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Cancer Surgery: What You Need to Know Ahead of Time
By Dr. Steven Nemeroff, Oncology Health Advisor
Life Extension Foundation
The surgical removal of the primary tumor has been the cornerstone of treatment for the great
majority of cancers. The rationale for this approach is straightforward: if you can get rid of the cancer
by simply removing it from the body, then a cure can likely be achieved. Unfortunately, this approach
does not take into account that after surgery the cancer will frequently metastasize (spread to
different organs). Quite often the metastatic recurrence is far more serious than the original tumor. In
fact, for many cancers it is the metastatic recurrence—and not the primary tumor—that ultimately
proves to be fatal.
In a shocking irony, a growing body of scientific evidence has revealed that cancer surgery can
increase the risk of metastasis.1 This would fly in the face of conventional medical thinking, but the
facts are undeniable.
To gain a better understanding of how surgery can increase the risk of metastasis, let’s first discuss
the actual process of cancer metastasis. A complicated sequence of events must occur in order for
cancer to spread to another part of the body.1 Isolated cancer cells that break away from the primary
tumor must first breach the connective tissue immediately surrounding the cancer. Once the cancer
cell has broken free of the surrounding connective tissue, the next step is to enter a blood or
lymphatic vessel. This is easier said than done, as entry into a blood vessel requires the cancer cell to
secrete enzymes that degrade the basement membrane of the blood vessel.3 Entry into a blood
vessel is vitally important for the aspiring metastatic cancer cell, since it uses the bloodstream as a
highway for transportation to other vital organs of the body—such as the liver, brain, or lungs—where
it can form a new deadly tumor.
Now that the lone cancer cell has finally entered the bloodstream, its problems have only just begun.
Traveling within the bloodstream can be a hazardous journey for cancer cells. Turbulence from the
fast moving blood can damage and destroy the cancer cell. Furthermore, cancer cells must avoid
detection and destruction from white blood cells circulating in the blood stream.
To complete its voyage, the rogue cancer cell must adhere to the lining of the blood vessel, where it
degrades through and exits the basement membrane of the blood vessel. Its final task is to burrow
through the surrounding connective tissue to arrive at the organ that is its final destination. Now the
cancer cell can multiply and form a growing colony that serves as the foundation for a new metastatic
cancer. Time is working against these solitary cancer cells. This entire sequence of events must
happen quickly, since these cells have a limited lifespan.2
We now see that cancer metastasis is a complicated and difficult process. Fraught with peril, very few
free-standing cancer cells survive this arduous journey.1 The probability of cancer cells surviving this
journey and forming new metastases can be increased by anything that serves to make this process
easier. In a groundbreaking study published in the medical journal Annals of Surgery in 2009,
researchers reported that cancer surgery itself can create an environment in the body that greatly
lessens the obstacles to metastasis that cancers cells must normally face.1
Just as concerning is the revelation that cancer surgery can produce an alternate route of metastasis
that bypasses natural barriers. During cancer surgery, the removal of the tumor almost always
disrupts the structural integrity of the tumor and/or the blood vessels feeding the tumor. This can
lead to an unobstructed dispersal of cancer cells into the bloodstream, or seeding of these cancer
cells directly into the chest or abdomen.4,5 This surgery-induced "alternate route" can greatly simplify
the path to metastasis. To illustrate, a study published in the British Journal of Cancer in 2001
compared the survival of women with breast cancer who had their tumors removed surgically, to the
survival of women with breast cancer who did not have surgery. The findings established that surgery
substantially improved survival compared to the group that did not have surgery. However, further
analysis of the data determined that women who had surgery had a spike in their risk of death at 8
years that was not evident in the group who did not have surgery.6 In their interpretation of the
results, the authors of the study stated: "A reasonable hypothesis to explain the observed
patterns of the hazard functions [risk of cancer death] is to assume that…primary tumor
removal may result in sudden acceleration of metastatic process…" Another group of
researchers commenting on this study were far bolder in their conclusions : "This finding strongly
supports that surgery alters the natural course of the disease by elongating life
expectancy in the greater part of the patient population, but also by simultaneously
shortening survival in a smaller subset of patients. Thus, both experimental and clinical
evidence support that surgery, although greatly reducing tumor mass and potentially
curative, paradoxically can also augment metastasis development." 1
Given these disturbing findings, what can individuals undergoing surgery for their cancers do to
protect themselves against an increased risk of metastasis? A worthwhile strategy would be to
examine all of the mechanisms by which surgery promotes metastasis, and then create a
comprehensive plan that counteracts each and every one of these mechanisms.
One mechanism by which surgery increases the risk of metastasis is by enhancing cancer cell
adhesion. Cancer cells that have broken away from the primary tumor utilize adhesion to boost their
ability to form metastasis in distant organs. These cancer cells must be able to clump together and
form colonies that can expand and grow. It is unlikely that a single cancer cell will form a metastatic
tumor, just as one person is unlikely to form a thriving community. Cancer cells use adhesion
molecules--called galectin-3—to facilitate their ability to clump together. Present on the surface of
cancer cells, these molecules act like "Velcro®" by allowing free-standing cancer cells to adhere to
each other.7 Cancer cells circulating in the bloodstream (CTC) also make use of galectin-3 surface
adhesion molecules to latch onto the lining of blood vessels.8 The adherence of circulating tumor cells
(CTC) to the blood vessel walls is an essential step for the process of metastasis. Just like a person
sliding down an icy hill has no hope of stopping if they cannot grab onto something, a cancer cell that
cannot adhere to the blood vessel wall will just continue to wander through the blood stream
incapable of forming metastasis. Unable to latch onto the wall of the blood vessel, these circulating
tumor cells (CTC) become "ships without a port" and are unable to dock. Eventually, white blood cells
circulating in the blood stream will target and destroy the CTC. If the CTC successfully bind to the
blood vessel wall and burrow their way through the basement membrane, they will then utilize
galectin-3 adhesion molecules to adhere to the organ to form a new metastatic cancer. 7
Combating Cancer Cell Adhesion
Regrettably, research has shown that cancer surgery increases tumor cell adhesion. In one
experiment that mimicked surgical conditions, scientists reported that the binding of cancer cells to
the blood vessel walls was increased by 250%, compared to cancer cells not exposed to surgical
conditions.9 Therefore, it is critically important for the person undergoing cancer surgery to take
measures that can help to neutralize the surgery-induced increase in cancer cell adhesion.
Fortunately, a natural supplement called modified citrus pectin (MCP) can do just that. Citrus
pectin—a type of dietary fiber—is not absorbed from the intestine. However, modified citrus pectin
has been altered so that it can be absorbed into the blood and exert its anti-cancer effects. The
mechanism by which modified citrus pectin inhibits cancer cell adhesion is by binding to galectin3 adhesion molecules on the surface of cancer cells, thereby preventing cancer cells from sticking
together and forming a cluster.10 Modified citrus pectin can also inhibit circulating tumor cells from
latching onto the lining of blood vessels. This was demonstrated by an experiment in which modified
citrus pectin blocked the adhesion of galectin-3 to the lining of blood vessels by an astounding
95%. Modified citrus pectin also substantially decreased the adhesion of breast cancer cells to the
blood vessel walls.10
Impressive research has documented the power of modified citrus pectin to directly inhibit cancer
metastasis. In a study published in the Journal of the National Cancer Institute, modified citrus pectin
was administered to rats that were injected with prostate cancer cells, while rats not receiving
modified citrus pectin served as the control group. Lung metastasis was noted in 94% of the control
group, whereas only 50% of the modified citrus pectin group experienced lung metastasis. Even
more noteworthy was the finding that the modified citrus pectin group had an 89% reduction in the
size of the metastatic colonies, compared to the control group.11 In a similar experiment, mice
injected with melanoma cancer cells that were fed modified citrus pectin experienced a greater than
90% reduction in lung metastases compared to the control group.12
After these exciting findings in animal research, modified citrus pectin was then put to the test in men
with prostate cancer. In this trial, 10 men with recurrent prostate cancer received modified citrus
pectin (14.4 grams per day). After one year, a considerable improvement in cancer progression was
noted, as determined by a reduction of the rate at which the PSA increased. 13 This was followed by a
study in which 49 men with advanced prostate cancer were given modified citrus pectin for a fourweek cycle. After two cycles of treatment with modified citrus pectin, 21% of the men experienced a
stabilization of their disease or improved quality of life; 12% had stable disease for more than 24
weeks. The authors of the study concluded that "MCP (modified citrus pectin) seems to have
positive impacts especially regarding clinical benefit and life quality for patients with far
advanced solid tumor."14
Please remember that these prostate cancer study subjects already suffered from advanced disease.
It would appear more logical if these patients had initiated modified citrus pectin supplementation
before surgical procedures to prevent metastatic colonies from being established, as was done in the
successful laboratory studies.
In addition to modified citrus pectin, a well-known over-the-counter medication can also play a pivotal
role in reducing cancer cell adhesion. Cimetidine—commonly known as Tagamet® --is a drug
historically used to alleviate heartburn. A growing body of scientific evidence has also revealed that
cimetidine possesses potent anti-cancer activity. Cimetidine inhibits cancer cell adhesion by blocking
the expression of an adhesive molecule—called E-selectin—on the surface of cells lining blood
vessels.15 Cancers cells latch onto E-selectin in order to adhere to the lining of blood vessels. By
preventing the expression of E-selectin, cimetidine significantly limits the ability of cancer cell
adherence to the blood vessel walls. This effect is analogous to removing the Velcro® from the blood
vessels walls that would normally enable circulating tumor cells to bind.
Cimetidine’s potent anti-cancer effects were clearly displayed in a report published in the British
Journal of Cancer in 2002. In this study, 64 colon cancer patients received chemotherapy with or
without Cimetidine (800mg per day) for one year. The 10-year survival for the Cimetidine group was
84.6%. This is in stark contrast to the control group, which had a 10-year survival of only 49.8%.
Remarkably, for those patients with a more aggressive form of colon cancer, the 10 year survival was
85% in those treated with Cimetidine compared to a dismal 23% in the control group.16 The
authors of the study concluded, "Taken together, these results suggested a mechanism
underlying the beneficial effect of cimetidine on colorectal cancer patients, presumably
by blocking the expression of E-selectin on vascular endothelial [lining of blood vessels]
cells and inhibiting the adhesion of cancer cells". These findings were supported by another
study with colorectal cancer patients whereby cimetidine given for just seven days at the time of
surgery increased 3-year survival from 59% to 93%!17
This data provides a compelling case for cancer patients, at least five days prior to surgery, to ingest
800 mg of cimetidine daily and at least 14 grams of modified citrus pectin daily. This
combination regimen may be followed for a year or longer to reduce metastatic risk.
Preventing Surgery-induced Immune Suppression
The essential role the immune system plays in combating cancer cannot be overstated. Although
there are many aspects of the immune system that come into play when fighting cancer, the role of
the natural killer cell predominates. Natural killer (NK) cells are a type of white blood cell tasked with
seeking out and destroying cancer cells. Research has shown that NK cells can spontaneously
recognize and kill a variety of cancer cells.18 To illustrate the importance of NK cell activity in fighting
cancer, a study published in the journal Breast Cancer Research and Treatment examined NK cell
activity in women shortly after surgery for breast cancer. The researchers reported that low levels of
NK cell activity were associated with an increased risk of death from breast cancer.19 In fact, reduced
NK cell activity was a better predictor of survival than the actual stage of the cancer. In another
alarming study, individuals with reduced NK cell activity before surgery for colon cancer had a 350%
increased risk of metastasis during the following 31 months!41
The likelihood of surgery-induced metastasis requires the immune system to be highly active and
vigilant in seeking out and destroying renegade cancer cells during the perioperative period (the time
immediately before and after surgery). Tragically, numerous studies have documented that cancer
surgery results in a substantial reduction in NK cell activity.20-23 In an investigation having ominous
implications, NK cell activity in women having surgery for breast cancer was reduced by over 50%
on the first day after surgery.20 In light of this mounting evidence, a group of researchers stated:
"We therefore believe that shortly after surgery, even transitory immune dysfunction
might permit neoplasms [cancer] to enter the next stage of development and eventually
form sizable metastases."23
The surgical procedure itself reduces NK activity. This NK impairing effect that occurs immediately
after surgery could not happen at a worse possible time. NK cell activity falters at the very time it is
most needed to fight metastasis. The surgery-induced increased risk of metastasis combined with a
reduction in NK cell activity can have disastrous consequences for the person undergoing cancer
surgery. With that said, the perioperative period presents a window of opportunity to actively
strengthen immune function by enhancing NK cell activity. Fortunately, numerous nutraceutical,
pharmaceutical, and medical interventions known to enhance NK cell activity are available to the
person undergoing cancer surgery.
One prominent natural supplement that can increase NK cell activity is PSK, a specially prepared
extract from the mushroom Coriolus. PSK has been shown to enhance NK cell activity in multiple
studies.24-27 PSK’s ability to enhance NK cell activity helps to explain why it has been shown in
numerous studies to dramatically improve survival in cancer patients. For example, 225 patients with
lung cancer received radiation therapy with or without PSK (3 grams per day). For those with more
advanced stage 3 cancers, more than three times as many individuals taking PSK were alive after 5
years (26%), compared to those not taking PSK (8%). PSK more than doubled 5-year survival in
those individuals with less advanced stage 1 or 2 disease (39% vs.17%).28
A group of colon cancer patients were randomized to receive chemotherapy alone or chemotherapy
plus PSK, which was taken for 2 years. The group receiving PSK had an exceptional 10-year survival
of 82%. Sadly, the group receiving chemotherapy alone had a 10 year survival of only 51%.29 In a
similar trial reported in the British Journal of Cancer in 2004, colon cancer patients received
chemotherapy alone or combined with PSK (3 grams per day) for 2 years. In the group with a more
dangerous stage 3 colon cancer, the 5-year survival was 75% in the PSK group. This compared to a
5-year survival of only 46% in the group receiving chemotherapy alone.30 Research has confirmed
that PSK also improves survival in cancers of the breast, stomach, esophagus, and uterus/cervix.31-34
Other nutraceuticals that have been documented to increase NK cell activity are garlic, glutamine, IP6
(inositol hexaphosphate), AHCC (active hexose correlated compound), and lactoferrin. 35-39 One
experiment in mice with breast cancer found that glutamine supplementation resulted in a 40%
decrease in tumor growth paired with a 2.5-fold increase in NK cell activity.38
Scientists in Germany explored the effects of mistletoe extract on NK cell activity in 62 patients
undergoing surgery for colon cancer. The participants were randomized to receive an intravenous
infusion of mistletoe extract immediately before they were given general anesthesia, or were general
anesthesia alone. Measurements of NK cell activity were taken before and 24 hours after surgery. As
expected, the group that did not receive mistletoe experienced a 44% reduction in NK cell activity 24
hours after surgery. Interestingly, the scientists reported that the group receiving mistletoe did not
experience a significant decrease in NK cell activity after surgery. They went on to conclude that
"perioperative infusion of mistletoe extracts can prevent a suppression of NK cell activity
in cancer patients.42
Pharmaceuticals used to increase NK cell activity include interferon-alpha and granulocytemacrophage colony stimulating factor. These drugs were shown to prevent surgery-induced
immune suppression when given perioperatively.95,96 Another immune boosting drug to consider in
the perioperative setting may be interleukin-2.
At least five days prior to surgery, it would appear logical to institute a natural killer (NK) cell
enhancing program involving nutrients like PSK, lactoferrin, glutamine and others.
Drugs such as interleukin-2 and granulocyte-macrophage stimulating factor are approved in the
United States, but health insurance does not usually cover them for the perioperative purposes
suggested here. If you have any questions regarding the natural supplements or drugs discussed in
this article, call 1-888-884-3666.
Heightening Immune Surveillance with Cancer Vaccines
An enlightened medical approach to cancer treatment involves the use of cancer vaccines. The
concept is the same as using vaccines for infectious diseases, expect that tumor vaccines target
cancer cells instead of a virus. Another distinguishing feature of tumor vaccines is that while viral
vaccines are created from a generic virus, tumor vaccines are produced from a person’s own cancer
cells removed during surgery. This is a critical distinction since there can be considerable genetic
differences between cancers. This highly individualized cancer vaccine greatly amplifies the ability of
the immune system to identify and target any residual cancer cells present in the body. Cancer
vaccines provide the immune system with the specific identifying markers of the cancer that can then
be used to mount a successful attack against metastatic cancer cells.
Cancer vaccines have been studied extensively, with the most encouraging results noted in trials
including over 1300 patients in which tumor vaccines were given after surgery. These trials reported
reduced recurrence rates and improved survival.93 Unlike chemotherapy which can cause severe side
effects and toxicity, cancer vaccines are a gentle therapy with proven long-term safety.94
In a landmark study conducted in 2005, 567 individuals with colon cancer were randomized to receive
surgery alone, or surgery combined with vaccines derived from their own cancer cells. The median
survival for the cancer vaccine group was over 7 years, compared to the median survival of 4.5 years
for the group receiving surgery alone. The 5-year survival was 66.5% in the cancer vaccine group,
which dwarfed the 45.5% 5-year survival for the group receiving surgery alone.92 This glaring
difference in 5-year survival, clearly displays the power of individually tailored cancer vaccines to
greatly focus a person’s own immunity to target and attack residual metastatic cancer cells.
Cancer Surgery, Angiogenesis, and Metastasis
Cancers employ a clever strategy in their quest to grow and thrive within the body. Angiogenesis is
the process by which new blood vessels are formed from pre-existing blood vessels. The formation of
new blood vessels is a normal and necessary process for childhood growth and development, as well
as for wound healing. Unfortunately, cancers hijack this otherwise normal process in order to increase
blood supply to the tumor. The formation of new blood vessels supplying the tumor is an absolute
requirement for successful metastasis since tumors cannot grow beyond the size of a pinhead (i.e. 12mm) without expanding their blood supply.
It might be surprising to learn that the presence of the primary tumor serves to inhibit the growth of
metastatic cancer elsewhere in the body. The primary tumor produces anti-angiogenic factors which
restricts the growth of metastases.43-45 These anti-angiogenic factors inhibit the formation of new
blood vessels to potential sites of metastatic cancer. Regrettably, the surgical removal of the primary
cancer also results in the removal of these anti-angiogenic factors, and the growth of metastasis is no
longer inhibited. With these restrictions lifted, it is now easier for small sites of metastatic cancer to
attract new blood vessels that promote their growth.40 Indeed, these concerns were voiced by
researchers who declared that "...removal of the primary tumor might eliminate a safeguard
against angiogenesis and thus awaken dormant micrometastasis [small sites of
metastatic cancer]."23
As if the loss of angiogenic inhibition by the primary tumor were not enough of a problem, it turns out
the surgery causes another angiogenic predicament. After surgery, levels of factors that increase
angiogenesis—called vascular endothelial growth factor (VEGF)—are significantly elevated. This
can result in an increased formation of new blood vessels supplying areas of metastatic cancer. A
group of scientists summarized this research quite well when they asserted that "after surgery, the
angiogenic balance of pro- and antiangiogenic factors is shifted in favor of angiogenesis
to facilitate wound healing.1 Especially levels of vascular endothelial growth factor
(VEGF) are persistently elevated.46,47 This may not only benefit tumor recurrence and the
formation of metastatic disease, but also result in activation of dormant
micrometastases."48
Given the metastatic cancer’s need for an expanding blood supply, then inhibition of angiogenesis
would certainly be an integral part of a comprehensive strategy to combat surgery-induced
metastasis. To that end, various nutrients have been shown to inhibit VEGF. These include soy
isoflavones (genistein), silibinin (a component of milk thistle), chrysin, green tea (EGCG), and
curcumin.49-56
In one experiment, EGCG—the active constituent of green tea—was administered to mice with
stomach cancer. The results demonstrated that green tea reduced the tumor mass by 60%, while
also reducing the concentration of blood vessels feeding the tumor by 38%. Remarkably, EGCG
decreased the expression of VEGF in cancer cells by an astounding 80%! The authors of the study
concluded "EGCG inhibits the growth of gastric cancer by reducing VEGF production and
angiogenesis, and is a promising candidate for anti-angiogenic treatment of gastric
cancer".49
In the evaluation of the research pertaining to curcumin’s anti-angiogenic effects, researchers at
Emory University School of Medicine noted that "curcumin is a direct inhibitor of angiogenesis
and also downregulates various proangiogenic proteins like vascular endothelial growth
factor…Cell adhesion molecules are upregulated in active angiogenesis and curcumin can
block this effect, adding further dimensions to curcumin's antiangiogenic
effect…Curcumin's effect on the overall process of angiogenesis compounds its enormous
potential as an antiangiogenic drug."97
Five days prior to surgery, the patient may consider supplementing with standardized green tea
extract, curcumin, soy genistein extract and other nutrients that suppress VEGF and thus may help
protect against angiogenesis. If you have any questions regarding the natural supplements or drugs
discussed in this article, call 1-888-884-3666.
The Choice of Surgical Anesthesia Can Influence Metastasis
The conventional medical approach to surgical anesthesia has been the use of general anesthesia
during surgery, followed by intravenous morphine after surgery for pain control. The conventional
approach, however, may not be the optimal approach for preventing surgery-induced metastasis. The
use of morphine directly after surgery poses significant problems. At a time when immune function is
already suppressed, morphine further weakens the immune system by diminishing NK cell activity. 57
One study found that morphine increased angiogenesis and stimulated the growth of breast cancer in
mice. The researchers concluded: "These results indicate that clinical use of morphine could
potentially be harmful in patients with angiogenesis-dependent cancers."58 Surgical
anesthesia has also been shown to weaken NK cell activity.59
Given the inherent problems associated with the use of morphine and anesthesia, researchers have
explored other approaches to surgical anesthesia and pain control. One novel approach is the use of
conventional general anesthesia combined with regional anesthesia, which refers to anesthesia that
only affects a specific part of the body. The benefits achieved with this approach are two-fold: the
use of regional anesthesia reduces the amount of general anesthesia required during surgery, as well
as decreasing the amount of morphine needed after surgery for pain control. 40
This elegant approach to surgical anesthesia and pain control has been validated in scientific studies.
In one experiment, cancerous mice received surgery with general anesthesia alone or combined with
regional anesthesia. The scientists reported that the addition of regional anesthesia to general
anesthesia "markedly attenuates the promotion of metastasis by surgery." Regional
anesthesia reversed 70% of the metastasis-promoting effects of surgery caused by general
anesthesia alone.60
Doctors at Pennsylvania State University College of Medicine compared NK cell activity in patients
receiving general or regional anesthesia for abdominal surgery. NK cell activity dropped substantially
in the general anesthesia group, while NK cell activity was preserved at pre-operative levels in the
group that received regional anesthesia.61
Building upon these encouraging findings, researchers then explored if regional anesthesia can affect
metastasis in women undergoing surgery for breast cancer. In a pioneering study, 50 women having
breast cancer surgery with general anesthesia combined with regional anesthesia were compared to
79 women who received general anesthesia during their breast cancer surgery followed by morphine
for pain control. The type of regional anesthesia used is called a paravertebral block, which
involves the injection of a local anesthetic around the spinal nerves between the vertebral bones of
the spine. After a follow-up period of 3 years, dramatic differences were noted between the two
groups. Only 6% of patients who received regional anesthesia were diagnosed with liver, lung, or
bone metastasis, compared to a 24% risk of metastatic recurrence in the group that did not receive
regional anesthesia. Stated differently, women who received regional and general anesthesia had a
75% decreased risk for metastatic cancer. Furthermore, the women who did not receive regional
anesthesia had almost a 7-fold greater risk of lymph node metastasis compared to the women who
received regional anesthesia. These startling findings led researchers to proclaim that regional
anesthesia for breast cancer surgery "markedly reduces the risk of recurrence or metastasis
during the initial years following surgery."40
Surgeons at Duke University Medical Center then compared regional anesthesia alone to general
anesthesia in women having surgery for breast cancer. The surgeons reported that while 39% of the
general anesthesia group required medication for nausea and vomiting, only 20% of the regional
anesthesia group needed this medication. Narcotic medication was needed for pain control after
surgery in 98% of the general anesthesia group, compared to only 25% of the regional anesthesia
group. 96% of the women receiving regional anesthesia had returned home within a day after
surgery, compared with 76% of the women who received general anesthesia. The surgeons
concluded that regional anesthesia "can be used to perform major operations for breast
cancer with minimal complications...Most importantly, by reducing nausea, vomiting, and
surgical pain, paravertebral block [regional anesthesia] markedly improves the quality of
operative recovery for patients who are treated for breast cancer and therefore provides
the patient with the choice to return home as early as desired after surgery." 63
The results of these studies have vast implications for those undergoing cancer surgery, as a group of
researchers enthusiastically announced: "As regional techniques [anesthesia]…are easy to
implement, inexpensive, and do not pose a threat greater than general anesthesia, it
would be easy for anesthesiologists to implement them, thus reducing the risk of disease
recurrence and metastasis."40
Finally, those requiring morphine for pain control after surgery can consider asking their doctor for a
medication called tramadol instead. Unlike morphine, tramadol does not suppress immune function.
On the contrary, tramadol has been shown to stimulate NK cell activity. In one experiment, tramadol
blocked the formation of lung metastasis induced by surgery in rats. Tramadol also prevented the
surgery-induced suppression of NK cell activity.64
Less Invasive Surgery Reduces Risk of Metastasis
Surgery places an enormous physical stress upon the body. There is considerable scientific evidence
supporting that surgeries that are less invasive—and therefore less traumatic—pose less risk of
metastasis, compared to more invasive and traumatic surgery. Laparoscopic surgery is one type of
minimally invasive surgery, in which operations in the abdomen, pelvis and other regions are
performed through small incisions, as compared to the much larger incisions needed in traditional
"open" surgeries.
A study published in the prestigious medical journal The Lancet compared laparoscopic to open
surgery in patients with colon cancer. In contrast to the group receiving traditional open surgery, the
laparoscopic surgery group had a 61% decreased risk of cancer recurrence coupled with a 62%
decreased risk of death from colon cancer. The surgeons concluded that "LAC [laparoscopic
surgery] is more effective than OC [open surgery] for treatment of colon cancer in terms
of…tumor recurrence and cancer-related survival."65 A similar study reported a 56%
decreased risk of death from colon cancer for laparoscopic surgery as compared to traditional open
surgery.66 Another comparison of laparoscopic surgery to open surgery for colon cancer reported a 5year survival rate of 64.1% for the laparoscopic group, and a 5-year survival rate of 58.5% for the
group receiving open surgery.67
Minimally invasive surgery has produced substantial improvements in survival for those with lung
cancer. Video-assisted thoracic surgery (VATS), a minimally invasive surgery was compared to
traditional open surgery. The 5-year survival from lung cancer was 97% in the VATS group. This
greatly contrasts the 79% 5-year survival in the open surgery group.68
Commenting on the use of minimally invasive surgery for lung cancer, surgeons at Cedars-Sinai
Medical Center stated: "VL [minimally invasive surgery] can be performed safely with
proven advantages over conventional thoracotomy [chest surgery] for lobectomy
[removal of the lung]: smaller incisions, decreased postoperative pain,…decreased blood
loss, better preservation of pulmonary function, and earlier return to normal activities…
the evidence in the literature is mounting that VATS may offer reduced rates of
complications and better survival."69
Inflammation and Metastasis
Cancer surgery causes an increased production of inflammatory chemicals, such as interleukin-1.70-72
These chemicals are known to increase the activity of cyclooxygenase-2 (COX-2). A highly potent
inflammatory enzyme, COX-2 plays a pivotal role in promoting cancer growth and metastasis. This
was evident in an article appearing in the journal Cancer Research that found levels of COX-2 in
pancreatic cancer cells to be 60 times greater than in normal pancreatic cells. 73 Levels of COX-2 were
150 times higher in cancer cells from individuals with head and neck cancers compared to healthy
volunteers.74 COX-2 fuels cancer growth by stimulating the formation of new blood vessels feeding
the tumor.75,76 COX-2 increases cancer cell adhesion to the blood vessel walls.77 Cox-2 also enhances
the ability of cancer cells to metastasize, as experiments with mice revealed that colon cancer cells
expressing high levels of COX-2 metastasized freely to the liver, while colon cancer cells expressing
low levels of COX-2 did not metastasize to the liver.77
The adverse influence of COX-2 on the growth and progression of cancer was clearly revealed in a
study published in the journal Clinical Cancer Research in 2004. 288 individuals undergoing surgery
for colon cancer had their tumors examined for the presence of COX-2. The findings were alarming—
the group whose cancers tested positive for the presence of COX-2 had a 311% greater risk of death
compared to the group whose cancers did not express COX-2.78 A subsequent study in lung cancer
patients found that those with high tumor levels of COX-2 had a median survival of only 15 months,
whereas those with low tumor levels of COX-2 had a median survival of 40 months.79
Given these findings, researchers began investigating the anti-cancer effects of COX-2 inhibitor drugs.
Although initially used for inflammatory conditions, such as arthritis, COX-2 inhibitor drugs have been
shown to possess powerful anti-cancer activity. For example, 134 patients with advanced lung cancer
were treated with chemotherapy alone or combined with Celebrex® (a COX-2 inhibitor). For those
individuals with cancers expressing higher amounts of COX-2, treatment with Celebrex® resulted in a
dramatic 66% reduced risk of death compared to those who did not receive Celebrex®.80 Treatment
with Celebrex® also slowed cancer progression in men with recurrent prostate cancer. 81
Perhaps the most impressive display of the anti-metastatic effects of COX-2 inhibitor drugs was
presented at the annual conference of the American Society of Clinical Oncology in 2008. In this
study, the incidence of bone metastases in breast cancer patients who had taken a COX-2 inhibitor
for at least 6 months following the diagnosis of breast cancer was compared to the incidence of bone
metastases in breast cancer patients who had not taken a COX-2 inhibitor. Remarkably, those in the
high-risk group who were treated with a COX-2 inhibitor were 90% less likely to develop bone
metastases than those who were not treated with a COX-2 inhibitor drug.82
Non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen, are COX-2 inhibitors.
The widespread use of NSAIDs for pain and arthritis has created an ideal environment in which to
examine if these drugs can prevent cancer. Large-scale studies have documented a substantial
reduction in cancer risk with the use of NSAIDs. A comprehensive review of the scientific literature
(91 published studies) reported that the long-term use of NSAIDs (primarily aspirin) produced risk
reductions of 63% for colon cancer, 39% for breast cancer, 36% for lung cancer, 39% for prostate
cancer, 73% for esophageal cancer, 62% for stomach cancer, and 47% for ovarian cancer. "This
review provides compelling…evidence that regular intake of NSAIDs that…block COX-2
protects against the development of many types of cancer", the authors concluded.83
A number of nutritional and herbal supplements are known to inhibit COX-2. These include curcumin,
resveratrol, vitamin E, soy isoflavones (genistein), green tea (EGCG), quercetin, fish oil, feverfew, and
silymarin (milk thistle).84-91
Scientists at Memorial Sloan-Kettering Cancer Center in New York created an experimentally-induced
4-fold increase in COX-2 activity in human breast cells, which was completely prevented by
resveratrol. Resveratol blocked the production of COX-2 within the cell, as well as blocking COX-2
enzyme activity.86
To discuss the latest dosing recommendations for the use of nutrients (and drugs) in suppressing
inflammatory reactions, call 1-888-884-3666.
Conclusion
A group of noted experts in the field of surgery-induced metastasis stated that cancer treatment
"…necessitates the surgical excision of the primary tumor in order to relieve the patient
of the major tumor burden, which is the main source of mutating and metastasizing cells.
However, along with its obvious benefits, the surgical procedure has been suggested to
involve serious hazards as it releases tumor cells into the circulation or lymphatics,
promotes the secretion of angiogenic and growth factors, and induces suppression of
CMI [immune function]. These consequences synergistically facilitate the establishment
of new metastases and the development of preexisting micrometastases. As cancerrelated death is most commonly the result of metastatic disease, it is crucial to minimize
this facilitation…Taken together, it is evident that the perioperative period harbors many
risks; however, it is also the ideal time for battling MRD [small numbers of cancer cells
remaining after surgery] to reduce recurrence and future metastases…Therefore it is
essential to employ preventative interventions during this critical time…Ideally, each
problematic aspect of surgery should be treated when oncological patients undergo
resection [surgery] in order to minimize recurrence and metastatic spread."40
Armed with the knowledge discussed in this chapter, the person with cancer can reap all the benefits
that cancer surgery offers, while simultaneously avoiding the metastatic perils imposed by this
procedure.
If you have any questions regarding the natural supplements or drugs discussed in this article, call 1888-884-3666.
Read more on Cancer Surgery Special Report – Dosage Suggestions
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