Cervical, Uterine and Ovarian cancers
Cancer of the cervix, an extension of the uterine endometrium, has been one of the most prevelant cancers worldwide for some time. Perhaps due to aggressive screening of precancerous HPV infection and cervical dysplasia and precancerous tissue changes, the incidence of cervical cancer in the United States is one fifth to one twelfth the rate in other countries. It is estimated that 30-50 percent of high-grade cervical dysplasia may lead to cervical cancer, and identifying these cell abnormalities in the early stages and reversing their growth and development is very important. On the other hand, the advancing of low-grade cervical hyperplasia to a spreading cancer is negligible. Identifying the grade of abnormal cell growth, or hyperplasia, is thus important, and an in-office colposcopy, or microscopic exam of the cervix, is used to perform this task. After this exam, where a small biopsy, or tissue sample, may be extracted to perform a laboratory analysis, or histology and cytology, an objective analysis of the type of abnormal cell growth may help determine the patient choice in treatment. In most cases, the typical treatment, involving destruction of the abnormal cells with conisation, loop electrical excision, laser or cryoaurterization, may be put off safely, especially if the woman is expecting to have children in the near future, as these techniques are shown to increase the risk of preterm delivery and mortality. Fortunately, excision or destruction of the hyperplasia, or abnormal cells, is not the only treatment option, and Complementary Medicine offers an array of therapeutic aids that may be integrated to correct the cell environment that causes cervical hyperplasia. In addition, a more benign treatment option for high-grade cervical dysplasia is now routinely used in Europe. The Photodynamic Therapy (PDT), with hexylaminoevulinate, was tested in 2011 at the University Women's Hospital at Hanover Medical School in Germany (Soergel P et al; PMID:22057499), and proven that this procedure is less costly than conisation and has much less risk of perinatal morbidity, mortality, and other health risks, with a 70 percent response rate, and a 50 percent recurrence rate, similar to conisation. These researchers also recommended this option as an excellent choice to integrate with herbal and nutrient medicine. Unfortunately, most gynecologists in the United States are loathe to even mention this less profitable option, or integration with Complementary Medicine. It may take some urging on the part of informed patients to achieve this.
More recent advances in cervical cancer screening have achieved better differentiation between benign and threatening cancers. Combining DNA testing with the initial PAP smear, and utilizing new cervical smear liquid-based cytology (ThinPrep), has been supported by large studies of the National Cancer Institute and the American Cancer Society, and should be requested by the patient. It has been confirmed that 19 types of human papilloma virus are associated with cervical cancer, although only 2 types at present, types 16 and 18, are considered high-risk. The combined use of DNA testing with the initial PAP smear increases the accuracy of screening considerably, avoiding many false positives and the stress and worry that accompany them. Studies have indicated that this initial testing combination of negative HPV DNA and PAP indicates the absence of CIN3 (cervical intraepithelial neoplasm stage 3) or cancer with nearly 100 percent certainty. A higher degree of certainty of diagnosing CIN2 is also achieved, and if these tests are negative, increased assurance of low risk of cancer is achieved. Large studies indicate that after such negative screening results, that the incidence of cancer and other problems detected in women receiving a follow-up PAP DNA test in 3 years was no different from those receiving the test each year. This reassurance from improved screening tests affords greater peace of mind to women, and thus better health and quality of life. Understanding these nuances of the testing and diagnostic procedures is thus important.
A comprehensive treatment program that addresses both the underlying causes and the variety of problems in the cellular environment that lead to cervical dysplasia, and a program of prevention and preventive medicine that includes more than just the testing and excision, but also includes Complementary and Integrative Medicine (CIM) and patient education is needed. Waiting until cancer becomes a serious and immediate threat is not a sensible solution, and many intelligent women today are studying this pathology and taking sensible measures to prevent its development.
There is today a notion that vaccinating against the human papilloma virus (HPV) will be a panacea, but while this may be of help in preventing cervical dysplasia, there is not evidence that it will in fact be effective. The effectiveness of viral vaccines have not been demonstrated to date, but the adverse effects have been well noted. Even the influenza vaccine, developed and used extensively for a number of decades in the U.S. has not effectively reduced the mortality associated with virulent strains of this virus. The length of time the HPV vaccine will be effective has been called into question by its leading researchers, and the ability of viruses to adapt and mutate has hampered all attempts at utilization of viral vaccines to date. Even if the types of HPV that are associated with cervical dysplasia and cancer are reduced in the population from a legally mandated vaccination of all prepubescent girls and boys, there will still be the cervical cancers that are now unassociated with these HPV types, which account presently for about 25 percent of all cervical cancers. To effectively prevent and treat cervical cancer, we cannot adopt such a narrow allopathic method of prevention alone.
All respected medical websites and authoritative sources will inform patients that there is a high association between 2 to 4 types of human papilloma virus (HPV) and high-grade cervical dysplasia that may progress to cancer, but that the precise cause of cervical dysplasia remains unknown. While the introduction of an HPV vaccine has given the impression that elimination of 2 of the many types of HPV will eliminate cervical cancer, this is highly unlikely. With few preventive options in standard medicine, the vaccine may be the best aid to decreasing this cancer in standard practice, but there a number of options researched in Complementary Medicine that may address the array of known contributors to the cancerous cell mutations. Whether the human papilloma virus wil mutate to new associated types in the future, or whether other types of common low-grade infection will be found to contribute to the cellular environment that allows cervical dysplasia and spreading cancers is unknown. There is an array of preventive measures and treatment protocols that the individual may take advantage of to insure that cervical cancer is properly prevented and treated.
In the United States, it is estimated that two of the many types of human papilloma virus (HPV) are associated with nearly 75 percent of cervical cancers, types 16 and 18. All types of HPV can cause an abnormal Pap test in females, though, and an abnormal Pap does not have a significant rate of risk of advancing to a serious malignant cancer. Pap tests are important as a first line of screening, but should not be a cause of worry and fear. Genital warts are also caused by HPV virus, and two other types of HPV than those that cause cervical cancer are responsible for about 90 percent of genital warts. When an abnormal Pap test occurs, a series of further screening tests may be performed to identify the small percentage of women with a risk of a dangerous cancer, and for most women this will rule out a significant cancer risk. A Pap smear or biopsy may be performed and identify the various types of squamous cell lesions or endocervical epithelial neoplasias. These abnormalities are called dysplasia, or abnormal growths in the cervical membrane (epithelium) that may turn into a cancerous growth. Most changes of dysplasia occur in women ages 25-35, but may occur at any age. There are a number of effective strategies for preventing the development of cancerous growth when dysplasia, or abnormality of size, shape or organization of cells in the cervical membrane, occurs. Changing the cellular environment that is responsible for this pathological progression is very important. Monitoring these changes with mild to moderate cervical dysplasia is the standard of treatment today, but many women are now also utilizing Complementary and Integrative medicine to take a more proactive approach and do all that can be done to change the cellular environment and discourage the development of cancer from cervical dysplasia. Utilizing a knowledgeable professional to help in this regard may be the key to success.
Cervical cancer has been about the tenth leading cause of cancer death in the United States in recent decades. In 2007, the CDC reported that a little over 12 thousand women were diagnosed and about 4000 died of cervical cancer. The CDC lists risk factors for cervical cancer as the use of birth control synthetic hormones for five years or more, and smoking, as well as poor immune function and immunosuppression from drugs such as corticosteroids. Since contracting of a sexually transmitted virus is associated with up to 90 percent of cervical cancers, the limiting of sexual partners and use of a condom or antiviral contraceptive are listed as important ways to decrease risk, along with a yearly Pap test, or a Pap test with DNA testing and liquid-based cytology performed every 3 years. Since viral infections are more likely to persist when the vaginal membrane is irritated, control of yeast infections and other forms of vaginitis may also be important in the prevention of acquiring the few types of sexually transmitted HPV associated with cervical dysplasia and cancer. In 2002, legislation was proposed in the U.S. congress to increase funding for NIH microbicidal research that could also lead to ease of use of an antiviral agent on condoms, diaphragms, cervical caps, or contraceptive gels, and was defeated, as was a similar bill in the U.S. senate sponsored by the Republican senator Olympia Snow. An emphasis is now placed on the HPV vaccine developed by Merck pharmaceuticals, which presents many significant unanswered questions concerning benefit and risks, and which is being heavily promoted by the pharmaceutical industry without a real questioning of the benefit versus risks, thus giving the public a false impression of the efficacy of this strategy to effectively further reduce the incidence and mortality of cervical cancer.
Controversies surrounding the mandating of the HPV vaccine and its efficacy
There may be an unspoken reason behind the huge amount of money involved in the marketing of the HPV vaccine as the primary preventive measure against cervical cancer. The vaginal ring (OrthoEvra) may also be associated with a higher risk of cervical cancer, given that the use of the combination progestin and synthetic estradiol is associated with an increased risk of viral infections such as HIV in large studies, and that the vaginal ring also has a risk of irritation of the vaginal membrane, vaginitis, and increased incidence of yeast infections, all of which increase the risk of the human papilloma virus (HPV) types that are associated with most cervical cancers to infect and spread. Added to this is the finding by the manufacturer that the vaginal ring is associated with a higher risk of uterine cancer. Since Merck is the manufacturer of both the popular OrthoEvra vaginal ring contraceptive and the most popularly prescribed HPV vaccine, Gardasil, there is an obvious reason why Merck is investing so heavily into lobbying to mandate the HPV vaccines in prepuberty, which may alleviate future concerns about the OrthoEvra vaginal ring and the increased risk of cervical cancer. But the question of the HPV vaccine has not addressed the effectivness, or the risk-versus-benefit, of this vaccine.
In 2009, Dr. Diane Harper, a lead researcher for Merck who helped design the phase 2 and 3 trials of Gardasil, the HPV vaccine, questioned the efficacy of this vaccine (see the link to the CBS investigative report below). Dr. Harper stated that data showed that the vaccine lasted a mere 5 years, with no data to support its effectiveness after this time period. Dr. Harper stated: "If we vaccinate 11 year olds and the protection doesn't last...we've put them at harm from side effects, small but real, for no benefit. The benefit to the public health is nothing, there is no reduction in cervical cancers, they are just postponed, unless the protection lasts for 15 years, and over 70 percent of all sexually active females of all ages are vaccinated (to significantly stop the spread of the HPV strains that cause cancer)." Dr. Harper also stated that the risks of serious adverse events after taking the HPV vaccine is comparable to the rate of serious cases of cervical cancer in the population, and that she believes that these risks with the vaccine are underreported, as they are based statistically on the denominator of doses distributed from Merck's warehouse, not the number of doses taken by the patients. Dr. Harper also stated that she believes that the aggressive marketing by Merck may be giving women a false sense of security, undermining sensible measures that can be taken by women to decrease the risk of HPV and of cervical and uterine cancers. A majority of Americans are now infected with HPV, but only a few strains of the virus are found to potentially cause cancers. Almost all of the high-risk types of HPV cause no health problems and will clear with a healthy immune response. The risk of HPV in cancer is the persistent infection, and the occurrence of cell changes in the cervical epithelium that may lead to metastatic cancer. A series of steps, starting with PAP smears, will determine if these cells are progressing to a dangerous cancer. The PAP test does not reveal the presence of cancer, and an abnormal PAP may be positive even when HPV is not present, so this test is merely the first step in diagnosing or ruling out cancer, unless the PAP test is combined with DNA testing and ThinPrep liquid-based cytology. If this type of PAP test is requested by the patient, the test alone, recommended once every 3 years, will effectively rule out cancerous cells. Standard PAP tests have been lauded as the reason for a 70 percent reduction in cervical cancer in the United States, and the addition of this combined PAP, DNA and ThinPrep test will certainly decrease the incidence much more.
While some proven measures to reduce human papilloma viral infection have been denied funding, such as simple and inexpensive antivirals added to barrier contraceptives, and the addition of herbal antivirals to the preventive protocol, the push by public health authorities for the universal HPV vaccine, sometimes mandated by state government, has been strong, despite the fact that the vaccine Gardasil cost $120 per dose when it was introduced, and requires 3 doses over a 6-month period to be considered effective. In 2012, Gannett Health Services of Cornell University cited the cost of the 3-dose Gardasil vaccine as $450, usually not covered by standard health insurance, and often paid for by government funded programs. A study published in the New England Journal of Medicine in 2008 stated that the cost of Gardasil for 12-year olds was calculated to be about $43,600 per quality adjusted life year gained, and that some researchers cited a $100,000 cost per quality adjusted life year gained, especially if the analysis is extended to the group of 12 to 18 year olds targeted. The estimated cost for all women through age 26 was estimated to be $133,600 for each quality-adjusted life year potentially gained. The cost for benefit, as well as the lack of evidence of benefit, for women older than 26 years old, has resulted in lack of FDA approval for the vaccine in older women. Many health economists are highly skeptical of the practical cost nature of this vaccination program, much less the still unproven ultimate benefits. While prominent legislators of both parties have proposed research to find a low-cost and safer method of preventing human papilloma virus, one that would also prevent other viral causes of cervical cancer, massive pharmaceutical lobbying has nullified these efforts.
By 2013, though, public health authorities and Merck Pharmaceuticals became concerned that the acceptance of the huge push to vaccinate all preteen girls in the United States with HPV vaccine had hit a snag. Statistics showed that barely 25 percent of these preteen and teenage girls had even gotten one vaccination in the 7 years of the vaccine existence, and that there was widespread concern among mothers about the need for and safety of the human papilloma viral vaccine, Gardasil. A number of news stories started to emerge on an almost weekly basis, such as the claim that preventing HPV would also prevent the occurrence of throat cancers in older men who had a history of performing oral sex, since HPV may be the main cause in this type of cancer as well (HPV is associated with just 12 percent of these cancers). Health authorities noted in June of 2013 that the most cancer causing of the HPV strains had already seen a drastic reduction in occurrence, with 2 strains of HPV believed to be responsible for (rather associated with) cervical cancer, types 16 and 18, dropping 56 percent in incidence in women tested that were between the age of 14 and 19. This occurred since 2006, yet the percentage of preteen and teenage women and girls that received even one dose of the HPV vaccine prior to 2010 was less than 15 percent, and since then only about 25 percent. A remarkable drop in cancer-associated HPV viral strains had occurred, yet the correlation with the vaccination program seemed not entirely clear. The explanation for this phenomenon was that the most sexually active of girls age 12 to 16 must have been vaccinated and created a herd immunity concept of benefit for the entire subset of the population. It is thought that each year in the United States that 14 million more people become infected with HPV, yet only about 12,000 new cases of cervical cancer occur yearly, and about 4000 deaths from metastatic cervical cancer occur. About 3000 cases of other types of cancer potentially caused by, or associated with, HPV also occur yearly. Current estimates find that 3 in 4 Americans from the age of 19 to 49 are now infected with HPV virus, though, with only about 1 percent of infected persons having noticeable symptoms. When nearly 80 percent of young Americans are infected with a family of viruses, yet only 12,000 out of 350 million acquire a cervical cancer, this raises a question of whether too much of our focus is on the human papilloma virus. Many questions remain in the public mind regarding the safety and effectiveness of the HPV vaccine, as well, and only time will tell if this is an effective strategy in the end with more benefits than risks.
Safer strategies to prevent pathogenic HPV and Cervical Cancer
There may be a number of simple strategies to reduce the risk of human papilloma virus types that may cause, but for now are only known to be associated with, cervical cancer. Of course, use of a condom or antiviral barrier could effectively reduce the risk of acquiring the types of HPV that cause the cancer, as well as the limiting of sexual partners. In 2002, legislation was introduced in the U.S. congress to increase NIH funding for research into antimicrobial and antiviral chemicals that could inexpensively be used to both effect contraception and the acquiring of sexually transmitted HPV, as well as HIV. These chemicals could be included with condoms, diaphragms and cervical caps, or be included in spermacidal gels and foams. Similar legislation was proposed in the U.S. senate, sponsored by the Republican senator Olympia Snow. Both of these acts were defeated, while the lobbying to promote the HPV vaccine reached enormous levels. Since the HPV virus needs a route of entry into the tissue membranes, and a less acidic environent to survive, a decrease in the irritation of the vaginal membrane from yeast infections as well as low-grade bacterial vaginosis, and a maintenance of the normal homeostatic pH of the vagina would be very effective in prevention. The use of lactic acid bacteria, or probiotic strategies, has been proposed, and douches with yoghurt containing these probiotics has long been used as an effective way to control alkalinity. Semen may be very alkalinizing, and the vaginal pH is often much less acidic following sexual intercourse. The vaginal acidity changes in the menstrual cycle, and is least acidic on the days just prior to and during menstruation, making infections more common with intercourse at these times. Researchers at the University of Pittsburgh investigated the use of suppositories of Lactobacillus crispatus that could be inserted monthly, or after coitus, to maintain high vaginal bacterial populations and a homeostatic acidic environment unfriendly to HPV. Studies researching the combining of such a strategy with the seaweed extract carrageenan, which would have antimicrobial properties and thicken the vaginal secretions to prevent viral entry, have also been found promising. Antiviral chemicals in Chinese herbs have been used for some time to effectively provide a suppository to treat a broad spectrum of vaginal infections, including yeasts and bacteria, and could be added to this simple preventive measure.
In 2011, a number of medical colleges in the United States became active in discovering whether herbal medicine could actually work to inhibit HPV (human papilloma virus) and cervical cancer. There is a realization that uncertainty still exists concerning the relationship between HPV and cervical cancer, with no studies making clear that HPV is actually a cause of abnormal cell growth, or just that HPV more easily grows in the cells in cervical dysplasia. Searching for new treatment protocols that both inhibit viral growth and infection, and decrease the mechanisms that promote abnormal cell growth, has gained momentum. The College of Staten Island developed a curcumin cream (Vacurin) that eliminated HPV cancer cells (HeLa) in laboratory animals, without adverse effects on tissues. This simple strategy eliminates not just the HPV but the actual high-risk cervical dysplasia. Curcumin, an active chemical in a number of common Chinese herbs (Curcuma long and zedoria for example), has been shown to be an effective antiviral, and anti-HPV agent, as well as a strong antioxidant and anti-cancer herbal chemical, but systemic delivery with enough potency has been problematic with oral use. A strong topical cream may be the answer. West Virginia University School of Medicine also found that curcumin may be used topically as a contraceptive aid, exerting anti-fertility effects that are reversible and safe, as well as significantly decreasing sperm motility and function (Mol Reprod Dev 2011 Feb; 78(2): 116-23 PMID: 21337449). These researchers point out that such an herbal cream could be useful as a contraceptive aid with barrier methods, such as diaphragms and cervical caps, and also inexpensively protect against HPV and HIV infection, and cancer. Whether HPV really is the cause of cervical cancer, or just associated with inflamed and hyperplastic cells, is still a question, but such a simple protocol as an herbal cream may offer protection for all the possibilities, without adverse effects and health risks.
Nutritional research has uncovered a number of chemicals that may be effective in prevention, or as an adjunct in treatment, for cervical cancer. For instance, research in 2011 at King Saud University in Saudi Arabia (PMID: 21967781) found that catechins in green tea demonstrated significant inhibition of the SiHa human cervical cancer cells with sufficient concentration, inducing cell apoptosis. Of course, to obtain a sufficient concentration, pill supplements may be needed, but it wouldn't hurt to drink green tea as well. Other nutritional strategies have been researched, and the use of DIM (diindolymethane) and plant Lignans has shown great promise as both a preventive and treatment, affecting the underlying hormonal mechanisms that promote abnormal cell growth. A large epidemiological study by the Yonsei University College of Medicine in Seoul, South Korea, found that there was a significant benefit from increase in dietary antioxidants, and that antioxidant micronutrients play a role in the prevention of cervical cancer (PMID: 19589102). A study at the Kyung Hee University College of Medicine in Seoul, South Korea, also found that blood plasma levels of beta-carotene and lycopene were inversely associated with risk of endometrial cancer in a sizable epidemiological study (PMID: 19235557). A 2008 study at the University of Brasilia, Brazil, found that fatty acid imbalances were highly associated with uterine and cervical cancers, with patients diagnosed with these cancers studied, and findings that weight loss programs with fatty acid depletion and decreased ingestion of healthy proteins was correlated with cancer onset. These researchers found that the blood plasma ratio of 18:0/18:1 fatty acids may serve as an indirect marker of fatty acid disregulation and correlate with prognosis in cervical and uterine cancers (PMID: 18485542). The 18:1 fatty acids that were found deficient include oleic acid, and the 18:2n linoleic acid, as well as the 16:0 hexadecanoic acid and palmitic acid. The inclusion of healthy cold-pressed oils (olive, walnut), fresh nuts, seeds, and whole grains, would supply these fatty acids, as well as a GLA (gamma linoleic acid) supplement, and the microalgaes spirulina, chlorella and blue-green algae. In addition, such prestigious institutions as the Unversity of Maryland Medical Center have listed these as the standard dietary recommendations: dark, leafy green vegetables, beans, almonds, broccolini, kale, collard greens, cabbage, berries, squash, bell pepper, and a variety of healthy unprocessed oils, which will supply a calcium-rich chlorophyll, phytohormonal chemicals, antioxidants, and beneficial essential fatty acids. In addition this source counsels avoidance of transfats, refined foods, processed oils, and reduction in consumption of red meats, alcohol, coffee, caffeine, and other stimulants when appropriate. They also consider these nutritional supplements applicable: omega-3 fatty acids, folic acid (5MTHF with liquid B12), Vitamin A (beta-carotene), Vitamin E (balanced tocopherols), essential minerals (selenium, magnesium, zinc), digestive enzymes, Coenzyme Q10 100-200 mg at bedtime (CoQ10-H2), N-acetyl cysteine 200 mg, acidophilus (or a probiotic regimen), grapefruit seed extract, and MSM (methylsulfonylmethane). All of these recommendations from a renowned University Medical Center come with the side effect of better overall health.
A number of Chinese herbs have been found to be effective as an adjunct therapy in the treatment of cervical cancer. For example, research in 2010, at the Shinsegae Women's Hospital in Busan, South Korea, found that the Chinese herb Trypterygium wilfordii, or Lei gong teng, induces caspase-dependent, mitochondrial-mediated apoptosis (programmed cell death) in cervical cancer cells, in part by negatively regulating the inflammatory pathways related to Akt and Mcl-1 (PMID: 20878065). Research at the Sharati Vidyapeeth University Medical College in Pune, Maharashtra, India, in 2010, found that the Chinese herb Cinnamomum cassia, or Rou gui, both inhibited growth and migration of cervical cancer cells, and inhibited the expression of the growth factor Her-2 as well. Rou gui also induced apoptosis (programmed cell death) in human cervical cancer cells by increases in intracellular calcium signalling and loss of mitochondrial membrane potential. These researchers concluded that Rou gui could be used as a dose-dependent effective chemopreventive for cervical cancer (PMID: 20482751). Many other Chinese herbs have been similarly researched and found to have great potential, including Curcuma wenjuyin, an essential oil extract of the Chinese herb Curcuma aromatica, or Yu jin, Artemesia princeps (eupafolin flavonoid), and Smilax chinensis, or Tu fu ling (Kaempferol-7-O-beta-D-glucoside). The potential for Chinese herbal medicine to effectively add to strategies to prevent or treat cervical cancer is now well documented. The University of Maryland Medical Center cited above provides documentation and recommendation for these herbs: green tea catechins, uncaria tomentosa (Cat's claw), curcuma longa (turmeric or other curcumin Chinese herbs), Reishi mushroom extract (ganoderma lucidum), and bromelain (ananus comosus), all of which are commonly prescribed in TCM practice. A link to the UMM website is available by clicking here: http://www.umm.edu/altmed/articles/cervical-dysplasia-000034.htm. These are the most studied of the herbal therapies, but certainly do not represent the totality of researched herbs, and perhaps not the most specific and potent. Current research is uncovering a wealth of data on herbal chemistry and clinical application at a fast rate. Enhanced curcumin has been developed in a patented process and is now available as the product LongVida, optimized with a solid lipid coating to decrease metabolization and deactivation before it reaches target cells. A topical capsule suppository with the potent antiviral Isatis seu baphicanthi (Ban lan gen), and other antiviral herbal extracts, is available as well (Vagistatin HC). A number of products now offer a combination of boswellia and green tea catechins, such as Advanced Inflammation Control, by Vitamin Research Products. The array of profession products available for prescription by a Licensed herbalist is growing and supported by scientific evidence.
Understanding of the pathophysiology of cervical and uterine cancers helps guide therapy in treatment of aggressive cancers as well as prevention and treatment of cervical dysplasia. Cervical cancer can occur in the endoepithelium or squamous cells of the cervical membrane. Epithelium is the surface membrane of most structures in the body, and the functions of epithelial tissue include protection, secretion and absorption, as well as transcellular transport and sensation. Epithelial tissues are not vascularized and depend on nourishment via diffusion of fluids from underlying tissues. The endocervical epithelium is one type of tissue where dysplasia occurs, and where adenocarcinoma (cancer of the glandular epithelium) may arise. The endocervical tissue is a term that refers to the uterine tissues that serve as the canal from the vagina, or the cervix, and the term endo- means within. 85-90 percent of cervical cancers occur in the squamous cells, which are also part of the epithelium, though, and are the more superficial cells. Thus the surface epithelium, or membrane, of the canal of the uterus is where almost all cervical cancers originate. The immune system of the vagina and cervix maintains an environment that prevents irritation of these delicate and thin squamous cells of the epithelium. The chief immune protection in the vagina is the biota, or balance of symbiotic bacteria. A type of bacteria, the lactobacillus, produces the acidic lactate, which maintains an acidic environment that prevents the growth of pathological microbes and virally infected cells. An alkaline environment allows the spread of papilloma virus and other inflammatory agents, and inhibits the effectiveness of the immune responses to a virus. Maintaining the proper homeostatic acidic environment, treating mild yeast infections and other membrane irritants when they occur, and avoiding the use of hormonal contraceptive rings such as NuvaRing may be important in the prevention of squamous cell dysplasia of the cervical epithelium. Clinical trials of the NuvaRing produced vaginitis and leukorrhea in up to 14 percent of the study participants, with the synthetic hormones in the ring producing cervical erosion or ulceration in some of the women.
The immune responses in the vagina and cervix have not been well studied. A 1998 study at Marshall University School of Medicine note the "limited information available on the mucosal immunity of the lower reproductive organs", and noted that the CD4/CD8 ratio in the human vaginal mucosa is reversed compared to the gut membrane lymphocytes. A 2002 study at Louisiana University Health Sciences Center noted that a common infection of the vaginal mucosa, candidiasis, was poorly understood, but study revealed that immune responses to Candida are site-specific, and involve unique responses in vaginal mucosa from both the innate and acquired immune systems, and both systemic and local responses. This tells us that the support of the normal homeostatic mechanisms of immune health are what are important in preventing the viral pathology and mucosal ill health that leads to cervical cancer. Complementary Medicine takes a holistic approach to restore this homeostatic mechanism, and while this may be more complicated than an allopathic approach, we can clearly see the need for such a holistic restorative approach with current research.
Neuroendocrine cervical cancer and other subtypes indicate a need to address more than just the human papilloma virus in the prevention of aggressive cervical cancers
Small-cell neuroendocrine cancers (SNCC) of the cervix and uterus represent a relatively small subset of these cancers that is particularly aggressive, often leading to a more rapid spread, or metastasis. These neuroendocrine cancers, and adenocarcinomas, or cancers of the hormonal glands, represent the most aggressive type of cervical cancer (adenomas refer to the benign form of glandular tumors). Most cases of cervical cancer involve squamous cell cancer, by far the least dangerous and aggressive. Together, these more aggressive hormonal types of cervical cancer, adenocarcinoma and neuroendocrine, represent a sizable percentage of cervical cancers, and present the most concern. Small cell neuroendocrine cancers are seen throughout the body, and present a similar phenotype of cellular appearance, yet are distinguished and varied by the type of damage to the genetic allele (half of the gene expression) linked to their tissue site origins. While studies indicate that small cell neuroendocrine cancers of the cervix represent only about 2 percent of the total diagnosed, they are the most aggressive, and this number may be misleading, as concurrent diagnosis of other types of cervical cancer often occur, and these small cell neuroendocrine cancer cells easily migrate and end up being diagnosed as lung cancer, pancreatic cancer, etc. Cancer of unknown primary site represent about 5 percent of all invasive cancers.
Neuroendocrine tumors are increasingly common and still poorly understood. They arise from a cell type, unlike many other common cancers, and have not been well studied. This type of cancer is not associated with most types of HPV, and most cases of small cell neuroendocrine cancer of the cervix and uterus present with negative Pap smears. Most experts attribute the rise in incidence of these neuroendocrine cancers to improved diagnostic classification and recognition, implying that they were overlooked in the diagnostic algorithm of the past. In 1997, the College of American Pathologists and the National Cancer Institute identified 4 types of neuroendocrine cancers of the uterine cervix, small cell, large cell, typical and atypical carcinoid, each of which were associated with adenocarcinoma or squamous cell carcinoma. Experts are looking for specific markers for diagnosis of these more aggressive cancers, as well as a better multidisciplinary treatment protocol. The growing field of neurohormonal immunology may also provide answers to the complex causative factors and means of prevention.
Herbal medicine in the care of cervical cancer - Recent advances in research
In 2014, Dr. Richard Schlegel of the Georgetown University Medical Center, the inventor of Gardasil vaccine for prevention of cervical cancer, announced that his pioneering research in oncology found that a chemical in a Chinese herb, Artemesia Qinghao, now standardized as a very effective anti-malarial medicine, artemesinin, showed a surprising anticancer effect on cervical cancer cells. Dr. Schlegel is now collaborating with oncologists at Johns Hopkins University School of Medicine, and Dr. Connie Trimble, to complete a randomized controlled human clinical trial of artemesinin for women diagnosed with early stage cervical cancer, to prove the efficacy of this herbal chemical in prevention of a potentially deadly form of cancer. Prior studies (cited below with links in Additional Information) have showed that artemesinin and hydroartemisinin is a potent inhibitor of ovarian, cervical, colon and lung cancer cell growth, with evidence of induction of apoptosis and inhibition of G2 growth cycle effects in specific cancer cell lines.
In an interview with National Public Radio (NPR) in 2014, Dr. Schlegel described how he was able to overcome the problem of direct study of cancer cells in the laboratory, which are difficult to keep alive outside the body, and hence research on direct cancer cell effects of drugs and herbs has been sparse. Dr. Schlegel was able to take cancer cells from hundreds of patients and keep these cells in a living and growing environment in the laboratory almost indefinitely. He then systematically tested many medicines to discover unknown anticancer effects specific to cancer cell lines. To his great surprise, the most dramatic early discovery was not the effects of a pharmaceutical drug, but one derived from Chinese Herbal Medicine. As this method expands, with over 30 labs in the world using this pioneering research method in 2014, more and more research proving the efficacy of specific herbal chemicals is sure to occur. Also, the key to this research is the discovery that a medium of cells derived from the mouse is able to provide the growth factors and nutrient producing effects needed to sustain the cancer cells in the laboratory, and future research is sure to determine specific nutrient molecules, and the chemical environment, which sustain this cancer cell growth in this mouse cell medium. Such research is sure to reveal just how we may utilize nutrient and herbal medicine, integrated with synthetic biological chemistry, to alter the growth cycle of many types of cancer. Obviously, the focus on inhibiting cancerous growth, and the environment of cancerous spread and subversion of normal cell programmed death, or apoptosis, provides us finally with a way to safely inhibit and prevent cancerous growth. Hopefully, the example of the success of artemisinin, a naturally derived herbal chemical, will be a precursor to expanded integration of Complementary Medicine in cancer care.
Ovarian Cancers
Ovarian cancer is one of the most aggressive types of cancer in the United States, primarily because adequate preventive measures are not taken, and most ovarian cancers are caught too late, already metastasized, or spread from the ovary. Ovarian cancer is the leading cause of death from cancers of the female reproductive system in the United States. In 2013, a study at the University of California, Irvine, found that a majority of women with ovarian cancer do not receive the best type of intervention for these metastasized ovarian cancers, and that referral to specialized hospitals and clinics that utilized the most advanced surgical and chemotherapy techniques could add years to the life of these patients. Cytoreduction surgery combined with HIPEC (hyperthermic intraperitoneal chemotherapy) has been found to kill more of the microscopic cancer cells spread throughout the abdomen, with much less adverse effect, since the heated chemotherapy is drained and rinsed from the abdominal cavity after the procedure. Women should insist on this type of treatment, and afterward, consult a Complementary Medicine physician to help restore health and function. More importantly, though, is a better protocol to prevent ovarian cancer. The current protocols in standard medicine, pushing synthetic hormone contraceptives that cause anovulation, as well as the high rate of use of artificial reproductive technology, with harsh chemicals that hyperstimulate the ovaries and cause swelling and overproduction of egg follicles, is not a sensible approach. We already have ample evidence that hormone replacement therapy after menopause significantly increased the risk and occurrence of Ovarian cancers, despite decades of advice reassuring women that this was not the case, but that it was protective. Now women are asked to trust these same authorities in recommending more synthetic hormones to prevent ovarian cancers. Pregnancies and breastfeeding are proven to significantly reduce the incidence of ovarian cancers, primarily because of the resetting of natural hormonal homeostasis achieved with these natural processes. Complementary Medicine provides a balanced approach utilizing restoration of ovulatory and menstrual hormonal function, better control of inflammatory mechanisms, and sensible nutrient medicine. Resolving problems with obesity, Metabolic Syndrome, and other underlying health problems is also important, and a holistic approach with Complementary Medicine should be integrated with your standard care.
Research in recent years has found that an important nutrient molecule in the body, d-chiro inositol, is highly associated in metabolic imbalance with polycystic ovarian syndrome (PCOS), obesity, insulin resistance, and perhaps ovarian cancer. A research summary printed in the 2006 issue of Diabetes Care, the journal of the American Diabetic Association, and conducted at the University of Sherbrooke, Quebec, Canada (Jean-Patrice Baillargeon MD et al), showed that urinary clearance of this metabolite correlated highly with insulin sensitivity in women with PCOS, the most common cause of anovulatory infertility in the United States and Canada. PCOS and insulin resistance is associated with increased risk of ovarian cancer, cardiovascular disease, and type 2 diabetes, or Metabolic Syndrome. This study showed that women with PCOS had a circulating concentration of d-chiro inositol that was half of normal, and an excess urinary clearance rate, indicating poor utilization and metabolism. Subsequent studies revealed that d-chiro inositol is involved in the hormonal triggers at the membrane in the ovarian egg follicle, and a deficiency is linked to overstimulation of the ovary with localized testosterone. While it may be years before large clinical studies identify d-chiro inositol as an aid to decreased risk of ovarian cancer, the evidence of benefit is strong. In studies of women with PCOS, supplementation with d-chiro inositol showed lowered free testosterone, increased insulin sensitivity, and increased frequency of ovulation. While this appears to be contrary to the advice of standard medicine, namely to artificially prevent ovulation with synthetic hormones to prevent ovarian cancer, many sensible proactive women are looking for a restoration of healthy homeostasis, not an allopathic blocking of function, as a sensible approach.
Other scientific studies of nutrient medicine in prevention of ovarian cancer have identified higher intake of dietary fiber, total carotenoids (Vitamin A family), stigmasterol (plant sterols, or phytosterols), and total plant lignans, as nutrients correlated with lowered risk of ovarian cancer (Susan E. McCann et al; 2003 The American Society of Nutritional Sciences). Potent lignans from the Norway Spruce have been extracted in a patented process, producing NuLignan. Phytosterols, including stigmasterol, are found in a number of herbs, including saw palmetto, bitter melon, gou qi zi berry, fennel seed, Reishi mushroom, black cumin seed, evening primrose oil, Ashwaghanda (Withania somnifera), and various common Chinese herbs. These phytosterols are more available in alcohol extracts, which capture the fat-based molecules, or food spreads containing such phytosterol-rich foods as wheat germ oil, rice bran oil, unrefined sesame seed oil, and pumpkin seed oil. Also whole grain buckwheat, peanuts, fresh nuts and seed, and legumes may supply a significant amount of phytosterols. In addition, a 2012 study at Texas Tech University Health Sciences Center (Prabodh K Kandala and Sanjay K Srivastava), printed in BMC Medicine, concluded that DIM (diindolylmethane), a nutrient molecule derived from I3C found in cruciferous vegetables, "targets STAT3 to suppress the growth of ovarian tumor cells in vitro and in vivo...inhibits angiogenesis and invasion of ovarian cancer cells...and potentiates the effect of cisplatin (chemotherapy) both in culture as well as in a tumor xenograft model." In 2013, research at the University of Louisiana at Monroe (PMID: 24231340) found that the nutrient molecule gamma-tocotrienol, in the Vitamin E family, exerted significant cytotoxic effects on various breast cancer cell lines at a normal dosage, which had no adverse effects on normal breast cells. Utilization of these healthy nutrient medicines, D-chiro inositol, NuLignan, gamma-tocotrienol, and ProDIM, together with herbal medicine and acupuncture, may provide an important adjunct therapy for prevention and treatment of ovarian and breast cancer, and provide an array of other health benefits as well.
Endometrial Cancer
Endometrial cancer involves the lining of the uterus, and affects approximately 2.7 percent of women in their lifetime. About 75 percent of cases of endometrial cancer occur after menopause, with peak incidence in the late 60s, and a survival rate in the United States of 81.5 percent at 5 years. This type of cancer is the most common type of gynecological cancer in developed countries. Risk factors include the use of Tamoxifen therapy for more than a year, unopposed synthetic estrogen in hormone replacement therapy, polycystic ovarian syndrome, obesity, diabetes and Metabolic Syndrome, and late menopause. Postmenopausal bleeding occurs in about one-third of cases, and should be investigated with biopsy. Estrogen dominance is thought to be the main factor that drives endometrial cancer, both stimulating tissue growth in the uterine lining, as well as tissue healing, perpetuating the factors that drive many cancers, inflammatory processes, and excess growth factors. Diagnostic tools include the transvaginal ultrasound to evaluate endometrial thickness, biopsy, and dilation and curretage (D and C) with hysteroscopy. Endometrial cancer needs to be detected before it spreads to the lymph system, bladder or bowel mucosa. The primary treatment in standard medicine is a surgical hysterectomy, but a host of therapies should be integrated with Complementary Medicine before the need for a surgical hysterectomy is apparent. Most women could prevent this scenario, and the time to focus on prevention is during perimenopause, or when hormonal imbalances causing more severe premenstrual syndrome (PMS), anovulation, polycystic ovarian syndrome, or endometriosis occur prior to perimenopause. By 2014, a few very small studies showed positive results in early stage cervical cancers associated with PCOS treated with a combination of Diane-35 hormonal ablation and metformin for 6 months, and this is now presented as an option. Diane-35 is a drug called cyproterone acetate, a synthetic steroidal antiandrogen progestin, introduced in 1964, but still not approved by the U.S. FDA due to liver toxicity and other adverse effects. In the United States, this protocol substitutes medroxyprogesterone acetate, or Depo-Provera, which acts as an agonist of receptors for progesterone, androgen and glucocorticoids, and comes with a long history of dissatisfaction for many women due to adverse side effects and prolonged amenorrhea or irregular menstruation after stopping use. Metformin is a widely used medication to inhibit insulin resistance in Type 2 diabetes, but large randomized controlled human clinical studies have shown that it may have little efficacy to treat PCOS. If a short course of hormonal ablation and metformin is utilized in early stage endometrial cancer with PCOS, Complementary and Integrative Medicine may provide significant benefits to resolve adverse effects of medication and restore hormonal and metabolic balance.
Obviously, treatment of hormonal imbalance in menopause or perimenopause, polycystic ovarian syndrome (PCOS), Metabolic Syndrome, and obesity, integrating Complementary Medicine, would be sensible to decrease the risk of endometrial cancer. The focus should be on countering estrogen dominance, and simple saliva tests and short courses of low-dose bioidentical hormonal creams to stimulate increased progesterone and supply increased pregnenelone often restore hormonal balance and resolve estrogen dominance effectively and safely when guided by a knowledgeable Complementary Medicine physician. Combining an array of therapeutic procotols that are individualized and based on sound research is possible in therapy from a Licensed Acupuncturist and herbalist. The only side effect is better overall health and quality of life. Research has also found that balancing the omega-6 and omega-3 essential fatty acids, and consuming a higher percentage of nutrients from plant sources, especially fiber, retinol, beta-carotene, vitamin C, and vitamin E lower risk for endometrial cancer (PMCID: PMC2039904). This type of comprehensive therapeutic protocol could be life-saving.