design and scientific strength of the treatment outcomes (i.e., endpoints) measured. The resulting two scores are then combined to produce an overall score. For additional information about levels of evidence analysis, refer to Levels of Evidence for Human Studies of Cancer Complementary and Alternative Medicine ².

Changes to This Summary (01/11/2008)

The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.

Overall Level of Evidence for Gerson Therapy ⁷

Added text ⁸ to state that separate levels of evidence scores are assigned to qualifying human studies on the basis of statistical strength of the study design and scientific strength of the treatment outcomes (i.e., endpoints) measured.

More Information

Additional Information about CAM Therapies

• The National Center for Complementary and Alternative Medicine ⁹ (NCCAM).
• The National Cancer Institute Office of Cancer Complementary and Alternative Medicine ¹⁰ (OCCAM).
• CAM on PubMed ¹¹, a special subset of the PubMed scientific literature database created through a partnership between NCCAM and the National Library of Medicine.

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  Side effects of cancer treatment, management of cancer-related complications and pain, and psychosocial concerns.

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• PDQ® Cancer Information Summaries: Prevention ¹⁷

  Risk factors and methods to increase chances of preventing specific types of cancer.

• PDQ® Cancer Information Summaries: Genetics ¹⁸

  Genetics of specific cancers and inherited cancer syndromes, and ethical, legal, and social concerns.

• PDQ® Cancer Information Summaries: Complementary and Alternative Medicine ¹⁹

  Information about complementary and alternative forms of treatment for patients with cancer.

Important:

This information is intended mainly for use by doctors and other health care professionals. If you have questions about this topic, you can ask your doctor, or call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237).

Glossary Terms

An unwanted side effect of treatment.

A process in which anything complex is separated into simple or less complex parts.

An incomplete description of the medical and treatment history of one or more patients. Anecdotal reports may be published in places other than peer-reviewed, scientific journals.

An animal with a disease either the same as or like a disease in humans. Animal models are used to study the development and progression of diseases and to test new treatments before they are given to humans. Animals with transplanted human cancers or other tissues are called xenograft models.

A laboratory experiment using animals to study the development and progression of diseases. Animal studies also test how safe and effective new treatments are before they are tested in people.

In healthcare, a process used to learn about a patient’s condition. This may include a complete medical history, medical tests, a physical exam, a test of learning skills, tests to find out if the patient is able to carry out the tasks of daily living, a mental health evaluation, and a review of social support and community resources available to the patient.

A tube through which bile passes in and out of the liver.

Pertaining to biology or to life and living things. In medicine, refers to a substance made from a living organism or its products. Biologicals may be used to prevent, diagnose, treat or relieve of symptoms of a disease. For example, antibodies, interleukins, and vaccines are biologicals. Biological also refers to parents and children who are related by blood.

A tissue with red blood cells, white blood cells, platelets, and other substances suspended in fluid called plasma. Blood takes oxygen and nutrients to the tissues, and carries away wastes.

Glandular organ located on the chest. The breast is made up of connective tissue, fat, and breast tissue that contains the glands that can make milk. Also called mammary gland.

Complementary and alternative medicine. Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices generally are not considered standard medical approaches. Standard treatments go through a long and careful research process to prove they are safe and effective, but less is known about most types of CAM. CAM may include dietary supplements, megadose vitamins, herbal preparations, special teas, acupuncture, massage therapy, magnet therapy, spiritual healing, and meditation. Also called complementary and alternative medicine.

A term for diseases in which abnormal cells divide without control. Cancer cells can invade nearby tissues and can spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood. Lymphoma and multiple myeloma are cancers that begin in the cells of the immune system. Central nervous system cancers are cancers that begin in the tissues of the brain and spinal cord.

In medicine, a sac of tissue and blood vessels that surrounds an organ, joint, or tumor. A capsule is also a form for medicine that is taken by mouth. It usually has a shell made of gelatin with the medicine inside.

A detailed report of the diagnosis, treatment, and follow-up of an individual patient. Case reports also contain some demographic information about the patient (for example, age, gender, ethnic origin).

A family of plants with daisy-like flowers. Two types are German chamomile and Roman or English chamomile. These are used in teas to calm and relax, to improve sleep, and to help with stomach problems. The essential oil (scented liquid taken from plants) of chamomile is used in perfumes, shampoos, lotions, and aromatherapy.

Treatment with drugs that kill cancer cells.

Having to do with the examination and treatment of patients.

A type of research study that tests how well new medical approaches work in people. These studies test new methods of screening, prevention, diagnosis, or treatment of a disease. Also called a clinical trial.

A type of research study that tests how well new medical approaches work in people. These studies test new methods of screening, prevention, diagnosis, or treatment of a disease. Also called a clinical study.

A substance found in most tissues in the body, and in many foods. It can also be made in the laboratory. It is used by the body to produce energy for cells, and as an antioxidant. It is being studied in the treatment of cancer and in the relief of side effects caused by some cancer treatments. Also called Q10, CoQ10, vitamin Q10, and ubiquinone.

The longest part of the large intestine, which is a tube-like organ connected to the small intestine at one end and the anus at the other. The colon removes water and some nutrients and electrolytes from partially digested food. The remaining material, solid waste called stool, moves through the colon to the rectum and leaves the body through the anus.

Cancer that develops in the colon (the longest part of the large intestine) and/or the rectum (the last several inches of the large intestine before the anus).

CAM. Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices generally are not considered standard medical approaches. Standard treatments go through a long and careful research process to prove they are safe and effective, but less is known about most types of CAM. CAM may include dietary supplements, megadose vitamins, herbal preparations, special teas, acupuncture, massage therapy, magnet therapy, spiritual healing, and meditation. Also called CAM.

To heal or restore health; a treatment to restore health.

A disease in which the function or structure of the affected tissues or organs changes for the worse over time. Osteoarthritis, osteoporosis, and Alzheimer disease are examples.

To make something less poisonous or harmful. It may refer to the process of removing toxins, poisons, or other harmful substances from the body.

The things a person eats and drinks.

A product that is added to the diet. A dietary supplement is taken by mouth, and usually contains one or more dietary ingredient (such as vitamin, mineral, herb, amino acid, and enzyme). Also called nutritional supplement.

The process of breaking down food into substances the body can use for energy, tissue growth, and repair.

To widen or enlarge an opening or hollow structure beyond its usual size, such as the pupil of the eye or a blood vessel.

Effectiveness. In medicine, the ability of an intervention (for example, a drug or surgery) to produce the desired beneficial effect.

A substance that breaks up into ions (electrically charged particles) when it is dissolved in body fluids or water. Some examples of electrolytes are sodium, potassium, chloride, and calcium. Electrolytes are primarily responsible for the movement of nutrients into cells and the movement of wastes out of cells.

In clinical trials, an event or outcome that can be measured objectively to determine whether the intervention being studied is beneficial. The endpoints of a clinical trial are usually included in the study objectives. Some examples of endpoints are survival, improvements in quality of life, relief of symptoms, and disappearance of the tumor.

The injection of a liquid through the anus into the large bowel.

A protein that speeds up chemical reactions in the body.

In medicine, a preparation of a substance obtained from plants, animals, or bacteria and used as a drug or in drugs.

The seed of the flax plant. It is a rich source of omega-3 fatty acid, fiber, and a compound called lignin. It is being studied in the prevention of prostate cancer. Also called linseed.

Liquid.

Monitoring a person's health over time after treatment. This includes keeping track of the health of people who participate in a clinical study or clinical trial for a period of time, both during the study and after the study ends.

FDA. An agency in the U.S. federal government whose mission is to protect public health by making sure that food, cosmetics, and nutritional supplements are safe to use and truthfully labeled. The Food and Drug Administration also makes sure that drugs, medical devices, and equipment are safe and effective, and that blood for transfusions and transplant tissue are safe. Also called FDA.

GI. Refers to the stomach and intestines. Also called GI.

A diet plan that has been claimed to be a treatment for cancer, migraine, tuberculosis, and other diseases. It is a vegetarian diet that includes eating organic fruits and vegetables and 13 glasses of fresh juice each day. It also includes supplements with iodine, vitamin B-12, potassium, thyroid hormone, liver extract, and pancreatic enzymes. No clinical trial to test Gerson therapy has been reported.

An alternative therapy that is being studied as a treatment for pancreatic cancer. It includes a special diet, nutritional supplements, pancreatic enzymes, and coffee enemas.

The complex group of organs and cells that defends the body against infections and other diseases.

In the body. The opposite of in vitro (outside the body or in the laboratory).

Redness, swelling, pain, and/or a feeling of heat in an area of the body. This is a protective reaction to injury, disease, or irritation of the tissues.

Use of a syringe and needle to push fluids or drugs into the body; often called a "shot."

Having to do with the intestines.

The long, tube-shaped organ in the abdomen that completes the process of digestion. The intestine has two parts, the small intestine and the large intestine. Also called the bowel.

An element that is necessary for the body to make thyroid hormone. It is found in shellfish and iodized salt.

Research done in a laboratory. These studies may use test tubes or animals to find out if a drug, procedure, or treatment is likely to be useful. Laboratory studies take place before any testing is done in humans.

A ranking system used to describe the strength of the results measured in a clinical trial or research study. The design of the study (such as a case report for an individual patient or a randomized double-blinded controlled clinical trial) and the endpoints measured (such as survival or quality of life) affect the strength of the evidence.

A large organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile.

A statistics term. The average value in a set of measurements. The mean is the sum of a set of numbers divided by how many numbers are in the set.

Refers to the practices and procedures used for the prevention, treatment, or relief of symptoms of a diseases or abnormal conditions. This term may also refer to a legal drug used for the same purpose.

A form of cancer that begins in melanocytes (cells that make the pigment melanin). It may begin in a mole (skin melanoma), but can also begin in other pigmented tissues, such as in the eye or in the intestines.

Having to do with metabolism (the total of all chemical changes that take place in a cell or an organism to produce energy and basic materials needed for important life processes).

The total of all chemical changes that take place in a cell or an organism. These changes make energy and the materials needed for growth, reproduction, and maintaining health. They also help get rid of toxic substances.

The spread of cancer from one part of the body to another. A tumor formed by cells that have spread is called a “metastatic tumor” or a “metastasis.” The metastatic tumor contains cells that are like those in the original (primary) tumor. The plural form of metastasis is metastases (meh-TAS-tuh-SEEZ).

A nutrient required to maintain health.

The National Cancer Institute, part of the National Institutes of Health of the United States Department of Health and Human Services, is the Federal Government's principal agency for cancer research. The National Cancer Institute conducts, coordinates, and funds cancer research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer. Access the National Cancer Institute Web site at http://www.cancer.gov. Also called NCI.

NCI, part of the National Institutes of Health of the United States Department of Health and Human Services, is the Federal Government's principal agency for cancer research. It conducts, coordinates, and funds cancer research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer. Access the NCI Web site at http://www.cancer.gov. Also called National Cancer Institute.

Any of a large group of cancers of the immune system. Non-Hodgkin lymphomas can occur at any age and are often marked by enlarged lymph nodes, fever, and weight loss. There are many different types of non-Hodgkin lymphoma, which can be divided into aggressive (fast-growing) and indolent (slow-growing) types and can be classified as either B-cell or T-cell non-Hodgkin lymphoma. B-cell non-Hodgkin lymphomas include Burkitt lymphoma, diffuse large B-cell lymphoma, follicular lymphoma, immunoblastic large cell lymphoma, precursor B-lymphoblastic lymphoma, and mantle cell lymphoma. T-cell non-Hodgkin lymphomas include mycosis fungoides, anaplastic large cell lymphoma, and precursor T-lymphoblastic lymphoma. Lymphomas related to lymphoproliferative disorders following bone marrow or stem cell transplantation are usually B-cell non-Hodgkin lymphomas. Prognosis and treatment depend on the stage and type of disease. Also called NHL.

A chemical compound (such as protein, fat, carbohydrate, vitamin, or mineral) contained in foods. These compounds are used by the body to function and grow.

The taking in and use of food and other nourishing material by the body. Nutrition is a 3-part process. First, food or drink is consumed. Second, the body breaks down the food or drink into nutrients. Third, the nutrients travel through the bloodstream to different parts of the body where they are used as "fuel" and for many other purposes. To give the body proper nutrition, a person has to eat and drink enough of the foods that contain key nutrients.

A product that is added to the diet. A nutritional supplement is taken by mouth, and usually contains one or more dietary ingredient (such as vitamin, mineral, herb, amino acid, and enzyme). Also called dietary supplement.

Closely monitoring a patient's condition but withholding treatment until symptoms appear or change. Also called watchful waiting.

A part of the body that performs a specific function. For example, the heart is an organ.

A living thing, such as an animal, a plant, a bacterium, or a fungus.

A specific result or effect that can be measured. Examples of outcomes include decreased pain, reduced tumor size, and improvement of disease.

Cancer that forms in tissues of the ovary (one of a pair of female reproductive glands in which the ova, or eggs, are formed). Most ovarian cancers are either ovarian epithelial carcinomas (cancer that begins in the cells on the surface of the ovary) or malignant germ cell tumors (cancer that begins in egg cells).

A glandular organ located in the abdomen. It makes pancreatic juices, which contain enzymes that aid in digestion, and it produces several hormones, including insulin. The pancreas is surrounded by the stomach, intestines, and other organs.

A protein secreted by the pancreas that aids in the digestion of food.

PDQ is an online database developed and maintained by the National Cancer Institute. Designed to make the most current, credible, and accurate cancer information available to health professionals and the public, PDQ contains peer-reviewed summaries on cancer treatment, screening, prevention, genetics, complementary and alternative medicine, and supportive care; a registry of cancer clinical trials from around the world; and directories of physicians, professionals who provide genetics services, and organizations that provide cancer care. Most of this information, and more specific information about PDQ, can be found on the NCI's Web site at http://www.cancer.gov/cancertopics/pdq. Also called Physician Data Query.

A publication that contains original articles that have been written by scientists and evaluated for technical and scientific quality and correctness by other experts in the same field.

Medical doctor.

An abnormal collection of fluid between the thin layers of tissue (pleura) lining the lung and the wall of the chest cavity.

A metallic element that is important in body functions such as regulation of blood pressure and of water content in cells, transmission of nerve impulses, digestion, muscle contraction, and heartbeat.

A doctor's order for medicine or another intervention.

In medicine, action taken to decrease the chance of getting a disease or condition. For example, cancer prevention includes avoiding risk factors (such as smoking, obesity, lack of exercise, and radiation exposure) and increasing protective factors (such as getting regular physical activity, staying at a healthy weight, and having a healthy diet).

In medicine, a study or clinical trial in which participants are identified and then followed forward in time.

A molecule made up of amino acids that are needed for the body to function properly. Proteins are the basis of body structures such as skin and hair and of substances such as enzymes, cytokines, and antibodies.

The overall enjoyment of life. Many clinical trials assess the effects of cancer and its treatment on the quality of life. These studies measure aspects of an individual’s sense of well-being and ability to carry out various activities.

A treatment plan that specifies the dosage, the schedule, and the duration of treatment.

In medicine, an improvement related to treatment.

Looking back at events that have already taken place.

A study that compares two groups of people: those with the disease or condition under study (cases) and a very similar group of people who do not have the disease or condition (controls). Researchers study the medical and lifestyle histories of the people in each group to learn what factors may be associated with the disease or condition. For example, one group may have been exposed to a particular substance that the other was not. Also called a case-control study.

A person who has studied science, especially one who is active in a particular field of investigation.

A problem that occurs when treatment affects healthy tissues or organs. Some common side effects of cancer treatment are fatigue, pain, nausea, vomiting, decreased blood cell counts, hair loss, and mouth sores.

A mineral needed by the body to keep body fluids in balance. Sodium is found in table salt and in many processed foods. Too much sodium can cause the body to retain water.

The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer, and whether the cancer has spread from the original site to other parts of the body.

Describes a mathematical measure of difference between groups. The difference is said to be statistically significant if it is greater than what might be expected to happen by chance alone. Also called significant.

The material in a bowel movement. Stool is made up of food that was not digested, bacteria, mucus, and cells from the intestines. Also called feces.

Adding nutrients to the diet.

A procedure to remove or repair a part of the body or to find out whether disease is present. An operation.

The percentage of people in a study or treatment group who are alive for a certain period of time after they were diagnosed with or treated for a disease, such as cancer. The survival rate is often stated as a five-year survival rate, which is the percentage of people in a study or treatment group who are alive five years after diagnosis or treatment. Also called overall survival rate.

An indication that a person has a condition or disease. Some examples of symptoms are headache, fever, fatigue, nausea, vomiting, and pain.

Having to do with treating disease and helping healing take place.

Treatment.

A group or layer of cells that work together to perform a specific function.

Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects.

A poison produced by certain animals, plants, or bacteria.

An abnormal mass of tissue that results when cells divide more than they should or do not die when they should. Tumors may be benign (not cancerous), or malignant (cancerous). Also called neoplasm.

Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra.

A key nutrient that the body needs in small amounts to grow and stay strong. Examples are vitamins A, C, and E.

One of several vitamins that the body needs in small amounts to function and stay healthy. Vitamin A is needed for vision, bone growth, reproduction, growth of epithelium (cells that line the internal and external surfaces of the body), and fighting infections. It is fat-soluble (can be stored in the body’s fatty tissue). Foods with vitamin A include fish oils and liver, egg yolks, and whole milk dairy products from animals. It also can be made in the body from a substance found in fruits and vegetables such as cantaloupes, carrots, spinach, and sweet potatoes. Vitamin A is being studied in the prevention and treatment of some types of cancer. Also called retinol.

A vitamin that is needed to make red blood cells and DNA (the genetic material in cells) and to keep nerve cells healthy. It is found in eggs, meat, poultry, shellfish, milk, and milk products. Vitamin B12, along with folate, may be given to help reduce side effects in cancer patients being treated with drugs called antimetabolites. Also called cobalamin.

A key nutrient that the body needs to fight infection, heal wounds, and keep tissues healthy, including the blood vessels, cartilage, ligaments, tendons, bones, muscle, skin, teeth, and gums. It is an antioxidant that helps prevent tissue damage caused by free radicals. The body does not make or store vitamin C, so it must be taken in every day. It is found in many fruits and vegetables, especially green peppers, citrus, strawberries, tomatoes, broccoli, leafy greens, potatoes, and cantaloupe. Also called ascorbic acid.

A type of high-energy radiation. In low doses, x-rays are used to diagnose diseases by making pictures of the inside of the body. In high doses, x-rays are used to treat cancer.