Purpose of This PDQ Summary
Overview
General Information
History
Laboratory/Animal/Preclinical Studies
Human/Clinical Studies

Effect of Acupuncture on Immune Function Effect of Acupuncture on Cancer Pain Effect of Acupuncture on Chemotherapy-Induced Nausea and Vomiting Effect of Acupuncture on Cancer and Cancer Treatment-Related Side Effects

Adverse Effects
Overall Level of Evidence for Acupuncture Treatment of Cancer-Related Symptoms
Changes to This Summary (09/26/2008)
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 acupuncture as a treatment for cancer. The 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 acupuncture research.
• The results of clinical studies of acupuncture.
• Possible side effects of acupuncture 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 of 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 use of acupuncture as a treatment for individuals with cancer or cancer-related disorders. The summary includes a brief history of acupuncture practice, a review of laboratory and animal studies, the results of clinical observations and trials, and possible side effects of acupuncture therapy. Information presented in some sections of the summary can also be found in tables located at the end of those sections.

This summary contains the following key information:

• As part of traditional Chinese medicine, acupuncture has been practiced in China and other Asian countries for thousands of years.
• Acupuncture is defined as the application of stimulation such as needling, moxibustion, cupping, and acupressure on specific sites of the body known as acupuncture points.
• Acupuncture has been practiced in the United States for about 200 years. The U.S. Food and Drug Administration approved the acupuncture needle as a medical device in 1996.
• Acupuncture is used to treat a wide range of illnesses and ailments; however, cancer patients predominantly use it for pain management and nausea and vomiting control.
• To date, most reported acupuncture research on cancer has been carried out in China.
• Laboratory and animal studies to explore the mechanisms of acupuncture for cancer treatment have focused mainly on the role of acupuncture in the activation of immune functions, such as increasing blood cell count and enhancing lymphocyte and natural killer cell activity.
• The aim of most acupuncture clinical observation and clinical trials in cancer patients has been to evaluate the effects of acupuncture on symptom management.
• The most convincing research data on the effects of acupuncture in cancer patients have emerged from studies of the management of chemotherapy -induced nausea and vomiting.

Many of the medical and scientific terms used in this summary are hypertext linked (at first use in each section) to the NCI Dictionary 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 the 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 the Web sites or of any treatment or product by the PDQ Cancer CAM Editorial Board or the National Cancer Institute.

General Information

Acupuncture, a complementary and alternative (CAM) therapy used in cancer management,[1-4] has been used clinically to manage cancer-related symptoms, treat side effects induced by chemotherapy or radiation therapy, boost blood cell count, and enhance lymphocyte and natural killer (NK) cell activity. In cancer treatment, its primary use is symptom management; commonly treated symptoms are cancer pain,[4,5] chemotherapy-induced nausea and vomiting, [6] and other symptoms that affect a patient’s quality of life, including weight loss, anxiety, depression, insomnia, poor appetite, and diarrhea. [7-9] Acupuncture is generally accepted by children aged 10 years and older.[10]

More than 40 states and the District of Columbia have laws regulating acupuncture practice. The National Certification Commission for Acupuncture and Oriental Medicine offers national certification examinations for practitioners of acupuncture and traditional Chinese medicine (TCM) (www.nccaom.org); most, but not all, states require this certification. More than 50 schools and colleges of acupuncture and Oriental medicine operate in the United States, many of which offer master’s-level programs and are accredited by or have been granted candidacy status by the Accreditation Commission for Acupuncture and Oriental Medicine (ACAOM). ACAOM standards for a master's-level degree require a 3-year program (approximately 2,000 hours of study) for acupuncture and a 4-year program for Oriental medicine, which includes acupuncture and herbal therapy (www.ACAOM.org). Some Western medical training, including the study of anatomy, physiology, and clean-needle technique is included in the curriculums of these schools. Postgraduate training programs in medical acupuncture for physicians also exist. In the United States, training to be a licensed acupuncturist (LAc) is regulated according to individual state law. Because the educational and licensing requirements for acupuncture practice vary from state to state, one should inquire from each state board of acupuncture (or other relevant board) for particular information.[11] Third-party reimbursements also vary from state to state. Some insurance companies cover acupuncture or limited acupuncture treatment. Federal payers such as Medicaid and Medicare do not generally reimburse for acupuncture treatment.

Acupuncture has been practiced in China and other Asian countries for more than 4,000 years.[12-14] In China, acupuncture is part of a TCM system of traditional medical knowledge and is practiced along with other treatment modalities such as herbal medicine, tui na (massage and acupressure), mind/body exercise (e.g., qigong and tai chi), and dietary therapy.[15,16] In the United States, several different acupuncture styles are practiced in addition to TCM. These include Japanese acupuncture (e.g., meridian therapy), English acupuncture (e.g., five element or traditional acupuncture), French acupuncture (e.g., French energetic acupuncture), Korean acupuncture (e.g., constitutional acupuncture), and American medical acupuncture. Most of these are derived from ancient Chinese medical philosophy and practices. All are based on the view that the human body must be perceived and treated as a whole and as part of nature; health is the result of harmony among bodily functions and between the body and nature, and disease occurs when this harmony is disrupted. TCM therapeutic interventions, including acupuncture are used to restore the state of harmony.

Acupuncture is closely associated with Chinese meridian theory. According to this theory, there are 12 primary meridians, or channels, and eight additional meridians, each following a particular directional course along the body. A vital energy known as qi flows through these meridians and participates in the homeostatic regulation of various bodily functions. Some 360 points distributed along the meridians serve as both pathognomonic signs of disorder and as loci for acupuncture treatments.[14,17] When the normal flow of energy over a meridian is obstructed (e.g., as a result of tissue injury or a tumor), pain or other symptoms result.

The purpose of acupuncture therapy is to re-open the normal energy flow, thereby relieving the symptoms by stimulating specific sites (acupuncture points) on the meridians.[18] In acupuncture treatment, stainless steel needles, usually ranging from 0.22 to 0.25 mm in diameter, are inserted into relevant acupuncture points to stimulate the affected meridians. A needling sensation known as de qi sensation, in which the patient feels heaviness, numbness, or tightness, is often required during an acupuncture treatment. Length and frequency of treatment vary according to the condition being treated. Chronic conditions usually require a longer treatment period. Typically, two or three sessions per week are required initially and may decrease to once a week after several weeks of treatment. Needles are typically left in place for 15 to 30 minutes after insertion, and their effects may be augmented with manual or electrical stimulation and/or heat (e.g., moxibustion).

Classical techniques of acupuncture include needling, moxibustion, and cupping. Acupressure, using fingers to apply pressure on acupuncture points, is also considered a form of acupuncture treatment. Moxibustion is a method in which an herb (Artemisia vulgaris) is burned above the skin or on an acupuncture point for the purpose of warming it to alleviate symptoms. Cupping promotes blood circulation and stimulates acupuncture points by creating a vacuum or negative pressure on the surface of the skin.[18] During the past several decades, various new auxiliary devices have been developed. Acupuncture devices such as electroacupuncture (EA) machines and heat lamps are commonly used to enhance the effects of acupuncture.

In addition to classical acupuncture techniques, other techniques have been developed and are sometimes used in cancer management. These include trigger point acupuncture, laser acupuncture, acupuncture point injection, and techniques focusing on particular regions of the body: auricular acupuncture, scalp acupuncture, face acupuncture, hand acupuncture, nose acupuncture, and foot acupuncture. Of these, auricular acupuncture is the most commonly used.

Although acupuncture has been practiced for millennia, it has come under scientific investigation only recently. To date, most studies and clinical trials of the mechanisms and efficacy of acupuncture in cancer management have been carried out in China. In 1976, however, the U.S. Food and Drug Administration (FDA) classified acupuncture needles as investigational devices (Class III) (www.fda.gov). This resulted in a number of research studies on the effectiveness and safety of acupuncture.[19] In November 1994, the Office of Alternative Medicine (the predecessor of the National Center for Complementary and Alternative Medicine) at the National Institutes of Health (NIH) sponsored an NIH-FDA workshop on the status of acupuncture needle usage. Two years later, the FDA reclassified acupuncture needles as medical devices (Class II) without, however, giving specific indications for their use (www.fda.gov). In 1997, NIH held a Consensus Development Conference on Acupuncture to evaluate its safety and efficacy. The 12-member panel concluded that promising research results showing the efficacy of acupuncture in certain conditions have emerged and that further research is likely to uncover additional areas in which acupuncture intervention will be useful. The panel stated that “there is clear evidence that needle acupuncture treatment is effective for postoperative and chemotherapy nausea and vomiting.” It also stated that there are “a number of other pain-related conditions for which acupuncture may be effective as an adjunct therapy, an acceptable alternative, or as part of a comprehensive treatment program,” and it agreed that further research is likely to uncover additional areas in which acupuncture intervention will be useful.[19]

These actions by the FDA and NIH have resulted in the establishment of a number of active programs of research into the mechanisms and efficacy of acupuncture, much of which is, or is potentially, relevant to cancer management. To date, the most extensively investigated aspect of these mechanisms has been the effect of acupuncture on pain management. The NIH Consensus Panel concluded that “acupuncture can cause multiple biological responses,” local and distal, “mediated mainly by sensory neurons…within the central nervous system.” Acupuncture “may also activate the hypothalamus and the pituitary gland, resulting in a broad spectrum of systemic effects,” including “alterations in peptides, hormones and neurotransmitters and the regulation of blood flow.”[19] Recent studies show the effect of acupuncture on chronic inflammatory pain.[20,21] Evidence suggests that acupuncture operates through the autonomic nervous system to balance the sympathetic and parasympathetic systems and suggests that the anti-inflammatory effects of acupuncture are mediated by its electrophysiologic effects on neurotransmitters, cytokines, and neuropeptides.[21-30] Reviewed in [1] Many studies provide evidence that opioid peptides are released during acupuncture and that acupuncture analgesia is mediated by the endogenous opioid system.[31,32]

Laboratory and animal cancer studies exploring the mechanisms of acupuncture have focused mainly on the activation and modulation of immune functions. Acupuncture treatment points are located by using standard anatomic landmarks and comparative anatomy. EA is the most commonly used treatment intervention; a few studies have used moxibustion.[33] These studies show that acupuncture may boost animal immune function by increasing blood cells and enhancing NK cell and lymphocyte activity.[33-35] According to one animal behavioral study, acupuncture may be a useful adjuvant for suppressing chemotherapy-induced emesis. [36]

Although several studies published in China examined the effect of acupuncture on the human immune system,[7,28,31,37-40] most cancer-related human clinical studies of acupuncture evaluated its effect on patient quality of life. These investigations mainly focused on cancer symptoms or cancer treatment–related symptoms, predominantly cancer pain [9,22,41-45] and chemotherapy-induced nausea and vomiting.[24,26,46-54] Studies have also been done on the effect of acupuncture on radiation -induced xerostomia (dry mouth), rectitis, dysphonia, weight loss, cough, thoracodynia, hemoptysis, fever, esophageal obstruction, poor appetite, night sweats, hot flashes, dizziness, fatigue, anxiety, and depression in cancer patients.[7-9,55-58] The evidence from most of these clinical studies is inconclusive, despite their positive results; either poor research design or incompletely described methodologic procedures limit their value. The positive results of the studies on chemotherapy-induced nausea and vomiting, which benefit from scientifically sound research designs, are the most convincing.

References

1. Wong R, Sagar CM, Sagar SM: Integration of Chinese medicine into supportive cancer care: a modern role for an ancient tradition. Cancer Treat Rev 27 (4): 235-46, 2001.  [PUBMED Abstract]
   
   
2. Pan CX, Morrison RS, Ness J, et al.: Complementary and alternative medicine in the management of pain, dyspnea, and nausea and vomiting near the end of life. A systematic review. J Pain Symptom Manage 20 (5): 374-87, 2000.  [PUBMED Abstract]
   
   
3. Norheim AJ, Fønnebø V: Attitudes to the contribution of placebo in acupuncture--a survey. Complement Ther Med 10 (4): 202-9, 2002.  [PUBMED Abstract]
   
   
4. Sellick SM, Zaza C: Critical review of 5 nonpharmacologic strategies for managing cancer pain. Cancer Prev Control 2 (1): 7-14, 1998.  [PUBMED Abstract]
   
   
5. Charlton JE: Cancer pain management. Cah Anesthesiol 41 (6): 621-4, 1993.  [PUBMED Abstract]
   
   
6. Vickers AJ: Can acupuncture have specific effects on health? A systematic review of acupuncture antiemesis trials. J R Soc Med 89 (6): 303-11, 1996.  [PUBMED Abstract]
   
   
7. Xia YQ, Zhang D, Yang CX, et al.: An approach to the effect on tumors of acupuncture in combination with radiotherapy or chemotherapy. J Tradit Chin Med 6 (1): 23-6, 1986.  [PUBMED Abstract]
   
   
8. Johnstone PA, Polston GR, Niemtzow RC, et al.: Integration of acupuncture into the oncology clinic. Palliat Med 16 (3): 235-9, 2002.  [PUBMED Abstract]
   
   
9. Niemtzow RC: Integration of complementary disciplines into the oncology clinic. Part I. Acupuncture. Curr Probl Cancer 24 (4): 184-93, 2000 Jul-Aug.  [PUBMED Abstract]
   
   
10. Kemper KJ, Sarah R, Silver-Highfield E, et al.: On pins and needles? Pediatric pain patients' experience with acupuncture. Pediatrics 105 (4 Pt 2): 941-7, 2000.  [PUBMED Abstract]
    
    
11. Mitchell BB: Acupuncture and Oriental Medicine Laws. Gig Harbor, Wash: National Acupuncture Fondation, 2001. 
    
    
12. Liu G, Hyodo A, eds.: Fundamentals of Acupuncture & Moxibustion. Tianjin, China: Tianjin Science & Technology Translation & Publishing Corp, 1994. 
    
    
13. Cheng X, ed.: Chinese Acupuncture and Moxibustion. Beijing, China: Foreign Languages Press, 1987. 
    
    
14. O'Connor J, Bensky D, eds.: Acupuncture: A Comprehensive Text. Chicago, Ill: Eastland Press, 1981. 
    
    
15. Lao L: Traditional Chinese medicine. In: Jonas WB, Levin JS, eds.: Essentials of Complementary and Alternative Medicine. Philadelphia, Pa: Lippincott Williams & Wilkins, 1999, pp 216-233. 
    
    
16. Ergil KV: China's traditional medicine. In: Micozzi MS, ed.: Fundamentals of Complementary and Alternative Medicine. New York, NY: Churchill Livingstone, 1996, pp 185-223. 
    
    
17. Stux G: History of acupuncture. In: Stux G, Pomeranz B: Acupuncture: Textbook and Atlas. New York, NY: Springer-Verlag, 1987, pp 36-7. 
    
    
18. Lao L: Acupuncture techniques and devices. J Altern Complement Med 2 (1): 23-5, 1996.  [PUBMED Abstract]
    
    
19. NIH Consensus Conference. Acupuncture. JAMA 280 (17): 1518-24, 1998.  [PUBMED Abstract]
    
    
20. Lao L, Zhang G, Wei F, et al.: Electro-acupuncture attenuates behavioral hyperalgesia and selectively reduces spinal Fos protein expression in rats with persistent inflammation. J Pain 2 (2): 111-7, 2001.  [PUBMED Abstract]
    
    
21. Zijlstra FJ, van den Berg-de Lange I, Huygen FJ, et al.: Anti-inflammatory actions of acupuncture. Mediators Inflamm 12 (2): 59-69, 2003.  [PUBMED Abstract]
    
    
22. Dang W, Yang J: Clinical study on acupuncture treatment of stomach carcinoma pain. J Tradit Chin Med 18 (1): 31-8, 1998.  [PUBMED Abstract]
    
    
23. Moyad MA, Hathaway S, Ni HS: Traditional Chinese medicine, acupuncture, and other alternative medicines for prostate cancer: an introduction and the need for more research. Semin Urol Oncol 17 (2): 103-10, 1999.  [PUBMED Abstract]
    
    
24. Dundee JW, Ghaly RG, Fitzpatrick KT, et al.: Acupuncture prophylaxis of cancer chemotherapy-induced sickness. J R Soc Med 82 (5): 268-71, 1989.  [PUBMED Abstract]
    
    
25. Hoskin PJ, Hanks GW: The management of symptoms in advanced cancer: experience in a hospital-based continuing care unit. J R Soc Med 81 (6): 341-4, 1988.  [PUBMED Abstract]
    
    
26. Dundee JW, Ghaly RG, Fitzpatrick KT, et al.: Optimising antiemesis in cancer chemotherapy. Br Med J (Clin Res Ed) 294 (6565): 179, 1987.  [PUBMED Abstract]
    
    
27. Harris PF, Remington PL, Trentham-Dietz A, et al.: Prevalence and treatment of menopausal symptoms among breast cancer survivors. J Pain Symptom Manage 23 (6): 501-9, 2002.  [PUBMED Abstract]
    
    
28. Zhou RX, Huang FL, Jiang SR, et al.: The effect of acupuncture on the phagocytic activity of human leukocytes. J Tradit Chin Med 8 (2): 83-4, 1988.  [PUBMED Abstract]
    
    
29. Petti F, Bangrazi A, Liguori A, et al.: Effects of acupuncture on immune response related to opioid-like peptides. J Tradit Chin Med 18 (1): 55-63, 1998.  [PUBMED Abstract]
    
    
30. Johnstone PA, Bloom TL, Niemtzow RC, et al.: A prospective, randomized pilot trial of acupuncture of the kidney-bladder distinct meridian for lower urinary tract symptoms. J Urol 169 (3): 1037-9, 2003.  [PUBMED Abstract]
    
    
31. He CJ, Gong KH, Xu QZ, et al.: Effects of microwave acupuncture on the immunological function of cancer patients. J Tradit Chin Med 7 (1): 9-11, 1987.  [PUBMED Abstract]
    
    
32. Mayer DJ: Biological mechanisms of acupuncture. Prog Brain Res 122: 457-77, 2000.  [PUBMED Abstract]
    
    
33. Wu P, Cao Y, Wu J: Effects of moxa-cone moxibustion at Guanyuan on erythrocytic immunity and its regulative function in tumor-bearing mice. J Tradit Chin Med 21 (1): 68-71, 2001.  [PUBMED Abstract]
    
    
34. Liu LJ, Guo CJ, Jiao XM: [Effect of acupuncture on immunologic function and histopathology of transplanted mammary cancer in mice] Zhongguo Zhong Xi Yi Jie He Za Zhi 15 (10): 615-7, 1995.  [PUBMED Abstract]
    
    
35. Sato T, Yu Y, Guo SY, et al.: Acupuncture stimulation enhances splenic natural killer cell cytotoxicity in rats. Jpn J Physiol 46 (2): 131-6, 1996.  [PUBMED Abstract]
    
    
36. Lao L, Zhang G, Wong RH, et al.: The effect of electroacupuncture as an adjunct on cyclophosphamide-induced emesis in ferrets. Pharmacol Biochem Behav 74 (3): 691-9, 2003.  [PUBMED Abstract]
    
    
37. Wu B, Zhou RX, Zhou MS: [Effect of acupuncture on interleukin-2 level and NK cell immunoactivity of peripheral blood of malignant tumor patients] Zhongguo Zhong Xi Yi Jie He Za Zhi 14 (9): 537-9, 1994.  [PUBMED Abstract]
    
    
38. Wu B, Zhou RX, Zhou MS: [Effect of acupuncture on immunomodulation in patients with malignant tumors] Zhongguo Zhong Xi Yi Jie He Za Zhi 16 (3): 139-41, 1996.  [PUBMED Abstract]
    
    
39. Wei Z: Clinical observation on therapeutic effect of acupuncture at zusanli for leukopenia. J Tradit Chin Med 18 (2): 94-5, 1998.  [PUBMED Abstract]
    
    
40. Ye F, Chen S, Liu W: Effects of electro-acupuncture on immune function after chemotherapy in 28 cases. J Tradit Chin Med 22 (1): 21-3, 2002.  [PUBMED Abstract]
    
    
41. Li QS, Cao SH, Xie GM, et al.: Combined traditional Chinese medicine and Western medicine. Relieving effects of Chinese herbs, ear-acupuncture and epidural morphine on postoperative pain in liver cancer. Chin Med J (Engl) 107 (4): 289-94, 1994.  [PUBMED Abstract]
    
    
42. Alimi D, Rubino C, Leandri EP, et al.: Analgesic effects of auricular acupuncture for cancer pain. J Pain Symptom Manage 19 (2): 81-2, 2000.  [PUBMED Abstract]
    
    
43. He JP, Friedrich M, Ertan AK, et al.: Pain-relief and movement improvement by acupuncture after ablation and axillary lymphadenectomy in patients with mammary cancer. Clin Exp Obstet Gynecol 26 (2): 81-4, 1999.  [PUBMED Abstract]
    
    
44. Filshie J, Redman D: Acupuncture and malignant pain problems. Eur J Surg Oncol 11 (4): 389-94, 1985.  [PUBMED Abstract]
    
    
45. Wen HL: Cancer pain treated with acupuncture and electrical stimulation. Mod Med Asia 13 (2): 12-6, 1977. 
    
    
46. Shen J, Wenger N, Glaspy J, et al.: Electroacupuncture for control of myeloablative chemotherapy-induced emesis: A randomized controlled trial. JAMA 284 (21): 2755-61, 2000.  [PUBMED Abstract]
    
    
47. Dundee JW, Yang J, McMillan C: Non-invasive stimulation of the P6 (Neiguan) antiemetic acupuncture point in cancer chemotherapy. J R Soc Med 84 (4): 210-2, 1991.  [PUBMED Abstract]
    
    
48. Dundee JW, Yang J: Prolongation of the antiemetic action of P6 acupuncture by acupressure in patients having cancer chemotherapy. J R Soc Med 83 (6): 360-2, 1990.  [PUBMED Abstract]
    
    
49. Aglietti L, Roila F, Tonato M, et al.: A pilot study of metoclopramide, dexamethasone, diphenhydramine and acupuncture in women treated with cisplatin. Cancer Chemother Pharmacol 26 (3): 239-40, 1990.  [PUBMED Abstract]
    
    
50. Dundee JW, McMillan CM: Clinical uses of P6 acupuncture antiemesis. Acupunct Electrother Res 15 (3-4): 211-5, 1990.  [PUBMED Abstract]
    
    
51. Dundee JW, Ghaly RG, Fitzpatrick KT, et al.: Acupuncture to prevent cisplatin-associated vomiting. Lancet 1 (8541): 1083, 1987.  [PUBMED Abstract]
    
    
52. Price H, Lewith G, Williams C: Acupressure as an antiemetic in cancer chemotherapy. Complementary Medical Research 5 (2): 93-4. 
    
    
53. Stannard D: Pressure prevents nausea. Nurs Times 85 (4): 33-4, 1989 Jan 25-31.  [PUBMED Abstract]
    
    
54. McMillan C, Dundee JW, Abram WP: Enhancement of the antiemetic action of ondansetron by transcutaneous electrical stimulation of the P6 antiemetic point, in patients having highly emetic cytotoxic drugs. Br J Cancer 64 (5): 971-2, 1991.  [PUBMED Abstract]
    
    
55. Porzio G, Trapasso T, Martelli S, et al.: Acupuncture in the treatment of menopause-related symptoms in women taking tamoxifen. Tumori 88 (2): 128-30, 2002 Mar-Apr.  [PUBMED Abstract]
    
    
56. Zhang ZH: Effect of acupuncture on 44 cases of radiation rectitis following radiation therapy for carcinoma of the cervix uteri. J Tradit Chin Med 7 (2): 139-40, 1987.  [PUBMED Abstract]
    
    
57. Yao W: Prof. Sheng Canruo's experience in acupuncture treatment of throat diseases with yan si xue. J Tradit Chin Med 20 (2): 122-5, 2000.  [PUBMED Abstract]
    
    
58. Feng RZ: Relief of oesophageal carcinomatous obstruction by acupuncture. J Tradit Chin Med 4 (1): 3-4, 1984.  [PUBMED Abstract]
    
    

History

Acupuncture /moxibustion (known as zhen jiu) is part of traditional Chinese medicine (TCM), an indigenous, coherent system of medicine that has been practiced in China for thousands of years. The history of acupuncture/moxibustion in China can be traced back archeologically at least 4,000 years, when bian (stone needles) were in use. During the long history of recorded practice, acupuncture has been applied to many disorders. The earliest written medical text, the ancient classic Huang Di Nei Jing (Yellow Emperor's Inner Classic, second century BC), records nine types of needles and their therapeutic functions.

The dissemination of acupuncture and TCM to other regions dates back centuries: first to Korea and Japan and then to other Asian countries.[1] The use of acupuncture in Europe was documented in the middle of the 16th century.[2] The relatively brief history of acupuncture in the United States can be traced back about 200 years, when Dr. Franklin Bache published a report in the North American Medical and Surgical Journal on his use of acupuncture to treat lower back pain.[3] However, until the 1970s, when U.S.–Chinese diplomatic ties were resumed, the practice of acupuncture in this country was mainly limited to Chinatowns.[4]

For centuries, Chinese acupuncturists treated cancer symptomatically. Ancient literature and acupuncture textbooks classify cancer as a Zheng syndrome or blood stasis condition and document acupuncture treatment principles and methods.[5-7] Since the development of modern conventional medicine, acupuncture has been used clinically only as an adjunct to conventional cancer treatment.

References

1. Lu GD, Needham J: A history of forensic medicine in China. Med Hist 32 (4): 357-400, 1988.  [PUBMED Abstract]
   
   
2. Peacher WG: Adverse reactions, contraindications and complications of acupuncture and moxibustion. Am J Chin Med (Gard City N Y) 3 (1): 35-46, 1975.  [PUBMED Abstract]
   
   
3. Bache F: Cases illustrative of the remedial effects of acupuncture. North American Medical and Surgical Journal 1: 311-21, 1826. 
   
   
4. Ergil KV: China's traditional medicine. In: Micozzi MS, ed.: Fundamentals of Complementary and Alternative Medicine. New York, NY: Churchill Livingstone, 1996, pp 185-223. 
   
   
5. Maciocia G: The Practice of Chinese Medicine: The Treatment of Diseases with Acupuncture and Chinese Herbs. New York, NY: Churchill Livingstone, 1994. 
   
   
6. Maciocia G: Obstetrics and Gynecology in Chinese Medicine. New York, NY: Churchill Livingstone, 1997. 
   
   
7. Kaptchuk T: The Web That Has No Weaver: Understanding Chinese Medicine. New York, NY: Congdon & Weed, 1983. 
   
   

Laboratory/Animal/Preclinical Studies

At least five animal studies investigating the effects of acupuncture in cancer or cancer-related conditions have been reported in the scientific literature (see table ⁵ at end of this section).[1-5] Two of the studies were conducted in China, one of which was published in Chinese with an English abstract. One study was conducted in Japan, one in Sweden, and one in the United States. Four of the studies were ex vivo laboratory investigations using blood samples or tissues; [1-3,5] the remaining study was an animal behavioral study testing the effect of acupuncture on chemotherapy -induced nausea and vomiting. [4]

The four ex vivo studies suggested that acupuncture is useful in anticancer therapy either by actively stimulating immune activity or by preventing chemotherapy suppression of immune activity.

In a study involving normal rats, electroacupuncture (EA) (1 Hz, 5–20 V, 1-millisecond pulse width, 2 hours) applied at the point Tsu-Sanli (S36) for 2 hours daily on 3 consecutive days enhanced the cytotoxicity of splenic natural killer (NK) cells compared with a stimulation of a nonacupuncture control point in the abdominal muscle.[3]

Another study found that NK cell activity and T- lymphocyte transformation rate were increased in a mouse model of transplanted mammary cancer compared with control (P < .05) after eight sessions of acupuncture and moxibustion.[2]

A study involving tumor -bearing mice (sarcoma S180) using moxibustion to warm the acupuncture point Guanyuan (CV4) once a day for 10 days found significantly increased production of erythrocytes, compared with a nontreatment control.[1]

The fourth ex vivo study used a rat model to investigate the effect of EA on nerve growth factor (NGF), which is associated with polycystic ovary syndrome (PCOS). Women with PCOS have an increased risk of endometrial cancer and other diseases. Repeated EA treatments (12 treatments administered over 30 days) in PCO rats significantly lowered the concentrations of NGF in the ovaries, compared with untreated PCO rats.[5]

A study of cyclophosphamide -induced emesis in a ferret behavioral model used acupuncture as an adjunct therapy in treating the emetic side effects of chemotherapy. EA at 100 Hz, 1.5 V, for 10 minutes in combination with subeffective doses of antiemetics such as ondansetron (0.04 mg/kg), droperidol (0.25 mg/kg), and metoclopramide (2.24 mg/kg) significantly reduced the total number of emetic episodes by 52%, 36%, and 73%, respectively (P < .01), in this ferret model.[4]

The findings of these studies suggest that acupuncture may be effective in treating cancer-related symptoms and cancer treatment–related disorders and that acupuncture may be able to activate immune functions [1-3] and regulate the autonomic nervous system.[4,5] Only one study reported a decrease in tumor volume in animals treated with acupuncture compared with control animals; however, the scientific value of this report is limited because of insufficient information about the research methodology.[2]

References

1. Wu P, Cao Y, Wu J: Effects of moxa-cone moxibustion at Guanyuan on erythrocytic immunity and its regulative function in tumor-bearing mice. J Tradit Chin Med 21 (1): 68-71, 2001.  [PUBMED Abstract]
   
   
2. Liu LJ, Guo CJ, Jiao XM: [Effect of acupuncture on immunologic function and histopathology of transplanted mammary cancer in mice] Zhongguo Zhong Xi Yi Jie He Za Zhi 15 (10): 615-7, 1995.  [PUBMED Abstract]
   
   
3. Sato T, Yu Y, Guo SY, et al.: Acupuncture stimulation enhances splenic natural killer cell cytotoxicity in rats. Jpn J Physiol 46 (2): 131-6, 1996.  [PUBMED Abstract]
   
   
4. Lao L, Zhang G, Wong RH, et al.: The effect of electroacupuncture as an adjunct on cyclophosphamide-induced emesis in ferrets. Pharmacol Biochem Behav 74 (3): 691-9, 2003.  [PUBMED Abstract]
   
   
5. Stener-Victorin E, Lundeberg T, Waldenström U, et al.: Effects of electro-acupuncture on nerve growth factor and ovarian morphology in rats with experimentally induced polycystic ovaries. Biol Reprod 63 (5): 1497-503, 2000.  [PUBMED Abstract]
   
   

Human/Clinical Studies

Effect of Acupuncture on Immune Function

At least seven human studies have evaluated the effect of acupuncture on immune system function in patients with cancer (see table ⁷ at end of this section).[1-7] These studies were all conducted in China. Five were reported in English,[1-3,6,7] and two were reported in Chinese with English abstracts.[4,5]

Four randomized controlled trials,[1,2,4,5] a nonrandomized clinical study,[3] and two case series [6,7] found that acupuncture enhanced or regulated immune function.

The first randomized controlled trial found that acupuncture treatment enhanced platelet count and prevented leukocyte decrease after radiation therapy or chemotherapy, in comparison with the control group.[1]

A second study involved a group of 40 postoperative cancer patients, 20 of whom received daily acupuncture treatment and 20 of whom served as a control group. After 3 days, leukocyte phagocytosis was enhanced in the treated group, compared with the baseline measurement (P < .01); no such enhancement was observed in the control group.[2]

A third study observed the effect of acupuncture on interleukin-2 (IL-2) and natural killer (NK) cell activity in the peripheral blood of patients with malignant tumors. The patients were divided into an acupuncture treatment group (n = 25), which received 30 minutes of acupuncture daily for 10 days, and a nonacupuncture control group (n = 20). The data showed that IL-2 level and NK cell activity were significantly increased in the acupuncture group, compared with the control group (P < .01).[4]

A fourth study observed the effect of acupuncture on T- lymphocyte subsets (CD₃+, CD₄+, and CD₈+), soluble IL-2 receptor (SIL-2R), and beta- endorphin (beta-EP) in the peripheral blood of patients with malignant tumors. The data showed that acupuncture treatment increased the proportion of the CD₃+ and CD₄+ T-lymphocyte subsets, the CD₄+/CD₈+ ratio (P < .01), and the level of beta-EP. It decreased the level of SIL-2R (P < .01). The investigators suggested that the anticancer effect of acupuncture may be mediated via the mechanism of immunomodulation. [5]

The nonrandomized clinical study showed that microwave acupuncture (MAT), a newly developed technique in which a specially designed device attached to a normally inserted acupuncture needle is used to deliver microwave radiation to a given point, enhanced the immunologic function of cancer patients. Although there was an increase in white blood cell count in the MAT group, the change was not significantly different from that seen in the control group under drug treatment.[3]

In a clinical case series, 28 cancer patients who were treated with electroacupuncture (EA) while undergoing chemotherapy experienced no declines in T cells (CD₃+, CD₄+, CD₈+) or in NK cell activity, both of which are usually suppressed by chemotherapy.[7]

In another clinical case series, 48 patients with leukopenia —including two cancer patients—who were treated with manual acupuncture experienced improvements in leukocyte count, intracutaneous phytohemagglutinin (PHA), and immunoglobulin (IgG, IgA, and IgM) levels after 14 daily acupuncture treatments, compared with their pretreatment levels.[6]

Eight clinical studies of acupuncture as a treatment for cancer-related pain have been reported in the English language (see table ⁹ at end of this section).[8-15] Three studies were randomized controlled clinical trials, with two studies conducted in China and one in France.[9,10,15] Two studies were nonrandomized clinical trials conducted in France and Germany.[11,12] Three studies were case series, with one each from England, Hong Kong, and the United States.[8,13,14]

One randomized trial compared classical Chinese acupuncture; acupuncture point injection with freeze-dried human transfer factor; and conventional analgesic treatment in patients with stomach cancer pain.[9] The investigators reported an equivalent analgesic effect among the three groups observed after 2 months of treatment; however, the conventionally treated group experienced significantly superior analgesia compared with both acupuncture treatment groups during the first 10 days of treatment. The researchers reported that the patients in both acupuncture treatment groups also experienced improved quality of life and a decrease in the side effects of chemotherapy, in addition to analgesia.

The second randomized clinical trial evaluated the effect of various combinations of auricular acupuncture, Chinese herbs, and epidural morphine to relieve postoperative pain in 16 patients with liver cancer.[10] The study design was complicated and had a very small sample size (n = 2 per group). On the basis of the Visual Analog Scale (VAS) (0–100 mm), all of the combination treatment groups experienced better analgesia than did a placebo -treated control group.

A nonrandomized single-arm observational clinical study evaluated the effect of auricular acupuncture in 20 cancer patients who were still experiencing pain after treatment with analgesics.[11] While patients continued their analgesic medication, auricular acupuncture needles were embedded in ear acupuncture points chosen according to clinical symptoms and electrodermal response and were left in place until they fell out. In some cases, the needles remained in place for 35 days, while in others they fell out after 5 days. Pain intensity was measured by a nurse on the VAS on day 0 and day 60, and the data were analyzed using a t test. The results showed that pain intensity decreased or remained stable after auricular acupuncture in all patients, with a significant average pain intensity decrease of 33 mm (P < .001). The same investigators later reported a larger (n = 90) randomized blinded controlled trial in which cancer pain intensity was significantly decreased (by 36%) in an auricular acupuncture treatment group, in comparison with control groups (acupuncture at placebo points or auricular seeds placed at placebo points) after 2 months of treatment (P < .001).[15]

Another nonrandomized study investigated the effect of acupuncture in postoperative pain management and arm movement in breast cancer patients after surgical excision of the cancer and axillary lymph node dissection.[12] Forty-eight patients were treated with acupuncture on the third, fifth, and seventh days after surgery and on the day of patient discharge. Compared with a control group of 32 patients who had the same surgery but did not receive acupuncture treatment, the acupuncture group had significant pain relief during arm movement on the fifth and seventh days following surgery and at the time of discharge. The range of arm motion also increased significantly in the treatment group, compared with the control group, during the postoperative period (P < .001). The authors concluded that acupuncture point selection based on the state of the patient and obtaining a needling "de qi" sensation were important to achieving an effective acupuncture treatment.

In a case series involving 183 cancer patients who were treated with acupuncture for cancer-related pain, 52% were significantly helped (P value not stated).[13] Multiple treatments at intervals of 1 to 4 weeks were nearly always necessary for significant and long-term pain control.

In another case series, 29 patients with malignant tumors who developed pain received EA treatment.[14] All experienced various degrees of pain relief, and 25 out of 29 were able to either reduce or eliminate their analgesic requirements following multiple EA treatments.

A third case series produced similar results.[8] After auricular EA treatment, five patients with cancer pain reported improvements.

Although most of these studies were positive and demonstrated the effectiveness of acupuncture in cancer pain control, the findings have limited significance because of methodologic weaknesses such as small sample sizes, an absence of patient blinding to treatment in most cases, varying acupuncture treatment regimens, a lack of standard outcome measurements, and an absence of adequate randomization. Further investigations into the effects of acupuncture on cancer pain using rigorous scientific methodology are warranted.

Of all the investigated effects of acupuncture on cancer-related or chemotherapy-related symptoms and disorders, the positive effect of acupuncture on chemotherapy-induced nausea and vomiting (N/V) is the most convincing, as demonstrated by the consistency of the results of a variety of clinical study types, including randomized clinical trials, nonrandomized trials, prospective consecutive case series, and retrospective studies (see table ¹¹ at end of this section). Consistent with the findings from clinical studies of acupuncture on N/V due to other causes such as postoperative N/V and morning sickness, these studies showed acupuncture to be effective in the treatment of chemotherapy-induced N/V. A well-documented example is discussed below.

A systematic review of the effect of acupuncture on N/V describes five clinical trials of chemotherapy-induced N/V, conducted by different investigators on different groups of patients and using different forms of acupuncture point stimulation.[16] All five trials yielded positive results. These consistent results support the claim that acupuncture is useful for treating chemotherapy-induced N/V. More recently, the efficacy of acupuncture point stimulation for chemotherapy-induced N/V has been reviewed, suggesting that acupuncture is more effective for acute vomiting than for acute or chronic nausea.[17]

A number of clinical studies of the effect of acupuncture on chemotherapy-induced N/V have been reported.[18-30]

A randomized placebo-controlled clinical trial investigated the effect of EA on chemotherapy-induced emesis in 104 patients with breast cancer who were undergoing a highly emetogenic chemotherapy regimen. [20] The patients were randomly assigned to receive low-frequency EA at classic antiemetic acupuncture points once daily for 5 days (n = 37); minimal needling at control points with mock EA on the same schedule (n = 33); or no adjunct needling (n = 34). All patients received concurrent antiemetic drugs (prochlorperazine, lorazepam, and diphenhydramine) and high-dose chemotherapy (cyclophosphamide, cisplatin, and carmustine). The main outcome measures were the total number of emesis episodes and the proportion of emesis-free days occurring during the 5-day study period. The data revealed fewer emesis episodes in the EA treatment group compared with those in the minimal needling and drug-only control groups (P < .001), although differences among the groups were not significant during the 9-day follow-up period (P = .18). These findings are consistent with results reported by other investigators.[18,19,21,22,24,25,28] However, another published study showed that acupuncture had no additional effect on the prevention of acute N/V in patients receiving high- dose chemotherapy when combined with ondansetron.[30] One study suggested decreased delayed nausea from acupressure at point p6 compared with sham acupressure.[31]

Nine studies have reported on the effects of acupuncture on cancer or other cancer treatment–related symptoms, including weight loss, cough, thoracodynia, hemoptysis, fever, anxiety, depression, night sweats, hot flashes, xerostomia, rectitis, dysphonia, esophageal obstruction, and postoperative lymphedema.[1,8,34-40] Four studies were from China,[1,36-38] one from Italy,[35] one from Japan,[39] and three from the United States.[8,34,40] Most were case studies or case series,[8,36-38] one was a retrospective survey study,[34] one was a phase I pilot study,[35] and two were randomized clinical trials.[1,40] The findings from these studies are summarized in a table ¹³ at the end of this section.

In a randomized clinical trial,[1] 76 patients with various types of cancer, including 38 with esophageal cancer, 24 with stomach cancer, and 14 with lung cancer, were randomly assigned to two groups (n = 38 per group). The treatment group received acupuncture in combination with radiation therapy or chemotherapy, and the control group was treated with radiation therapy or chemotherapy alone. The data showed that the patients in the acupuncture group gained significantly more body weight than patients in the control group (P < .001). The acupuncture group also showed greater improvement than the controls in the symptoms of cough, thoracodynia, hemoptysis, and fever for patients with lung cancer and the symptoms of chest pain, mucus vomiting, and difficulty in swallowing for patients with esophageal cancer. In addition, the acupuncture group suffered fewer side effects (poor appetite, nausea and vomiting, dizziness, or fatigue) from radiation therapy or chemotherapy than the control group. However, no statistical analysis was performed on these data. A randomized controlled trial of 138 patients treated with acupuncture plus massage versus usual care showed decreased pain (P = .05) and decrease in depressive mood (P = .003) in postoperative cancer patients.[41] A small randomized controlled trial of EA compared with hormone therapy in women with breast cancer suggested a prolonged effect of EA on hot flushes after 24 months. Seven of 19 women initially randomly assigned to EA had 2.1 flushes in 24 hours compared with a baseline of 9.6 flushes in 24 hours.[42]

In a randomized controlled trial, 47 cancer patients with moderate to severe fatigue were randomly assigned to one of three groups. One group received six 20-minute sessions of acupuncture (n = 15), one group was instructed to use acupressure (n = 16), and the third group, the sham acupressure group (n = 16), was taught to apply pressure in three points unrelated to true acupressure. All three groups continued with the same technique for 2 weeks. The study concluded acupuncture was a more effective method than acupressure or sham acupressure.[43]

The phase I pilot study evaluated the effect of acupuncture on tamoxifen -induced menopause symptoms.[35] Fifteen patients with breast cancer who were taking tamoxifen were treated with acupuncture weekly for 3 months. The Greene Menopause Index was used for outcome assessments at baseline before treatment and at 1, 3, and 6 months. The results showed that anxiety, depression, and somatic and vasomotor symptoms, but not libido, were significantly improved in comparison with baseline (P < .001). A retrospective evaluation of 194 patients with predominantly breast or prostate cancer and experiencing vasomotor symptoms found long-term relief of vasomotor symptoms associated with acupuncture and self-acupuncture. The authors suggested that overall treatment dose may be more important than point location, but favored SP6.[44]

The retrospective survey study involved patients of an oncology clinic who were offered acupuncture treatment for potential palliation of symptoms.[34] Among 89 patients treated with acupuncture, 79 responded to a telephone questionnaire survey. The data indicated that the major reasons for referral included pain (53%), xerostomia (32%), hot flashes (6%), and nausea/loss of appetite (6%). Sixty percent of the patients showed at least 30% improvement in their symptoms, and about one-third had no change in the severity of symptoms. Patients were not questioned regarding acupuncture treatment expectations.

Several case series reports describe clinically observed improvement of symptoms following acupuncture treatment.[8,36-38,45,46] These symptoms included cancer therapy–induced night sweats, hot flashes, rectitis, xerostomia, dysphonia, cancer-related esophageal obstruction, and postoperative lymphedema in patients following intrapelvic lymph node dissection for malignant gynecologic tumors.

References

1. Xia YQ, Zhang D, Yang CX, et al.: An approach to the effect on tumors of acupuncture in combination with radiotherapy or chemotherapy. J Tradit Chin Med 6 (1): 23-6, 1986.  [PUBMED Abstract]
   
   
2. Zhou RX, Huang FL, Jiang SR, et al.: The effect of acupuncture on the phagocytic activity of human leukocytes. J Tradit Chin Med 8 (2): 83-4, 1988.  [PUBMED Abstract]
   
   
3. He CJ, Gong KH, Xu QZ, et al.: Effects of microwave acupuncture on the immunological function of cancer patients. J Tradit Chin Med 7 (1): 9-11, 1987.  [PUBMED Abstract]
   
   
4. Wu B, Zhou RX, Zhou MS: [Effect of acupuncture on interleukin-2 level and NK cell immunoactivity of peripheral blood of malignant tumor patients] Zhongguo Zhong Xi Yi Jie He Za Zhi 14 (9): 537-9, 1994.  [PUBMED Abstract]
   
   
5. Wu B, Zhou RX, Zhou MS: [Effect of acupuncture on immunomodulation in patients with malignant tumors] Zhongguo Zhong Xi Yi Jie He Za Zhi 16 (3): 139-41, 1996.  [PUBMED Abstract]
   
   
6. Wei Z: Clinical observation on therapeutic effect of acupuncture at zusanli for leukopenia. J Tradit Chin Med 18 (2): 94-5, 1998.  [PUBMED Abstract]
   
   
7. Ye F, Chen S, Liu W: Effects of electro-acupuncture on immune function after chemotherapy in 28 cases. J Tradit Chin Med 22 (1): 21-3, 2002.  [PUBMED Abstract]
   
   
8. Niemtzow RC: Integration of complementary disciplines into the oncology clinic. Part I. Acupuncture. Curr Probl Cancer 24 (4): 184-93, 2000 Jul-Aug.  [PUBMED Abstract]
   
   
9. Dang W, Yang J: Clinical study on acupuncture treatment of stomach carcinoma pain. J Tradit Chin Med 18 (1): 31-8, 1998.  [PUBMED Abstract]
   
   
10. Li QS, Cao SH, Xie GM, et al.: Combined traditional Chinese medicine and Western medicine. Relieving effects of Chinese herbs, ear-acupuncture and epidural morphine on postoperative pain in liver cancer. Chin Med J (Engl) 107 (4): 289-94, 1994.  [PUBMED Abstract]
    
    
11. Alimi D, Rubino C, Leandri EP, et al.: Analgesic effects of auricular acupuncture for cancer pain. J Pain Symptom Manage 19 (2): 81-2, 2000.  [PUBMED Abstract]
    
    
12. He JP, Friedrich M, Ertan AK, et al.: Pain-relief and movement improvement by acupuncture after ablation and axillary lymphadenectomy in patients with mammary cancer. Clin Exp Obstet Gynecol 26 (2): 81-4, 1999.  [PUBMED Abstract]
    
    
13. Filshie J, Redman D: Acupuncture and malignant pain problems. Eur J Surg Oncol 11 (4): 389-94, 1985.  [PUBMED Abstract]
    
    
14. Wen HL: Cancer pain treated with acupuncture and electrical stimulation. Mod Med Asia 13 (2): 12-6, 1977. 
    
    
15. Alimi D, Rubino C, Pichard-Léandri E, et al.: Analgesic effect of auricular acupuncture for cancer pain: a randomized, blinded, controlled trial. J Clin Oncol 21 (22): 4120-6, 2003.  [PUBMED Abstract]
    
    
16. Vickers AJ: Can acupuncture have specific effects on health? A systematic review of acupuncture antiemesis trials. J R Soc Med 89 (6): 303-11, 1996.  [PUBMED Abstract]
    
    
17. Ezzo JM, Richardson MA, Vickers A, et al.: Acupuncture-point stimulation for chemotherapy-induced nausea or vomiting. Cochrane Database Syst Rev (2): CD002285, 2006.  [PUBMED Abstract]
    
    
18. Dundee JW, Ghaly RG, Fitzpatrick KT, et al.: Acupuncture prophylaxis of cancer chemotherapy-induced sickness. J R Soc Med 82 (5): 268-71, 1989.  [PUBMED Abstract]
    
    
19. Dundee JW, Ghaly RG, Fitzpatrick KT, et al.: Optimising antiemesis in cancer chemotherapy. Br Med J (Clin Res Ed) 294 (6565): 179, 1987.  [PUBMED Abstract]
    
    
20. Shen J, Wenger N, Glaspy J, et al.: Electroacupuncture for control of myeloablative chemotherapy-induced emesis: A randomized controlled trial. JAMA 284 (21): 2755-61, 2000.  [PUBMED Abstract]
    
    
21. Dundee JW, Yang J, McMillan C: Non-invasive stimulation of the P6 (Neiguan) antiemetic acupuncture point in cancer chemotherapy. J R Soc Med 84 (4): 210-2, 1991.  [PUBMED Abstract]
    
    
22. Dundee JW, Yang J: Prolongation of the antiemetic action of P6 acupuncture by acupressure in patients having cancer chemotherapy. J R Soc Med 83 (6): 360-2, 1990.  [PUBMED Abstract]
    
    
23. Aglietti L, Roila F, Tonato M, et al.: A pilot study of metoclopramide, dexamethasone, diphenhydramine and acupuncture in women treated with cisplatin. Cancer Chemother Pharmacol 26 (3): 239-40, 1990.  [PUBMED Abstract]
    
    
24. Dundee JW, McMillan CM: Clinical uses of P6 acupuncture antiemesis. Acupunct Electrother Res 15 (3-4): 211-5, 1990.  [PUBMED Abstract]
    
    
25. Dundee JW, Ghaly RG, Fitzpatrick KT, et al.: Acupuncture to prevent cisplatin-associated vomiting. Lancet 1 (8541): 1083, 1987.  [PUBMED Abstract]
    
    
26. Price H, Lewith G, Williams C: Acupressure as an antiemetic in cancer chemotherapy. Complementary Medical Research 5 (2): 93-4. 
    
    
27. Stannard D: Pressure prevents nausea. Nurs Times 85 (4): 33-4, 1989 Jan 25-31.  [PUBMED Abstract]
    
    
28. McMillan C, Dundee JW, Abram WP: Enhancement of the antiemetic action of ondansetron by transcutaneous electrical stimulation of the P6 antiemetic point, in patients having highly emetic cytotoxic drugs. Br J Cancer 64 (5): 971-2, 1991.  [PUBMED Abstract]
    
    
29. Roscoe JA, Morrow GR, Hickok JT, et al.: The efficacy of acupressure and acustimulation wrist bands for the relief of chemotherapy-induced nausea and vomiting. A University of Rochester Cancer Center Community Clinical Oncology Program multicenter study. J Pain Symptom Manage 26 (2): 731-42, 2003.  [PUBMED Abstract]
    
    
30. Streitberger K, Friedrich-Rust M, Bardenheuer H, et al.: Effect of acupuncture compared with placebo-acupuncture at P6 as additional antiemetic prophylaxis in high-dose chemotherapy and autologous peripheral blood stem cell transplantation: a randomized controlled single-blind trial. Clin Cancer Res 9 (7): 2538-44, 2003.  [PUBMED Abstract]
    
    
31. Dibble SL, Luce J, Cooper BA, et al.: Acupressure for chemotherapy-induced nausea and vomiting: a randomized clinical trial. Oncol Nurs Forum 34 (4): 813-20, 2007.  [PUBMED Abstract]
    
    
32. Molassiotis A, Helin AM, Dabbour R, et al.: The effects of P6 acupressure in the prophylaxis of chemotherapy-related nausea and vomiting in breast cancer patients. Complement Ther Med 15 (1): 3-12, 2007.  [PUBMED Abstract]
    
    
33. Choo SP, Kong KH, Lim WT, et al.: Electroacupuncture for refractory acute emesis caused by chemotherapy. J Altern Complement Med 12 (10): 963-9, 2006.  [PUBMED Abstract]
    
    
34. Johnstone PA, Polston GR, Niemtzow RC, et al.: Integration of acupuncture into the oncology clinic. Palliat Med 16 (3): 235-9, 2002.  [PUBMED Abstract]
    
    
35. Porzio G, Trapasso T, Martelli S, et al.: Acupuncture in the treatment of menopause-related symptoms in women taking tamoxifen. Tumori 88 (2): 128-30, 2002 Mar-Apr.  [PUBMED Abstract]
    
    
36. Zhang ZH: Effect of acupuncture on 44 cases of radiation rectitis following radiation therapy for carcinoma of the cervix uteri. J Tradit Chin Med 7 (2): 139-40, 1987.  [PUBMED Abstract]
    
    
37. Yao W: Prof. Sheng Canruo's experience in acupuncture treatment of throat diseases with yan si xue. J Tradit Chin Med 20 (2): 122-5, 2000.  [PUBMED Abstract]
    
    
38. Feng RZ: Relief of oesophageal carcinomatous obstruction by acupuncture. J Tradit Chin Med 4 (1): 3-4, 1984.  [PUBMED Abstract]
    
    
39. Kanakura Y, Niwa K, Kometani K, et al.: Effectiveness of acupuncture and moxibustion treatment for lymphedema following intrapelvic lymph node dissection: a preliminary report. Am J Chin Med 30 (1): 37-43, 2002.  [PUBMED Abstract]
    
    
40. Deng G, Vickers A, Yeung S, et al.: Randomized, controlled trial of acupuncture for the treatment of hot flashes in breast cancer patients. J Clin Oncol 25 (35): 5584-90, 2007.  [PUBMED Abstract]
    
    
41. Mehling WE, Jacobs B, Acree M, et al.: Symptom management with massage and acupuncture in postoperative cancer patients: a randomized controlled trial. J Pain Symptom Manage 33 (3): 258-66, 2007.  [PUBMED Abstract]
    
    
42. Frisk J, Carlhäll S, Källström AC, et al.: Long-term follow-up of acupuncture and hormone therapy on hot flushes in women with breast cancer: a prospective, randomized, controlled multicenter trial. Climacteric 11 (2): 166-74, 2008.  [PUBMED Abstract]
    
    
43. Molassiotis A, Sylt P, Diggins H: The management of cancer-related fatigue after chemotherapy with acupuncture and acupressure: a randomised controlled trial. Complement Ther Med 15 (4): 228-37, 2007.  [PUBMED Abstract]
    
    
44. Filshie J, Bolton T, Browne D, et al.: Acupuncture and self acupuncture for long-term treatment of vasomotor symptoms in cancer patients--audit and treatment algorithm. Acupunct Med 23 (4): 171-80, 2005.  [PUBMED Abstract]
    
    
45. Nedstrand E, Wyon Y, Hammar M, et al.: Psychological well-being improves in women with breast cancer after treatment with applied relaxation or electro-acupuncture for vasomotor symptom. J Psychosom Obstet Gynaecol 27 (4): 193-9, 2006.  [PUBMED Abstract]
    
    
46. Frisk J, Spetz AC, Hjertberg H, et al.: Two Modes of Acupuncture as a Treatment for Hot Flushes in Men with Prostate Cancer-A Prospective Multicenter Study with Long-Term Follow-Up. Eur Urol : , 2008.  [PUBMED Abstract]
    
    

Adverse Effects

Serious adverse effects of acupuncture are rare. Reported accidents and infections to organs or tissues appear to be related to violations of sterile procedure, negligence of the practitioner, or both.[1,2] A systematic review of case reports on the safety of acupuncture, involving 98 papers published in the English language from 22 countries during the period from 1965 to 1999, found only 202 incidents. The number of incidents appeared to decline as training standards and licensure requirements were enhanced. Among the 118 (60%) reported incidents involving infection, 94 (80%) involved hepatitis, occurring mainly in the late 1970s and early 1980s. Very few hepatitis or other infections associated with acupuncture have been reported since 1988, when widespread use of disposable needles was introduced and national certification requirements for clean needle techniques were developed and enforced as an acupuncture licensure requirement.[3,4] Because cancer patients who are undergoing chemotherapy or radiation therapy are immunocompromised, extra precautions must be taken and strict clean needle techniques must be applied when acupuncture treatment is given.[5]

Minor adverse effects of acupuncture, such as pain at needling sites, hematoma, tiredness, lightheadedness, drowsiness, and localized skin irritation, have been reported.[6-10] These minor adverse effects can be minimized by appropriate patient management, including local pressing and massage at the needling site after treatment.[11,12]

References

1. Lao L: Acupuncture techniques and devices. J Altern Complement Med 2 (1): 23-5, 1996.  [PUBMED Abstract]
   
   
2. MacPherson H: Fatal and adverse events from acupuncture: allegation, evidence, and the implications. J Altern Complement Med 5 (1): 47-56, 1999.  [PUBMED Abstract]
   
   
3. Lao L, Zhang G, Wong RH, et al.: The effect of electroacupuncture as an adjunct on cyclophosphamide-induced emesis in ferrets. Pharmacol Biochem Behav 74 (3): 691-9, 2003.  [PUBMED Abstract]
   
   
4. National Commission for the Certification of Acupuncturists.: Clean Needle Technique for Acupuncturists: A Manual: Guidelines and Standards for the Clean & Safe Clinical Practice of Acupuncture. 3rd ed. Washington, DC: National Commission for the Certification of Acupuncturists, 1989. 
   
   
5. Shen J, Wenger N, Glaspy J, et al.: Electroacupuncture for control of myeloablative chemotherapy-induced emesis: A randomized controlled trial. JAMA 284 (21): 2755-61, 2000.  [PUBMED Abstract]
   
   
6. Brattberg G: Acupuncture treatment: a traffic hazard? Am J Acupunct 14 (3): 265-7, 1986. 
   
   
7. Ernst E, White AR: Prospective studies of the safety of acupuncture: a systematic review. Am J Med 110 (6): 481-5, 2001.  [PUBMED Abstract]
   
   
8. White A, Hayhoe S, Hart A, et al.: Adverse events following acupuncture: prospective survey of 32 000 consultations with doctors and physiotherapists. BMJ 323 (7311): 485-6, 2001.  [PUBMED Abstract]
   
   
9. MacPherson H, Thomas K, Walters S, et al.: The York acupuncture safety study: prospective survey of 34 000 treatments by traditional acupuncturists. BMJ 323 (7311): 486-7, 2001.  [PUBMED Abstract]
   
   
10. Yamashita H, Tsukayama H, Tanno Y, et al.: Adverse events related to acupuncture. JAMA 280 (18): 1563-4, 1998.  [PUBMED Abstract]
    
    
11. Cheng X, ed.: Chinese Acupuncture and Moxibustion. Beijing, China: Foreign Languages Press, 1987. 
    
    
12. O'Connor J, Bensky D, eds.: Acupuncture: A Comprehensive Text. Chicago, Ill: Eastland Press, 1981. 
    
    

Overall Level of Evidence for Acupuncture Treatment of Cancer-Related Symptoms

It is noteworthy that almost all reported clinical studies on the effects of acupuncture on cancer or cancer therapy –related symptoms focus on symptom management rather than the disease itself. Investigations into the effects of acupuncture on chemotherapy -induced nausea and vomiting, many of which were randomized and well-controlled, produced the most convincing findings. Although a considerable number of favorable clinical acupuncture studies have been reported, most were case studies, clinical observations, or nonrandomized and poorly controlled clinical trials. In many studies, methodologic flaws in clinical study design hampered rigorous scientific efforts to evaluate the effects of acupuncture. Although pain relief is the most clinically common use of acupuncture, only a few studies on cancer pain are well-controlled or have sample sizes large enough to support their findings.

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 (09/26/2008)

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.

Human/Clinical Studies ¹⁵

Added text ¹⁶ about a study that suggested decreased delayed nausea from acupressure at point p6 compared with sham acupressure (cited Dibble et al. as reference 31).

Added text ¹¹ about a study of N/V from moderate to highly emetogenic chemotherapy to Table 4.

Added Deng et al. as reference 40 ¹⁷.

Added text ¹⁸ about a small randomized controlled trial of EA compared with hormone therapy in women with breast cancer that suggested a prolonged effect of EA on hot flushes after 24 months (cited Frisk et al. [Climacteric 2008] as reference 42).

Added text ¹⁹ about a randomized controlled trial in which 47 cancer patients with moderate to severe fatigue were randomly assigned to acupuncture, acupressure, or sham acupressure groups (cited Molassiotis et al. as reference 43).

Added Frisk et al. [Eur Urol 2008] as reference 46 ²⁰.

Added text ¹³ about hot flashes, cancer-related fatigue, and hot flushes to Table 5.

More Information

Additional Information about CAM Therapies

• The National Center for Complementary and Alternative Medicine ²¹ (NCCAM).
• The National Cancer Institute Office of Cancer Complementary and Alternative Medicine ²² (OCCAM).
• CAM on PubMed ²³, a special subset of the PubMed scientific literature database created through a partnership between NCCAM and the National Library of Medicine.

About PDQ

• PDQ® - NCI's Comprehensive Cancer Database ²⁴

  Full description of the NCI PDQ database.

Other PDQ Summaries

• PDQ® Cancer Information Summaries: Adult Treatment ²⁵

  Treatment options for adult cancers.

• PDQ® Cancer Information Summaries: Pediatric Treatment ²⁶

  Treatment options for childhood cancers.

• PDQ® Cancer Information Summaries: Supportive and Palliative Care ²⁷

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

• PDQ® Cancer Information Summaries: Screening/Detection (Testing for Cancer) ²⁸

  Tests or procedures that detect specific types of cancer.

• PDQ® Cancer Information Summaries: Prevention ²⁹

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

• PDQ® Cancer Information Summaries: Genetics ³⁰

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

• PDQ® Cancer Information Summaries: Complementary and Alternative Medicine ³¹

  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

Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs.

In biology, to stimulate a cell in a resting state to become active. This causes biochemical and functional changes in the activated cell.

The application of pressure or localized massage to specific sites on the body to control symptoms such as pain or nausea. It is a type of complementary and alternative medicine.

The technique of inserting thin needles through the skin at specific points on the body to control pain and other symptoms. It is a type of complementary and alternative medicine.

A stainless steel needle that is slightly thicker than a human hair. Acupuncture needles are inserted through the skin at specific points on the body to control pain and other symptoms.

A specific spot on the body where an acupuncture needle may be inserted to control pain and other symptoms. Also called acupoint.

A procedure in which drugs, vitamins, herbal extracts, or other fluids are injected into the body at an acupuncture point using a syringe and needle.

Mild electrical stimulation of acupuncture points to control symptoms such as nausea and vomiting.

Symptoms or signs that begin and worsen quickly; not chronic.

Another treatment used together with the primary treatment. Its purpose is to assist the primary treatment. Also called adjunctive therapy.

Treatment given after the primary treatment to increase the chances of a cure. Adjuvant therapy may include chemotherapy, radiation therapy, hormone therapy, or biological therapy.

A small gland that makes steroid hormones, adrenaline, and noradrenaline. These hormones help control heart rate, blood pressure, and other important body functions. There are two adrenal glands, one on top of each kidney. Also called suprarenal gland.

An unwanted side effect of treatment.

Pain relief.

A drug that reduces pain. Analgesics include aspirin, acetaminophen, and ibuprofen.

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

Having to do with anatomy (the study of the structure of a plant or animal).

The study of the structure of a plant or animal.

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 medicine, a substance that stops the action or effect of another substance. For example, a drug that blocks the stimulating effect of estrogen on a tumor cell is called an estrogen receptor antagonist.

Having to do with reducing inflammation.

A drug that prevents or reduces nausea and vomiting.

A drug or other substance used to prevent or stop seizures or convulsions. Also called anticonvulsant.

Feelings of fear, dread, and uneasiness that may occur as a reaction to stress. A person with anxiety may sweat, feel restless and tense, and have a rapid heart beat. Extreme anxiety that happens often over time may be a sign of an anxiety disorder.

Having to do with the ear.

The part of the nervous system that controls muscles of internal organs (such as the heart, blood vessels, lungs, stomach, and intestines) and glands (such as salivary glands and sweat glands). One part of the autonomic nervous system helps the body rest, relax, and digest food and another part helps a person fight or take flight in an emergency. Also called ANS and involuntary nervous system.

A lymph node in the armpit region that drains lymph channels from the breast.

Surgery to remove lymph nodes found in the armpit region. Also called axillary dissection.

An initial measurement that is taken at an early time point to represent a beginning condition, and is used for comparison over time to look for changes. For example, the size of a tumor will be measured before treatment (baseline) and then afterwards to see if the treatment had an effect.

Affecting both the right and left sides of the body.

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.

A test to check the number of red blood cells, white blood cells, and platelets in a sample of blood. Also called CBC and complete blood count.

In traditional Chinese medicine, a condition described as slowing or pooling of blood, which may cause pain or other symptoms.

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

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.

Cancer that forms in tissues of the breast, usually the ducts (tubes that carry milk to the nipple) and lobules (glands that make milk). It occurs in both men and women, although male breast cancer is rare.

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.

An anticancer drug that belongs to the family of drugs called alkylating agents.

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 group or series of case reports involving patients who were given similar treatment. Reports of case series usually contain detailed information about the individual patients. This includes demographic information (for example, age, gender, ethnic origin) and information on diagnosis, treatment, response to treatment, and follow-up after treatment.

The individual unit that makes up the tissues of the body. All living things are made up of one or more cells.

The brain and spinal cord. Also called CNS.

Cancer that forms in tissues of the cervix (the organ connecting the uterus and vagina). It is usually a slow-growing cancer that may not have symptoms but can be found with regular Pap tests (a procedure in which cells are scraped from the cervix and looked at under a microscope).

Treatment with drugs that kill cancer cells.

In traditional Chinese medicine, meridians are channels that form a network in the body, through which qi (vital energy) flows. Blocked qi causes pain or illness. The flow of qi is restored by using pressure, needles, suction, or heat at hundreds of specific points along the meridians.

A disease or condition that persists or progresses over a long period of time.

A drug used to treat many types of cancer. Cisplatin contains the metal platinum. It kills cancer cells by damaging their DNA and stopping them from dividing. Cisplatin is a type of alkylating agent.

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 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 clinical study.

The comparison of the structure (anatomy) of one animal or plant with the structure of a different animal or plant.

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.

A treatment that is given at the same time as another.

A program of the National Institutes of Health to bring together an independent group of experts to review scientific evidence related to an important public health issue. For a specific issue, a panel of experts (such as doctors and scientists) reviews reports and papers on the subject, listens to information presented by other experts in the field, and hears comments from the general public. Based on the evidence presented, the panel writes a report summarizing the findings, which is made available to the public. The report is not intended to be a practice guideline.

A type of acupuncture based on a form of Oriental medicine in which treatment is based on a person’s constitution. According to this type of medicine, the constitution is the specific way a person’s organs affect health and how he or she looks, thinks, behaves, and responds to treatment. Also called Korean acupuncture.

An animal in a study that does not receive the treatment being tested. Comparing the health of control animals with the health of treated animals allows researchers to evaluate the effects of a treatment more accurately.

In a clinical trial, the group that does not receive the new treatment being studied. This group is compared to the group that receives the new treatment, to see if the new treatment works.

A clinical study that includes a comparison (control) group. The comparison group receives a placebo, another treatment, or no treatment at all.

A system in which medical doctors and other healthcare professionals (such as nurses, pharmacists, and therapists) treat symptoms and diseases using drugs, radiation, or surgery. Also called allopathic medicine, biomedicine, mainstream medicine, orthodox medicine, and Western medicine.

A procedure in which a rounded glass cup is warmed and placed upside down over an area of the body, creating suction that holds the cup to the skin. Cupping increases the flow of blood. In traditional Chinese medicine, it is also thought to increase the flow of qi (vital energy).

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

An anticancer drug that belongs to the family of drugs called alkylating agents.

A substance that is made by cells of the immune system. Some cytokines can boost the immune response and others can suppress it. Cytokines can also be made in the laboratory by recombinant DNA technology and used in the treatment of various diseases, including cancer.

Cell-killing.

Tingling, numbness, heaviness, and other feelings that occur after an acupuncture needle has been properly placed in the body. The needle may be twirled, moved up and down at different speeds and depths, heated, or charged with a small electric current until the de qi sensation occurs.

A mental condition marked by ongoing feelings of sadness, despair, loss of energy, and difficulty dealing with normal daily life. Other symptoms of depression include feelings of worthlessness and hopelessness, loss of pleasure in activities, changes in eating or sleeping habits, and thoughts of death or suicide. Depression can affect anyone, and can be successfully treated. Depression affects 15-25% of cancer patients.

A synthetic steroid (similar to steroid hormones produced naturally in the adrenal gland). Dexamethasone is used to treat leukemia and lymphoma and may be used to treat some of the problems caused by other cancers and their treatment.

The length of a straight line that extends from one edge of a tumor or other object, through its center and to the opposite edge. It is usually used to measure the size of round or spherical shapes.

Frequent and watery bowel movements.

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.

A drug used to treat allergies and relieve cough and itching caused by insect bites, sunburn, and poison oak or ivy. It is also used to treat mild Parkinson disease, to prevent and treat motion sickness, to relieve cough and cold symptoms, and as a sleep aid. It is a type of antihistamine.

In medicine, a disturbance of normal functioning of the mind or body. Disorders may be caused by genetic factors, disease, or trauma.

In medicine, refers to a part of the body that is farther away from the center of the body than another part. For example, the fingers are distal to the shoulder. The opposite is proximal.

The amount of medicine taken, or radiation given, at one time.

A drug used to prevent nausea and vomiting in patients who receive anesthesia before surgery. It is also used to treat anxiety. Droperidol is a type of antiemetic, adjunct anesthesia, and antipsychotic.

Any substance, other than food, that is used to prevent, diagnose, treat or relieve symptoms of a disease or abnormal condition. Also refers to a substance that alters mood or body function, or that can be habit-forming or addictive, especially a narcotic.

Trouble with the voice when trying to talk, including hoarseness and change in pitch or quality or voice.

Swelling caused by excess fluid in body tissues.

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

A procedure in which pulses of weak electrical current are sent through acupuncture needles into acupuncture points in the skin. This procedure is being studied in the prevention of nausea and vomiting in patients undergoing chemotherapy.

Vomiting.

Describes a substance that causes vomiting. Also called emetogenic.

Describes a substance that causes vomiting. Also called emetic.

Produced inside an organism or cell. The opposite is external (exogenous) production.

Cancer that forms in the tissue lining the uterus (the small, hollow, pear-shaped organ in a woman's pelvis in which a baby grows). Most endometrial cancers are adenocarcinomas (cancers that begin in cells that make and release mucus and other fluids).

A morphine-like chemical that is made naturally in the brain and relieves pain.

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.

Having to do with the space between the wall of the spinal canal and the covering of the spinal cord. An epidural injection is given into this space.

A cell that carries oxygen to all parts of the body. Also called RBC and red blood cell.

Having to do with the esophagus, the muscular tube through which food passes from the throat to the stomach.

Cancer that forms in tissues lining the esophagus (the muscular tube through which food passes from the throat to the stomach). Two types of esophageal cancer are squamous cell carcinoma (cancer that begins in flat cells lining the esophagus) and adenocarcinoma (cancer that begins in cells that make and release mucus and other fluids).

Outside of the living body. Refers to a medical procedure in which an organ, cells, or tissue are taken from a living body for a treatment or procedure, and then returned to the living body.

Removal by surgery.

A condition marked by extreme tiredness and inability to function due lack of energy. Fatigue may be acute or chronic.

An ancient form of acupuncture based on the principle that there are five universal elements (wood, fire, earth, metal, and water) that affect a person's emotions, personality, health, and response to treatment. Each person is affected by one element more than the others. Also called traditional acupuncture.

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.

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.

A method used to dry substances, such as food, to make them last longer. The substance is frozen and then dried in a vacuum.

A tool used by researchers to study the symptoms of menopause. It is a standard list of 21 questions which women use to rate how much they are bothered by menopause symptoms such as hot flashes, night sweats, rapid heartbeat, and difficulty sleeping.

Having to do with the female reproductive tract (including the cervix, endometrium, fallopian tubes, ovaries, uterus, and vagina).

A pool of clotted or partially clotted blood in an organ, tissue, or body space, usually caused by a broken blood vessel.

Coughing or spitting up blood from the respiratory tract.

Disease of the liver causing inflammation. Symptoms include an enlarged liver, fever, nausea, vomiting, abdominal pain, and dark urine.

A type of medicine that uses roots, stems, leaves, flowers, or seeds of plants to improve health, prevent disease, and treat illness.

An intensive drug treatment to kill cancer cells, but that also destroys the bone marrow and can cause other severe side effects. High-dose chemotherapy is usually followed by bone marrow or stem cell transplantation to rebuild the bone marrow.

The study of diseased cells and tissues using a microscope.

An individual treated in the past and used in a comparison group when researchers analyze the results of a clinical study that had no control group. The use of a control, or comparison, group helps researchers determine the effects of a new treatment more accurately.

Having to do with homeostasis, which is a state of balance among all the body systems, needed for the body to function correctly.

One of many chemicals made by glands in the body. Hormones circulate in the bloodstream and control the actions of certain cells or organs. Some hormones can also be made in the laboratory.

Treatment that adds, blocks, or removes hormones. For certain conditions (such as diabetes or menopause), hormones are given to adjust low hormone levels. To slow or stop the growth of certain cancers (such as prostate and breast cancer), synthetic hormones or other drugs may be given to block the body’s natural hormones. Sometimes surgery is needed to remove the gland that makes a certain hormone. Also called endocrine therapy, hormonal therapy, and hormone treatment.

A sudden, temporary onset of body warmth, flushing, and sweating (often associated with menopause).

The area of the brain that controls body temperature, hunger, and thirst.

One of a group of related proteins made by leukocytes (white blood cells) and other cells in the body. IL-2 is made by a type of T lymphocyte. It increases the growth and activity of other T lymphocytes and B lymphocytes, and affects the development of the immune system. Aldesleukin (IL-2 made in the laboratory) is being used as a biological response modifier to boost the immune system in cancer therapy. IL-2 is a type of cytokine. Also called interleukin-2.

Production and action of cells that fight disease or infection.

The activity of the immune system against foreign substances (antigens).

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

Having a weakened immune system caused by certain diseases or treatments.

A protein that acts as an antibody. Immunoglobulins are made by B cells and plasma cells. An immunoglobulin is a type of glycoprotein with two heavy chains and two light chains. Also called Ig.

Change in the body's immune system, caused by agents that activate or suppress its function.

Invasion and multiplication of germs in the body. Infections can occur in any part of the body and can spread throughout the body. The germs may be bacteria, viruses, yeast, or fungi. They can cause a fever and other problems, depending on where the infection occurs. When the body’s natural defense system is strong, it can often fight the germs and prevent infection. Some cancer treatments can weaken the natural defense system.

Having to do with inflammation (redness, swelling, pain, and a feeling of heat that helps protect tissues affected by injury or disease).

In medicine, refers to the act of taking a substance into the body by breathing.

Difficulty in going to sleep or getting enough sleep.

A biological response modifier (a substance that can improve the body's natural response to infections and other diseases). Interferons interfere with the division of cancer cells and can slow tumor growth. There are several types of interferons, including interferon-alpha, -beta, and -gamma. The body normally produces these substances. They are also made in the laboratory to treat cancer and other diseases.

One of a group of related proteins made by leukocytes (white blood cells) and other cells in the body. Interleukin-2 is made by a type of T lymphocyte. It increases the growth and activity of other T lymphocytes and B lymphocytes, and affects the development of the immune system. Aldesleukin (interleukin-2 made in the laboratory) is being used as a biological response modifier to boost the immune system in cancer therapy. Interleukin-2 is a type of cytokine. Also called IL-2.

Within the skin. Also called intradermal.

Within the pelvis, the lower part of the abdomen between the hip bones.

In clinical trials, refers to a drug (including a new drug, dose, combination, or route of administration) or procedure that has undergone basic laboratory testing and received approval from the U.S. Food and Drug Administration (FDA) to be tested in human subjects. A drug or procedure may be approved by the FDA for use in one disease or condition, but be considered investigational in other diseases or conditions. Also called experimental.

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.

The use of a low-level laser beam instead of an acupuncture needle to stimulate an acupuncture point.

A type of immune cell. Most leukocytes are made in the bone marrow and are found in the blood and lymph tissue. Leukocytes help the body fight infections and other diseases. Granulocytes, monocytes, and lymphocytes are leukocytes. Also called WBC and white blood cell.

A condition in which there is a lower-than-normal number of leukocytes (white blood cells) in the blood.

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.

Sexual desire.

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

Primary liver cancer is cancer that forms in the tissues of the liver. Secondary liver cancer is cancer that spreads to the liver from another part of the body.

Restricted to the site of origin, without evidence of spread.

Specific place where something is located or occurs. It may refer to a specific place on the body (such as an acupuncture point) or the place on a chromosome where a specific gene is found.

A drug that is used to treat anxiety and certain seizure disorders (such as epilepsy), and to prevent nausea and vomiting caused by chemotherapy. It belongs to the families of drugs called antiemetics and benzodiazepines.

One of a pair of organs in the chest that supplies the body with oxygen, and removes carbon dioxide from the body.

Cancer that forms in tissues of the lung, usually in the cells lining air passages. The two main types are small cell lung cancer and non-small cell lung cancer. These types are diagnosed based on how the cells look under a microscope.

A surgical procedure in which the lymph nodes are removed and examined to see whether they contain cancer. For a regional lymph node dissection, some of the lymph nodes in the tumor area are removed; for a radical lymph node dissection, most or all of the lymph nodes in the tumor area are removed. Also called lymphadenectomy.

A condition in which excess fluid collects in tissue and causes swelling. It may occur in the arm or leg after lymph vessels or lymph nodes in the underarm or groin are removed or treated with radiation.

A type of immune cell that is made in the bone marrow and is found in the blood and in lymph tissue. The two main types of lymphocytes are B lymphocytes and T lymphocytes. B lymphocytes make antibodies, and T lymphocytes help kill tumor cells and help control immune responses. A lymphocyte is a type of white blood cell.

Cancerous. Malignant tumors can invade and destroy nearby tissue and spread to other parts of the body.

Having to do with the breast.

A treatment in which the soft tissues of the body are kneaded, rubbed, tapped, and stroked. Massage therapy may help people relax, relieve stress and pain, lower blood pressure, and improve circulation. It is being studied in the treatment of cancer symptoms such as lack of energy, pain, swelling, and depression.

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.

An instrument, tool, machine, test kit, or implant that is used to prevent, diagnose, or treat disease or other conditions. Medical devices range from tongue depressors to heart pacemakers and medical imaging equipment.

The time of life when a woman’s ovaries stop working and menstrual periods stop. Natural menopause usually occurs around age 50. A woman is said to be in menopause when she hasn’t had a period for 12 months in a row. Symptoms of menopause include hot flashes, mood swings, night sweats, vaginal dryness, trouble concentrating, and infertility.

In traditional Chinese medicine, one of 20 channels that form a network through which qi (the body's vital energy) flows and that connect the body’s acupuncture sites.

In medicine, the rules and procedures for doing research and evaluating results.

A drug that increases the motility (movements and contractions) of the stomach and upper intestine. It is used to treat certain stomach problems and nausea and vomiting caused by chemotherapy. It is a type of antiemetic and a type of motility agent. Also called Reglan.

A type of acupuncture in which a microwave device is attached to an acupuncture needle to give microwave radiation at an acupuncture point.

A form of exercise that combines body movement with mental focus and controlled breathing to improve strength, balance, flexibility, and overall health. Examples of mind/body exercises are yoga, tai chi, and qigong.

A method of treatment. For example, surgery and chemotherapy are treatment modalities.

A narcotic drug used in the treatment of pain.

In traditional Chinese medicine, a type of heat therapy in which an herb is burned on or above the skin to warm and stimulate an acupuncture point or affected area.

A thick, slippery fluid made by the membranes that line certain organs of the body, including the nose, mouth, throat, and vagina.

Chemical abbreviation for sodium chloride (table salt).

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.

A federal agency that uses science to explore complementary and alternative medicine (CAM) practices, trains CAM researchers, and provides authoritative information about CAM to professionals and the public. NCCAM awards grants for research projects, training, and career development in CAM; sponsors conferences, educational programs, and exhibits; studies ways to use proven CAM practices along with conventional medical practice; and supports adding CAM to medical, dental, and nursing school programs. NCCAM is part of the National Institutes of Health. Also called NCCAM.

A federal agency in the U.S. that conducts biomedical research in its own laboratories; supports the research of non-Federal scientists in universities, medical schools, hospitals, and research institutions throughout the country and abroad; helps in the training of research investigators; and fosters communication of medical information. Access the National Institutes of Health Web site at http://www.nih.gov. Also called NIH.

A type of immune cell that has granules (small particles) with enzymes that can kill tumor cells or cells infected with a virus. is a type of white blood cell. Also called NK cell, NK-large granular lymphocyte, and NK-LGL.

A feeling of sickness or discomfort in the stomach that may come with an urge to vomit. Nausea is a side effect of some types of cancer therapy.

In acupuncture, the insertion of a thin needle into a specific place on the body to unlock qi (vital energy). The needle may be twirled, moved up and down at different speeds and depths, heated, or charged with a low electric current.

A bundle of fibers that receives and sends messages between the body and the brain. The messages are sent by chemical and electrical changes in the cells that make up the nerves.

A protein made by the body that causes certain nerve cells to grow and helps keep them alive.

A member of a class of protein-like molecules made in the brain. Neuropeptides consist of short chains of amino acids, with some functioning as neurotransmitters and some functioning as hormones.

A chemical that is made by nerve cells and used to communicate with other cells, including other nerve cells and muscle cells.

A type of immune cell that has granules (small particles) with enzymes that can kill tumor cells or cells infected with a virus. is a type of white blood cell. Also called natural killer cell, NK-large granular lymphocyte, and NK-LGL.

A clinical study that includes some, but not all, of the eligible patients identified by the researchers during the study registration period. This type of study does not usually have a control group.

In medicine, it describes a procedure that does not require inserting an instrument through the skin or into a body opening. In cancer, it describes disease that has not spread outside the tissue in which it began.

A clinical trial in which the participants are not assigned by chance to different treatment groups. Participants may choose which group they want to be in, or they may be assigned to the groups by the researchers.

A health professional trained to care for people who are ill or disabled.

Closely monitoring a patient's condition but withholding treatment until symptoms appear or change. Also called active surveillance, expectant management, and watchful waiting.

Blockage of a passageway.

The study of cancer.

The active ingredient in a drug used to treat nausea and vomiting caused by cancer treatment. Ondansetron is a type of serotonin receptor antagonist and a type of antiemetic.

A drug used to treat moderate to severe pain. Opioids are similar to opiates such as morphine and codeine, but they do not contain and are not made from opium.

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

A medical system that has been used for thousands of years to prevent, diagnose, and treat disease. It is based on the belief that qi (the body's vital energy) flows along 20 meridians (channels) throughout the body and keeps a person’s spiritual, emotional, mental, and physical health in balance. Oriental medicine aims to restore the body’s balance and harmony between the natural opposing forces of yin and yang, which can block qi and cause disease. Oriental medicine includes acupuncture, diet, herbal therapy, meditation, physical exercise, and massage. Also called TCM and traditional Chinese medicine.

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

A statistics term. A measure of probability that a difference between groups during an experiment happened by chance. The lower the p-value, the more likely it is that the difference between groups was caused by treatment.

Relief of symptoms and suffering caused by cancer and other life-threatening diseases. Palliation helps a patient feel more comfortable and improves the quality of life, but does not cure the disease.

The part of the nervous system that slows the heart, dilates blood vessels, decreases pupil size, increases digestive juices, and relaxes muscles in the gastrointestinal tract.

Having to do with a sign or symptom that is specific to a certain disease.

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 molecule that contains two or more amino acids (the molecules that join together to form proteins). Peptides that contain many amino acids are called polypeptides or proteins.

Passing through the skin, as an injection or a topical medicine.

Blood circulating throughout the body.

The process by which a phagocyte (a type of white blood cell) surrounds and destroys foreign substances (such as bacteria) and removes dead cells.

The first step in testing a new treatment in humans. These studies test the best way to give a new treatment (for example, by mouth, intravenous infusion, or injection) and the best dose. The dose is usually increased a little at a time in order to find the highest dose that does not cause harmful side effects. Because little is known about the possible risks and benefits of the treatments being tested, phase I trials usually include only a small number of patients who have not been helped by other treatments.

Medical doctor.

A substance found in plants that causes red blood cells to clump together and certain white blood cells to divide.

The initial study examining a new method or treatment.

The main endocrine gland. It produces hormones that control other glands and many body functions, especially growth.

An inactive substance or treatment that looks the same as, and is given the same way as, an active drug or treatment being tested. The effects of the active drug or treatment are compared to the effects of the placebo.

Refers to a clinical study in which the control patients receive a placebo.

A tiny piece of a cell found in the blood that breaks off from a large cell found in the bone marrow. Platelets help wounds heal and prevent bleeding by forming blood clots. Also called thrombocyte.

A condition marked by infertility, enlarged ovaries, menstrual problems, high levels of male hormones, excess hair on the face and body, acne, and obesity. Women with polycystic ovary syndrome have an increased risk of diabetes, high blood pressure, heart disease, and endometrial cancer. Also called PCOS.

After surgery.

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).

A drug used to prevent or reduce nausea and vomiting. It belongs to the family of drugs called antiemetics.

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.

In traditional Chinese medicine, vital energy or life force that keeps a person’s spiritual, emotional, mental, and physical health in balance.

A form of traditional Chinese mind/body exercise and meditation that uses slow and precise body movements with controlled breathing and mental focusing to improve balance, flexibility, muscle strength, and overall health.

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.

Energy released in the form of particle or electromagnetic waves. Common sources of radiation include radon gas, cosmic rays from outer space, medical x-rays, and energy given off by a radioisotope (unstable form of a chemical element that releases radiation as it breaks down and becomes more stable).

The use of high-energy radiation from x-rays, gamma rays, neutrons, protons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Also called irradiation and radiotherapy.

When referring to an experiment or clinical trial, the process by which animal or human subjects are assigned by chance to separate groups that compare different treatments or other interventions. Randomization gives each participant an equal chance of being assigned to any of the groups.

A study in which the participants are assigned by chance to separate groups that compare different treatments; neither the researchers nor the participants can choose which group. Using chance to assign people to groups means that the groups will be similar and that the treatments they receive can be compared objectively. At the time of the trial, it is not known which treatment is best. It is the patient's choice to be in a randomized trial.

A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell.

Inflammation of the mucous membrane that lines the rectum (the last several inches of the large intestine closest to the anus). Also called proctitis.

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

In medicine, an improvement related to treatment.

An autoimmune disease that causes pain, swelling, and stiffness in the joints, and may cause severe joint damage, loss of function, and disability. The disease may last from months to a lifetime, and symptoms may improve and worsen over time.

A cancer of the bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue.

In clinical trials, the step-by-step plan for how patients are to be treated; for example, the drug or type of radiation therapy that is to be given, the method by which it is to be given, the amount of time between courses, and the total length of treatment.

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

Having to do with the senses.

An inactive treatment or procedure that is intended to mimic as closely as possible a therapy in a clinical trial. Also called placebo therapy.

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.

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

Able to be dissolved in a liquid.

Having to do with the body.

Having to do with the spleen (an organ in the abdomen that makes immune cells, filters the blood, stores blood cells, and destroys old blood cells).

In medicine, treatment that experts agree is appropriate, accepted, and widely used. Health care providers are obligated to provide patients with standard therapy. Also called best practice and standard of care.

Unable to produce children. Also means free from germs.

An organ that is part of the digestive system. The stomach helps digest food by mixing it with digestive juices and churning it into a thin liquid.

Cancer that forms in tissues lining the stomach. Also called gastric cancer.

A form of medicine contained in a small piece of solid material, such as cocoa butter or glycerin, that melts at body temperature. A suppository is inserted into the rectum, vagina, or urethra and the medicine is absorbed into the bloodstream.

A small device that is attached to the skin to measure or cause electrical activity in the tissue under it. Surface electrodes may be used to look for problems with muscles and nerves.

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

The part of the nervous system that increases heart rate, blood pressure, breathing rate, and pupil size. It also causes blood vessels to narrow and decreases digestive juices.

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

Care given to improve the quality of life of patients who have a serious or life-threatening disease. The goal of symptom management is to prevent or treat as early as possible the symptoms of a disease, side effects caused by treatment of a disease, and psychological, social, and spiritual problems related to a disease or its treatment. Also called comfort care, palliative care, and supportive care.

A set of symptoms or conditions that occur together and suggest the presence of a certain disease or an increased chance of developing the disease.

Affecting the entire body.

A type of immune cell that can attack foreign cells, cancer cells, and cells infected with a virus. T cells can also help control immune responses. A T cell is a type of white blood cell. Also called T lymphocyte and thymocyte.

A form of traditional Chinese mind/body exercise and meditation that uses slow sets of body movements and controlled breathing. Tai chi is done to improve balance, flexibility, muscle strength, and overall health.

A drug used to treat certain types of breast cancer in women and men. It is also used to prevent breast cancer in women who have had ductal carcinoma in situ (abnormal cells in the ducts of the breast) and are at a high risk of developing breast cancer. Tamoxifen is also being studied in the treatment of other types of cancer. It blocks the effects of the hormone estrogen in the breast. Tamoxifen is a type of antiestrogen. Also called Nolvadex and tamoxifen citrate.

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

Treatment.

A drug used to prevent or reduce nausea and vomiting. It belongs to the families of drugs called antiemetics and phenothiazines.

Chest pain. Also called thoracalgia.

The larger of two bones between the knee and ankle. Also called shinbone.

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

A medical system that has been used for thousands of years to prevent, diagnose, and treat disease. It is based on the belief that qi (the body's vital energy) flows along 20 meridians (channels) throughout the body and keeps a person’s spiritual, emotional, mental, and physical health in balance. Traditional Chinese medicine aims to restore the body’s balance and harmony between the natural opposing forces of yin and yang, which can block qi and cause disease. Traditional Chinese medicine includes acupuncture, diet, herbal therapy, meditation, physical exercise, and massage. Also called Oriental medicine and TCM.

A procedure in which mild electric currents are applied to some areas of the skin. Also called TENS.

A substance made by some white blood cells. Transfer factor from one person’s white blood cells may be able to cause a specific immune response when injected into the skin of another person.

In medicine, the change that a normal cell undergoes as it becomes malignant.

A surgical procedure in which tissue or an organ is transferred from one area of a person’s body to another area, or from one person (the donor) to another person (the recipient).

A type of drug used to treat depression.

Use of acupuncture to treat pain by inserting needles into trigger points on the body. Trigger points are places on the body where injury has occurred, but the pain has been sent along nerves and is felt in another place in the body.

Chinese massage that uses kneading, pressing, rolling, shaking, and stretching of the body. Tui na is thought to regulate qi (vital energy) and blood flow, and improve the function of tendons, bones, and joints.

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.

The size of a cancer measured by the amount of space taken up by the tumor. For example, the tumor volume of prostate cancer is the percentage of the prostate taken up by the tumor.

Affecting the narrowing and widening of the blood vessels.

A tool used to help a person rate the intensity of certain sensations and feelings, such as pain. The visual analog scale for pain is a straight line with one end meaning no pain and the other end meaning the worst pain imaginable. A patient marks a point on the line that matches the amount of pain he or she feels. It may be used to help choose the right dose of pain medicine. Also called VAS.

Necessary to maintain life. Breathing is a vital function.

A nutrient that the body needs in small amounts to function and stay healthy. Sources of vitamins are plant and animal food products and dietary supplements. Some vitamins are made in the human body from food products. Vitamins are either fat-soluble (can dissolve in fats and oils) or water-soluble (can dissolve in water). Excess fat-soluble vitamins are stored in the body’s fatty tissue, but excess water-soluble vitamins are removed in the urine. Examples are vitamin A, vitamin C, and vitamin E.

To eject some or all of the contents of the stomach through the mouth.

Refers to a blood cell that does not contain hemoglobin. White blood cells include lymphocytes, neutrophils, eosinophils, macrophages, and mast cells. These cells are made by bone marrow and help the body fight infections and other diseases. Also called leukocyte and WBC.

Dry mouth. It occurs when the body is not able to make enough saliva.

In traditional Chinese medicine, a way of diagnosing disease based on observing a set of signs and symptoms. A practitioner checks Zheng by looking at the patient; asking questions; feeling the pulse, organs, and tissues; listening to body sounds; and smelling the body.