The treatment of ovarian cancer is based on the stage of the disease, which is a reflection of the extent that the cancer has spread to other parts of the body. Treatments include surgery, chemotherapy, radiation, and biological therapy.

Surgery: When an ovarian tumor or cancer is found, removal of the ovaries or ovary (oophorectomy) is commonly performed. Removal of both ovaries makes the individual sterile and they cannot get pregnant. If all of the tumor can not be removed, the surgeon might remove as much as possible in a procedure called debulking or cytoreduction. If the cancer has spread, other organs may be removed such as the fallopian tubes and womb. Surgery is generally believed to greatly increase a woman's chance for surviving ovarian cancer. Other surgeries such as bilateral salpingo-oophorectomy (removal of the fallopian tubes and ovaries on both sides), omentectomy (removal of the fatty tissue that covers the bowels), lymphadenectomy (removal of one or more lymph nodes) may also be performed.

Chemotherapy: Chemotherapy refers to the use of drugs to kill cancer cells. Usually the drugs are given into a vein or by mouth. This treatment is especially useful when cancer has spread beyond the ovaries. Some chemotherapy drugs used in ovarian cancer include melphalan, etoposide (Etopophos®, Vepesid®), bleomycin paclitaxel (Taxol®), cisplatin (Platinol®), doxorubicin (Adriamycin®), doxorubicin HCl liposome injection (Doxil®), carboplatin (Paraplatin®), cyclophosphamide (Cytoxan®), hexamethylamine (Hexalen®, altretamine), topotecan (Hycamtin®), ifosfamide (Ifex®), and vinblastine (Velbe®). Some drugs may be given by mouth, intravenously (into the veins), or directly into the abdomen. Putting the drugs directly into the abdomen may help reduce some of the side effects of the medication. Drugs can be used alone or in combination.

Side effects from taking chemotherapy for ovarian cancer include loss of appetite, hair loss, hand and foot rashes, kidney or nerve damage, mouth sores, an increased chance of infection, bleeding or bruising after minor cuts, hair loss, decreased memory, confusion ("chemo fog"), and fatigue (from low red blood cell counts).

High dose chemotherapy with stem cell rescue (bone marrow transplant) may be used for women with ovarian cancer that has come back or recurred. The side effects reported with chemotherapy may be greatly increased.

Radiation Therapy: Radiation involves high-energy rays that shrink tumors by killing the cancer cells. The radiation destroys the ability of cancer cells to reproduce. Radiation is not commonly used to treat ovarian cancer, because of its damaging effects on surrounding organs. If used, premenopausal women can experience menopause because their ovarian functions may be destroyed by the radiation. Side effects include fatigue, swelling in the area being irradiated, nausea/vomiting, hair loss, and skin reddening.

Other therapies: Biological therapies involve treatments to help improve the immune system. It uses such agents as interleukin-2 (IL-2), vaccine therapy, and anti-HER-2. Anti-angiogenesis (the growth of new blood vessels to tumors) therapy decreases the amount of blood a tumor can get, thereby possibly killing or decreasing the tumor.

Some drugs treat the side effects of chemotherapy. Anemia (low number of red blood cells) is a frequent side effect of chemotherapy and may cause symptoms such as extreme tiredness, dizziness, or shortness of breath. Epoetin alfa (Procrit®, Epogen®) is a synthetic hormone that is used for the treatment of chemotherapy-related anemia by stimulating red blood cell production. Immune system problems caused by chemotherapy may be treated with filgrastim (Neupogen®), a human granulocyte colony-stimulating factor (G-CSF). G-CSF helps stimulate the production of cells of the immune system, including granulocytes, macrophages, and stem cells.

Epithelial ovarian cancer treatment: This ovarian cancer starts in the epithelial layer (outer layer of tissue) of the ovary. The treatment for epithelial ovarian cancer is based on how far and much the cancer has grown. Usually the first option is surgery to remove one or both ovaries, or other reproductive organs. Treatment usually includes chemotherapy or radiation therapy for early stage cancers. For stage III and IV cancers, the tumor will also be reduced in size.

Low Malignant Potential (LMP) tumor treatment: LMP tumors are tumors which rarely spread past the ovary. For LMP tumors, the ovary with the tumor and the fallopian tube on the affected side are usually removed. In certain cases, just the ovarian cyst with the tumor is removed. Chemotherapy and radiation are generally not used for treatment of these tumors, although they may be used if the tumor comes back after surgery.

Germ cell tumor treatment: Germ cells in the ovaries produce eggs. Women with benign germ cell tumors are treated by removing part or all of the ovary and the fallopian tube on the affected side. Chemotherapy may also be given.

Stromal cell tumor treatment: Stromal cells in the ovaries produce most of the female hormones estrogen and progesterone. Most stromal cell tumors are confined to the ovary. They are treated by removing the ovary with the tumor. If the tumor returns, more surgery and chemotherapy may also be used. Radiation therapy is rarely used.

Good scientific evidence :

Psychotherapy: Psychotherapy is an interactive process between a person and a qualified mental health professional (psychiatrist, psychologist, clinical social worker, licensed counselor, or other trained practitioner). There is good evidence that psychotherapy can enhance cancer patients' quality of life by reducing emotional distress and aiding in coping with the stresses and challenges of cancer. Therapy may be supportive-expressive therapy, cognitive therapy or group therapy. Studies conflict on whether therapy improves self-esteem, death anxiety, self-satisfaction, etc. While some patients seek psychotherapy in hopes of extending survival, there is no conclusive evidence of effects on medical prognosis. Psychotherapy can help people come to terms with the fact that they may die of cancer, which is the 4^th stage of dealing with a terminal illness (including denial, anger, bargaining, acceptance).

Unclear or conflicting scientific evidence :

Acupuncture: Acupuncture, or the use of needles to manipulate the "chi" or body energy, originated in China over 5,000 years ago. There has been limited research on acupuncture for cancer pain, and the research that was done was shown to have mixed results. More studies are needed to determine potential benefits. Evidence from several small studies supports use of acupuncture at a specific point on the wrist (P6) to help chemotherapy patients reduce nausea and vomiting. Acupuncture may also reduce the pain associated with cancer.

Aloe: Transparent gel from the pulp of the meaty leaves of Aloe vera has been used on the skin for thousands of years to treat wounds, skin infections, burns, and numerous other skin conditions. Preliminary research suggests that aloe may help prevent or aid in the regression of cancerous tumors. Additional research is needed in this area. Caution is advised when taking aloe supplements as numerous adverse effects including a laxative effect, cramping, dehydration and drug interactions are possible. Aloe should not be used if pregnant or breast feeding, unless otherwise directed by a doctor.

American pawpaw: Evidence supporting the use of the American pawpaw (Asimina triloba) tree for the treatment of cancer in humans is largely anecdotal and subjective. However, use in humans has reported minimal side effects, and evidence from animal and test tube studies suggest that American pawpaw extract does have some anticancer activity. Pawpaw standardized extract has been used for 18 months in patients with various forms of cancer. No well-designed studies on the long-term effects of pawpaw extracts have been conducted. Pawpaw should not be used if pregnant or breast feeding, unless otherwise directed by a doctor.

Antineoplastons: Antineoplastons are a group of naturally occurring peptide fractions, which were observed by Stanislaw Burzynski, MD, PhD in the late 1970s to be absent in the urine of cancer patients. There is inconclusive scientific evidence regarding the effectiveness of antineoplastons in the treatment of cancer. Several preliminary human studies (case series, phase I/II trials) have examined antineoplaston types A2, A5, A10, AS2-1, and AS2-5 for a variety of cancer types. It remains unclear if antineoplastons are effective, or what doses may be safe. Until better research is available, no clear conclusion can be drawn.

Arabinoxylan: Arabinoxylan is made by altering the outer shell of rice bran using enzymes from Hyphomycetes mycelia mushroom extract. Arabinoxylan has been found to improve immune reactions in diabetes and cancer patients. Arabinoxylan products may contain high calcium and phosphorus levels, which may be harmful for patients with compromised renal (kidney) function. Caution is advised when taking arabinoxylan supplements, as numerous adverse effects including drug interactions are possible. Arabinoxylan should not be used if pregnant or breast feeding, unless otherwise directed by a doctor.

Aromatherapy: Healing with fragrant oils has been used for thousands of years. Aromatherapy is often used in people with chronic illnesses (frequently in combination with massage), with the intention to improve quality of life or well-being. There is not enough scientific evidence in this area to form a firm conclusion about the effectiveness of aromatherapy. Essential oils should only be used on the skin in areas without irritation.

Art therapy: Art therapy involves the application of a variety of art modalities including drawing, painting, clay and sculpture. Art therapy enables the expression of inner thoughts or feelings when verbalization is difficult or not possible. Limited evidence suggests that family caregivers of cancer patients may benefit from art therapy to help them cope with the stress of care giving. Possible benefits include reduced stress, lowered anxiety, increased positive emotions and increased positive communication with cancer patients and health care professionals. Art therapy may also reduce pain and other symptoms in cancer patients. More studies are needed to determine how best to use this form of intervention with this population.

Astragalus: Astragalus (Astragalus membranaceus) has been used in Chinese medicine for centuries for its immune enhancing properties. Although early laboratory and animal studies report increased immune cell function and reduced cancer cell growth associated with the use of astragalus, there is no reliable human evidence in these areas. A recent study reports that astragalus-based Chinese herbal medicine may increase effectiveness of platinum-based chemotherapy such as cisplatin (Platinol®) when combined with chemotherapy. Astragalus is also sometimes used with the intention to reduce side effects of cancer treatments, such as fatigue and weight loss. Due to a lack of well-designed research, a firm conclusion cannot be drawn. Caution is advised when taking astragalus supplements, as numerous adverse effects including drug interactions are possible. Astragalus should not be used if pregnant or breast feeding, unless otherwise directed by a doctor.

Bee pollen: Bee pollen is considered a highly nutritious food because it contains a balance of vitamins, minerals, proteins, carbohydrates, fats, enzymes, and essential amino acids. Research has found that bee pollen may reduce some adverse effects of cancer treatment. Additional study is needed before a firm recommendation can be made. Caution is advised when taking bee pollen supplements as allergic reactions may occur in sensitive individuals. Bee pollen should not be used if pregnant or breast feeding, unless otherwise directed by a doctor.

Bitter melon: Bitter melon (Momordica charantia) is used in Avurvedic medicine from India to lower blood sugar levels. Research has also found that bitter melon extracts may be beneficial in cancer therapies. MAP30, a protein isolated from bitter melon extract, is reported to possess anti-cancer effects in laboratory studies. Potential anti-cancer effects have not been studied appropriately in humans. Caution is advised when taking bitter melon supplements, as numerous adverse effects, including decreased blood sugar and drug interactions, are possible. Bitter melon should not be used if pregnant or breast feeding, unless otherwise directed by a doctor.

Black tea: Black tea (Camellia sinensis) is from the same plant as green tea, but the leaves are processed differently. Black tea usually contains more caffeine than green tea. Several studies have explored a possible association between regular consumption of black tea and rates of cancer in populations. This research has yielded conflicting results, with some studies suggesting benefits, and others reporting no effects. Laboratory and animal studies report that components of tea, such as polyphenols, have antioxidant properties and effects against tumors. However, effects in humans remain unclear, and these components may be more common in green tea rather than in black tea. Some animal and laboratory research suggests that components of black tea may actually be carcinogenic, or cancer causing, although effects in humans are not clear. Overall, the relationship of black tea consumption and human cancer remains undetermined.

Bromelain: Bromelain is a sulfur-containing digestive enzyme (proteins that help with digestion) that is extracted from the stem and the fruit of the pineapple plant (Ananas comosus). There is not enough information to recommend for or against the use of bromelain in the treatment of cancer, either alone or in addition to other therapies. One small study found that a bromelain supplement decreased tumor size in 12 breast cancer patients. Patients took the supplements for different periods of time, lasting from months to years. Caution is advised when taking bromelain supplements, as numerous adverse effects including blood thinning and drug interactions are possible. Bromelain should not be used if pregnant or breast feeding, unless otherwise directed by a doctor.

Cat's claw: Originally found in Peru, the use of cat's claw (Uncaria tomentosa) has been said to date back to the Inca civilization, possibly as far back as 2,000 years. Cat's claw has anti-inflammatory properties, and several low-quality studies suggest that cat's claw may slow tumor growth. However, this research is early and has not identified specific types of cancer that may benefit; the results are not clear. A few studies suggest that cat's claw may also boost the immune system. Caution is advised when taking cat's claw supplements, as numerous adverse effects including blood thinning and drug interactions are possible. Cat's claw should not be used if pregnant or breast feeding, unless otherwise directed by a doctor.

Chaparral: Chaparral was used by the Native Americans for various health conditions. The chaparral component nordihydroguaiaretic acid (NDGA) has been evaluated as a treatment for cancer, but due to the risk of toxicity, is considered unsafe and not recommended for use. Chaparral and NDGA have been associated with cases of kidney and liver failure, liver cirrhosis, kidney cysts, and kidney cancer in humans. In response to these reports, the U.S. Food and Drug Administration (FDA) removed chaparral from its "generally recognized as safe" (GRAS) list in 1970. Chaparral and NDGA are generally considered unsafe and are not recommended for use.

Chelation therapy: Chelation therapy involves using a chemical called ethylenediaminetetraacetic acid (EDTA) to rid the body of heavy metals that may have accumulated from environmental exposure. Preliminary data from an exploratory study suggests concurrent administration of EDTA may have myeloprotective (muscle fiber protection) ability, which allows safe intraperitoneal administration of higher doses of radiation in the treatment of ovarian cancer. Randomized controlled trials are needed before definitive recommendations can be made. Note that EDTA chelation therapy is rejected by the conventional medical community including the American Medical Association, American Hospital Association, National Institutes of Health, and U.S. Food and Drug Administration (FDA) as a beneficial treatment due to lack of scientific evidence. Side effects include low blood sugar, headache, low calcium levels, low blood pressure, and seizures. ETDA use may result in death.

Copper: Copper is a mineral that occurs naturally in many foods, including vegetables, legumes, nuts, grains and fruits, as well as shellfish, avocado, and beef (organs such as liver). Preliminary research reports that lowering copper levels theoretically may arrest the progression of cancer by inhibiting blood vessel growth (angiogenesis). Copper intake has not been identified as a risk factor for the development or progression of cancer. Copper is potentially unsafe when used orally in higher doses than the RDA. Copper supplements should not be used if pregnant or breast feeding, unless otherwise directed by a doctor.

Cranberry: Several laboratory studies have reported positive effects of proanthocyanidins, flavonoid components of cranberry (Vaccinium macrocarpon) and other fruits such as blueberries, grape seed, and pomegranate, on health. Based on a small amount of laboratory research, cranberry has been proposed for cancer prevention. Study is needed in humans before a recommendation can be made.

Echinacea: The evidence from a small number of randomized trials evaluating the efficacy of Echinacea in the treatment of radiation-induced leukopenia (decrease in white blood cells) is equivocal. Studies have used the combination product Esberitox®, which includes extracts of echinacea (Echinacea purpurea and pallida) root, white cedar (Thuja occidentalis) leaf, and wild indigo (Baptisia tinctoria)root. Caution is advised when taking echinacea supplements, as numerous adverse effects including drug interactions are possible. Echinacea should not be used if pregnant or breast feeding, unless otherwise directed by a doctor.

Essiac®: Essiac® contains a combination of herbs, including burdock root (Arctium lappa), sheep sorrel (Rumex acetosella), slippery elm inner bark (Ulmus fulva), and Turkish rhubarb (Rheum palmatum). The original formula was developed by the Canadian nurse Rene Caisse (1888-1978) and is thought to be effective in cancer therapies, although currently there is not enough evidence to recommend for or against the use of this herbal mixture as a therapy for any type of cancer. Different brands may contain variable ingredients, and the comparative effectiveness of these formulas is not known. None of the individual herbs used in Essiac® have been tested in rigorous human cancer trials, although some components have anti-tumor activity in laboratory studies. Numerous individual patient testimonials and reports from manufacturers are available on the Internet, although these cannot be considered scientifically viable as evidence. Individuals with cancer are advised not to delay treatment with more proven therapies. Caution is advised when taking Essiac® supplements, as numerous adverse effects including drug interactions are possible. Essiac® should not be used if pregnant or breast feeding, unless otherwise directed by a doctor.

Focusing: Focusing (experiential therapy) is a method of psychotherapy that involves being aware of one's feelings surrounding a particular issue and understanding the meaning behind words or images conveyed by those feelings. Early evidence suggests focusing may improve the mood and body attitude in cancer patients. Firm recommendations cannot be made until well-designed clinical trials are available.

Folic acid: Folic acid or folate is a form of a water-soluble B vitamin needed for human health. Preliminary evidence surrounding the use of folate seems promising for decreasing the risk of breast, cervical, pancreatic and gastrointestinal cancer. However, currently there is insufficient evidence available to recommend folate supplementation for any type of cancer prevention or treatment. Please follow the advice of a qualified health care provider in this area. Folic acid may mask the symptoms of pernicious, aplastic, or normocytic anemias caused by vitamin B12 deficiency and may lead to neurological damage.

Gamma linolenic acid (GLA): GLA is an omega-6 essential fatty acid. Some laboratory and human studies indicate GLA may have anti-tumor activity and may be used as an adjunct agent to a chemotherapy regimen. Clinical trials have been conducted in treatments of breast, colorectal, and liver cancer. Caution is advised when taking GLA supplements, as numerous adverse effects including an increased risk of bleeding and drug interactions are possible. GLA should not be used if pregnant or breast feeding, unless otherwise directed by a doctor.

Garlic: Preliminary human studies suggest that regular consumption of garlic (Allium sativum) supplements may reduce the risk of developing several types of cancer. Some studies use multi-ingredient products so it is difficult to determine if garlic alone may play a beneficial role. Further well-designed human clinical trials are needed to conclude whether eating garlic or taking garlic supplements may prevent or treat cancer. Caution is advised when taking garlic supplements, as numerous adverse effects including an increased risk of bleeding and drug interactions are possible. Garlic should not be used if pregnant or breast feeding, unless otherwise directed by a doctor.

Ginseng: Several human studies suggest that Asian ginseng (Panax ginseng) may reduce the risk and progression of various organ cancers, especially if ginseng powder or extract is used. Results may have been affected by other lifestyle choices in people who use ginseng, such as exercise or dietary habits. Asian ginseng is also reported to help protect against radiation damage, increase immunity and well-being, and decrease fatigue. Additional trials are necessary before a clear conclusion can be reached. Caution is advised when taking ginseng supplements, as numerous adverse effects including an increased risk of drug interactions are possible. Ginseng should not be used if pregnant or breast feeding, unless otherwise directed by a doctor.

Green tea: Green tea is made from the dried leaves of Camellia sinensis, a perennial evergreen shrub. Green tea has a long history of use in health and longevity, dating back to China approximately 5,000 years ago. Although used for centuries to help prevent diseases, the relationship of green tea consumption and human cancer remains inconclusive. Evidence from well-designed clinical trials is needed before a firm recommendation can be made in this area. Caution is advised when taking green tea supplements, as numerous adverse effects including an increased risk of drug interactions are possible. Green tea should not be used if pregnant or breast feeding, unless otherwise directed by a doctor.

Healing touch (HT): Preliminary data suggests may be of benefit in cancer patients for inducing relaxation and improving quality of life. However, due to weaknesses in design and the small number of studies, data are insufficient to make definitive recommendations. Studies with stronger designs are needed.

Hoxsey formula: "Hoxsey formula" is a misleading name, because it is not a single formula, but rather it is a therapeutic regimen consisting of an oral tonic, topical (on the skin) preparations, and supportive therapy. The tonic is individualized for cancer patients based on general condition, location of cancer, and previous history of treatment. An ingredient that usually remains constant for every patient is potassium iodide. Other ingredients are then added and may include licorice, red clover, burdock, stillingia root, berberis root, pokeroot, cascara, Aromatic USP 14, prickly ash bark, and buckthorn bark. A red paste may be used, which tends to be caustic (irritating), and contains antimony trisulfide, zinc chloride, and bloodroot. A topical yellow powder may be used, and contains arsenic sulfide, talc, sulfur, and a "yellow precipitate." A clear solution may also be administered, and contains trichloroacetic acid. There are no well-designed human studies available evaluating the safety or effectiveness of Hoxsey formula. Caution is advised when taking the Hoxsey formula supplements, as numerous adverse effects including an increased risk of drug interactions are possible. Hoxsey formula should not be used if pregnant or breast feeding, unless otherwise directed by a doctor.

Hydrazine sulfate: Hydrazine is an industrial chemical marketed as having the potential to repress weight loss and cachexia (muscle wasting) associated with cancer, and to improve general appetite status. However, in large randomized controlled trials, hydrazine has not been proven effective for improving appetite, reducing weight loss or improving survival in adults. The National Cancer Institute (NCI) sponsored studies of hydrazine sulfate that claimed efficacy in improving survival for some patients with advanced cancer. Trial results found that hydrazine sulfate did not prolong survival for cancer patients. The U.S. Food and Drug Administration (FDA) has received requests from individual physicians for approval to use hydrazine sulfate on a case-by-case "compassionate use" basis on the chance that patients with no other available effective therapy might benefit. The overall controversy in the use of hydrazine sulfate is ongoing, and relevance to clinical practice is unknown. The use of hydrazine sulfate needs to be evaluated further before any recommendations can be made. Side effects have been reported, including dizziness, nausea, and vomiting.

Iodine: Iodine is an element (atomic number 53), which is required by humans for the synthesis of thyroid hormones (triiodothyronine/T3 and thyroxine/T4). The potential role of non-radioactive iodine in cancer care remains unknown. Antioxidant and anti-tumor effects have been proposed based on laboratory research. In contrast, some scientists have asserted that tumors may uptake more iodine than normal tissues. It has been suggested that high rates of gastric (stomach) cancer or low rates of breast cancer in coastal Japan may be due to high iodine intake, although this has not been demonstrated scientifically. Povidone-iodine solutions have been used as a part of alternative cancer regimens, such as the Hoxsey formula. Preliminary study has also indicated povidone-iodone solution as a potential rectal washout for rectal cancer. Overall, no clear conclusion can be drawn based on the currently available evidence. Iodine should not be used if pregnant or breast feeding, unless otherwise directed by a doctor.

Lavender: Perillyl alcohol (POH), derived from lavender (Lavendula officinalis), might be beneficial in the treatment of some types of cancer. This research has focused on cancers of the pancreas, breast, and intestine. Preliminary small studies in humans suggest safety and tolerability of POH, but effectiveness has not been established.

Lycopene: High levels of lycopene are found in tomatoes and in tomato-based products. Tomatoes are also sources of other nutrients such as vitamin C, folate, and potassium. Several laboratory and human studies examining tomato-based products and blood lycopene levels suggest that lycopene may be associated with a lower risk of developing cancer and may help stimulate the immune system. However, due to a lack of well-designed human research using lycopene supplements, this issue remains unclear.

Maitake mushroom: Maitake is the Japanese name for the edible mushroom Grifola frondosa. Maitake has been used traditionally both as a food and for medicinal purposes. Early studies in the laboratory as well as in humans suggest that beta-glucan extracts from maitake may increase the body's ability to fight cancer. However, these studies have not been well designed, and better research is needed before the use of maitake for cancer can be recommended. Caution is advised when taking maitake supplements, as numerous adverse effects including an increased risk of bleeding and drug interactions are possible. Maitake should not be used if pregnant or breast feeding, unless otherwise directed by a doctor.

Melatonin: There are several early-phase and controlled human trials of melatonin in patients with various advanced stage malignancies, including brain, breast, colorectal, gastric, liver, lung, pancreatic, and testicular cancer, as well as lymphoma, melanoma, renal cell carcinoma, and soft-tissue sarcoma. Currently, no clear conclusion can be drawn in this area. There is not enough definitive scientific evidence to discern if melatonin is beneficial against any type of cancer, whether it increases (or decreases) the effectiveness of other cancer therapies, or if it safely reduces chemotherapy side effects. Melatonin is not to be used for extended periods of time. Caution is advised when taking melatonin supplements, as numerous adverse effects including drug interactions are possible. Melatonin is not recommended during pregnancy or breastfeeding unless otherwise advised by a doctor.

Milk thistle: Milk thistle (Silybum marianum) has been used medicinally in China for over 2,000 years, most commonly for the treatment of liver and gallbladder disorders. There are early reports from laboratory experiments that the components silymarin and silibinin found in milk thistle may reduce the growth of human breast, cervical, and prostate cancer cells. There is also one report of a patient with liver cancer who improved following treatment with milk thistle. However, this research is too early to draw firm conclusions, and effects have not been shown in high-quality human trials. Caution is advised when taking milk thistle supplements, as numerous adverse effects including an increased risk of bleeding and drug interactions are possible. Milk thistle should not be used if pregnant or breast feeding, unless otherwise directed by a doctor.

Mistletoe: Mistletoe is one of the most widely used unconventional cancer treatments in Europe. Extracts have been studied for a variety of human cancers including bladder, breast, cervical, central nervous system (CNS), colorectal, head and neck, liver, lung, lymphatic, ovarian, and renal (kidney) cancers as well as melanoma and leukemia. However, efficacy has not been conclusively proven for any one condition. In fact, some studies have shown lack of efficacy of certain preparations for a variety of cancers. Larger, well-designed clinical trials are needed. Caution is advised when taking mistletoe supplements, as numerous adverse effects including nausea, vomiting, and drug interactions are possible. Mistletoe should not be used if pregnant or breast feeding, unless otherwise directed by a doctor.

Moxibustion: Moxibustion is a healing technique employed across the diverse traditions of acupuncture and oriental medicine for over 2,000 years. Moxibustion uses the principle of heat to stimulate circulation and break up congestion or stagnation of blood and chi. Moxibustion is closely related to acupuncture as it is applied to specific acupuncture points. Preliminary evidence from one study of patients with nasopharyngeal cancer suggests that moxibustion may reduce side effects of chemotherapy or radiation therapy. More studies are needed.

Oleander: Laboratory studies of oleander (Nerium oleander) suggest possible anti-cancer effects, although reliable research in humans is not currently available. There are reports that long-term use of oleander may have positive effects in patients with leiomyosarcoma, Ewing's sarcoma, prostate, or breast cancer. More research is needed. Caution is advised when taking oelander supplements, as numerous adverse effects including drug interactions are possible. Oleander should not be used if pregnant or breast feeding, unless otherwise directed by a doctor.

Omega: Omega-3 fatty acids are essential fatty acids found in some plants and fish. There should be a balance of omega-6 and omega-3 fatty acids for health. Several population (epidemiologic) studies report that dietary omega-3 fatty acids or fish oil may reduce the risk of developing breast, colon, or prostate cancer. Randomized controlled trials are necessary before a clear conclusion can be drawn. Caution is advised when taking omega-3 supplements, as numerous adverse effects including an increase in bleeding and drug interactions are possible. Omega-3 supplements should not be used if pregnant or breast feeding, unless otherwise directed by a doctor.

Prayer: Initial studies in patients with cancer (such as leukemia) report variable effects on disease progression or death rates when intercessory prayer is used. Better quality research is necessary before a firm conclusion can be drawn. Studies using prayer as healing have only been conduced when people know that others might be praying for them.

Reishi mushroom: Reishi (Ganoderma lucidum) has been shown to have antineoplastic and immunomodulatory effects in animal studies. One clinical trial and two case reports exist on advanced cancer patients using Ganopoly®, a Ganoderma lucidum polysaccharide extract. Results show improved quality of life and enhanced immune responses, which are typically reduced or damaged in cancer patients receiving chemotherapy and/or radiation therapy. Well-designed long-term studies are needed confirm these results and potential side effects. Caution is advised when taking reishi supplements, as numerous adverse effects including an increased risk of bleeding and drug interactions are possible. Reishi should not be used if pregnant or breast feeding, unless otherwise directed by a doctor.

Seaweed: Bladderwrack (Fucus vesiculosus) is a brown seaweed that grows on the northern coasts of the Atlantic and Pacific Ocean, and the North and Baltic Sea. Bladderwrack appears to suppress the growth of various cancer cells in animal and laboratory studies. However, currently there are no reliable human studies available to support a recommendation for use in cancer. Caution is advised when taking bladderwrack supplements, as numerous adverse effects including an increased risk of drug interactions are possible. Bladderwrack should not be used if pregnant or breast feeding, unless otherwise directed by a doctor.

Selenium: Selenium is a trace mineral found in soil, water, and some foods. It is an essential element in several metabolic pathways. Several studies suggest that low levels of selenium (measured in the blood or in tissues such as toenail clippings), may be a risk factor for developing cancer, particularly prostate cancer. Population studies suggest that people with cancer are more likely to have low selenium levels than healthy matched individuals, but in most cases it is not clear if the low selenium levels are a cause or merely a consequence of disease. It remains unclear if selenium is beneficial in the treatment of any type of cancer.

Shark cartilage: For several decades, shark cartilage has been proposed as a cancer treatment. Studies have shown shark cartilage or the shark cartilage product AE-941 (Neovastat®) to block the growth of new blood vessels, a process called "anti-angiogenesis," which is believed to play a role in controlling growth of some tumors. There have also been several reports of successful treatments of end-stage cancer patients with shark cartilage, but these have not been well-designed or included reliable comparisons to accepted treatments.

Many studies have been supported by shark cartilage product manufacturers, which may influence the results. In the United States, shark cartilage products cannot claim to cure cancer, and the U.S. Food and Drug Administration (FDA) has sent warning letters to companies not to promote products in this way. Without further evidence from well-designed human trials, it remains unclear if shark cartilage is of any benefit in cancer and patients are advised to check with their doctor and pharmacist before taking shark cartilage. Shark cartilage available in Asian grocery stores and restaurants should not be eaten due to declining populations of sharks. Caution is advised when taking shark cartilage supplements, as numerous adverse effects including an increased risk of drug interactions are possible. Shark cartilage should not be used by patients who are pregnant or breast feeding, unless otherwise directed by a doctor.

Shiitake mushroom: Shiitake (Lentinus edodes) has been taken by mouth for boosting the immune system, decreasing cholesterol levels, and for anti-aging. Lentinan, derived from shiitake, has been injected as an adjunct treatment for cancer and HIV infection. Laboratory, animal and human studies of lentinan have shown positive results in cancer patients when used in addition to chemotherapy drugs. Further well-designed clinical trials on all types of cancer are required to confirm these results. Caution is advised when taking shiitake supplements, as numerous adverse effects including an increased risk of bleeding and drug interactions are possible. Shiitake should not be used if pregnant or breast feeding, unless otherwise directed by a doctor.

Soy: Soy (Glycine max) contains compounds, which have been reported effective against tumors. Genistein, an isoflavone found in soy, has been found in laboratory and animal studies to possess anti-cancer effects, such as blocking new blood vessel growth (anti-angiogenesis), acting as a tyrosine kinase inhibitor (a mechanism of many new cancer treatments), or causing cancer cell death (apoptosis). In contrast, genistein has also been reported to increase the growth of pancreas tumor cells in laboratory research. Until reliable human research is available, it remains unclear if dietary soy or soy isoflavone supplements are beneficial, harmful, or neutral in people with various types of cancer. Caution is advised when taking soy supplements, as numerous adverse effects including an increased risk of drug interactions are possible. Soy should not be used if pregnant or breast feeding, unless otherwise directed by a doctor.

Thiamin (Vitamin B1): Thiamin deficiency has been observed in some cancer patients, possibly due to increased metabolic needs. It is not clear if lowered levels of thiamin in such patients may actually be beneficial. Currently, it remains unclear if thiamin supplementation plays a role in the management of any particular type(s) of cancer.

Transcutaneous electrical nerve stimulation (TENS): Transcutaneous electrical nerve stimulation (TENS) is a non-invasive technique in which a low-voltage electrical current is delivered through wires from a small power unit to electrodes located on the skin. Although TENS has been used with some success in pain associated with cancer, there is not enough reliable evidence to draw a firm conclusion in this area.

Traditional Chinese Medicine (TCM): The ancient Chinese philosophy of Taoism provided the basis for the development of Chinese medical theory. TCM uses over 120 different herbs in cancer treatment, depending on the type of cancer and its cause according to Chinese medical theory. Studies have reported significant benefits include reducing tumors, reducing treatment side effects and improved response to treatment. More studies of stronger design are needed before TCM can be recommended with confidence as an adjunct to cancer treatment, although centuries of traditional use in cancer cannot be discounted.

Turmeric: Turmeric (Curcuma longa) is commonly used for its anti-inflammatory properties. Several early animal and laboratory studies report anti-cancer (colon, skin, breast) properties of curcumin. Many mechanisms have been considered, including antioxidant activity, anti-angiogenesis (prevention of new blood vessel growth), and direct effects on cancer cells. Currently it remains unclear if turmeric or curcumin has a role in preventing or treating human cancers. There are several ongoing studies in this area. Caution is advised when taking turmeric supplements, as numerous adverse effects including an increased risk of bleeding and drug interactions are possible. Turmeric should not be used if pregnant or breast feeding, unless otherwise directed by a doctor.

Vitamin C (ascorbic acid): Dietary intake of fruits and vegetables high in vitamin C has been associated with a reduced risk of various types of cancer in population studies (particularly cancers of the mouth, esophagus, stomach, colon, or lung). However, it is not clear that it is specifically the vitamin C in these foods that is beneficial, and vitamin C supplements have not been found to be associated with this protective effect. Experts have recommended increasing dietary consumption of fruits and vegetables high in vitamin C, such as apples, asparagus, berries, broccoli, cabbage, melon (cantaloupe, honeydew, watermelon), cauliflower, citrus fruits (lemons, oranges), fortified breads/grains/cereal, kale, kiwi, potatoes, spinach, and tomatoes. Vitamin C has a long history of adjunctive use in cancer therapy, and although there have not been any definitive studies using intravenous (or oral) vitamin C, there is evidence that it has benefit in some cases. Better-designed studies are needed. Large doses (greater than 2 grams) may cause diarrhea and gastrointestinal upset.

Vitamin E: There is no reliable scientific evidence that vitamin E is effective as a treatment for any specific type of cancer. Caution is merited in people undergoing treatment with chemotherapy or radiation, because it has been proposed that the use of high-dose antioxidants may actually reduce the anti-cancer effects of these therapies. This remains an area of controversy and studies have produced variable results. Patients interested in using high-dose antioxidants such as vitamin E during chemotherapy or radiation should discuss this decision with their medical oncologist or radiation oncologist. Caution is advised when taking vitamin E supplements, as numerous adverse effects including an increased risk of bleeding and drug interactions are possible.

Yoga: Yoga is an ancient system of relaxation, exercise, and healing with origins in Indian philosophy. Several studies in cancer patients report enhanced quality of life, lower sleep disturbance, decreased stress symptoms and changes in cancer-related immune cells after patients received relaxation, meditation and gentle yoga therapy. Yoga is not recommended as a sole treatment for cancer but may be helpful as an adjunct therapy.

Dietary factors: Dietary factors that significantly influence the risk of gynecological cancer include eating more antioxidant containing fresh fruits and vegetables, and decreasing the intake of red meats and foods high in animal fat (such as dairy products - milk, cheese, sour cream). A study found the strongest link between dietary risk factors and ovarian cancer was meat and cheese intake. The study found significantly reduced risk of all ovarian cancer with higher tomato consumption. Other studies have found no link between preventing ovarian cancer and dietary factors.

Exercise: An increase in physical activity has been reported to decrease the chances of developing cancer. High levels of sedentary behavior may increase the risk of ovarian cancer, but they do not support a major impact of light and moderate physical activity on ovarian cancer risk. A doctor can advise the patient as to what type of exercise would be best for that individual.

Oral contraception (OC, birth control pills): Compared with women who have never used OC, women who use OC for three years or more reduce their risk of ovarian cancer by 30 - 50%.

Pregnancy and breast feeding: Having at least one child lowers the risk of developing ovarian cancer. Breast feeding a child for a year or longer also may reduce the risk of ovarian cancer.

Surgery: Women who are at very high risk of developing ovarian cancer may elect to have their ovaries removed as a means of preventing the disease. This surgery, known as prophylactic oophorectomy, is recommended primarily for women who have tested positive for a BRCA gene mutation or women who have a strong family history of breast and ovarian cancers, even if no genetic mutation has been identified. Studies indicate that prophylactic oophorectomy lowers ovarian cancer risk by up to 95%. This procedure is controversial because it does initiate menopause.

Tubal ligation or hysterectomy: The Nurses' Health Study, which followed thousands of women for 20 years, found a substantial reduction in ovarian cancer risk in women who had had tubal ligations. The procedure also has been shown to reduce ovarian cancer risk among women with mutations in the BRCA1 gene, although how the procedure helps is uncertain. The Nurses' Health Study also indicated that having a hysterectomy may reduce ovarian cancer risk, but not by as much as does tubal ligation.

Weight control: The incidence of obesity is increasing in the developed world such that it now contributes as much as smoking to overall cancer deaths. Women with a body mass index (BMI)>40 have a 60% higher risk of dying from all cancers than women of normal weight. They are also at increased risk for gynecological cancer.