institute for cancer research

What is Esophageal Cancer?

The esophagus is a hollow, muscular tube, about 10 inches long which connects the throat to the stomach. When a person swallows, the walls of the esophagus contract to push food down into the stomach. Esophageal cancer (also called esophagus cancer) begins when cells divide, unregulated by the normal processes that decide cell growth and death, and eventually form tumors.

Cancer of the esophagusbegins in the inner layer of the esophageal wall and grows outward. If it spreads through the esophageal wall (called metastasis) it can invade lymph nodes, blood vessels in the chest, and other nearby organs. Esophageal cancer can also spread to the lungs, liver, stomach and other parts of the body.

There are two types of esophageal cancer: squamous cell carcinoma and adenocarcinoma. Squamous cell carcinomas arise in squamous cells that line the esophagus. These cancers usually develop in the upper and middle part of the esophagus. Adenocarcinomas begin in the glandular tissue in the lower part of the esophagus. Treatment is similar for both types.

As we well know, there are many kinds of cancer; unfortunately they all come about because of the out-of-control growth of abnormal cells.

Cancer of the esophagus is also called esophageal cancer. Each year, about 11,000 Americans find out they have cancer of the esophagus. Cancer can develop in any part of the esophagus. If the cancer spreads outside the esophagus, it usually shows up in nearby lymph nodes (sometimes called lymph glands). In many cases, the cancer also spreads to the windpipe, the large blood vessels in the chest, and other nearby organs. Esophageal cancer can also spread to the lungs, liver, stomach, and other parts of the body.

Cancer that spreads is the same disease and has the same name as the original (primary) cancer. When cancer of the esophagus spreads, it is called metastatic esophageal cancer.

What causes cancer of the esophagus?

Cancer of the esophagus is fairly common in some parts of the world. But in the United States, this disease accounts for only about 1 percent of all cancers.

The exact causes of cancer of the esophagus are not known. Researchers are trying to solve this problem. The more they can find out about what causes this disease, the better the chance of finding ways to prevent it.

Studies in the United States show that esophageal cancer is found mainly in people over age 55. It affects men about twice as often as women, and it is more common in black people than in white people. Why one person gets esophageal cancer and another doesn't cannot be explained.

It is established that no one can "catch" esophageal cancer from another person. Cancer is not contagious.
Also, it is known that certain risk factors increase a person's chance of getting esophageal cancer. In the United States, smoking and excessive use of alcohol are the major risk factors for this disease. Heavy users of both alcohol and tobacco are much more likely to develop esophageal cancer than are people who do not drink or smoke.

Cutting down on the use of alcohol reduces the chance of getting esophageal cancer, as well as cancers of the mouth, throat, and larynx. By not smoking, people can lower their risk of cancers of the esophagus, lung, mouth, throat, larynx, bladder, and pancreas. Also, it is very important to know that people who develop cancer due to smoking are at risk of getting a second cancer. Most doctors urge esophageal cancer patients to stop smoking to cut down the risk of a new cancer and to reduce other problems, such as coughing.

The risk of cancer of the esophagus is also increased by long- term irritation of esophageal tissues. Tissue at the bottom of the esophagus can become irritated if the contents of the stomach frequently "back up" into the esophagus, a problem known as reflux. When cells in the irritated part of the esophagus change and begin to resemble the cells that line the stomach, doctors call this condition Barrett's esophagus. In some cases, Barrett's esophagus leads to esophageal cancer.

Other kinds of irritation or damage to the lining of the esophagus can also increase the risk of cancer. For example, people who have swallowed lye or other caustic substances have a higher-than-average risk because these substances damage esophageal tissue.

Poor nutrition is another factor that can increase a person's risk of esophageal cancer.Scientists are not sure exactly how diet changes the risk of developing this disease, but they think that it is important to have a well-balanced diet that includes generous amounts of fruits and vegetables.

Often, patients with esophageal cancer have no clear risk factors. In most cases, the disease is probably the result of several factors (known or unknown) acting together.

People who think they might be at increased risk for cancer of the esophagus should discuss this concern with their doctor. The doctor may be able to suggest ways to reduce the risk and can suggest an appropriate schedule of checkups.

Healthy Cells vs. Cancer Cells

Healthy cells are like a cat. They need structure to determine the size of bones and shape of the body, tail and whiskers. The DNA in genes and chromosomes determine this. They need energy to play and prowl and sustain life. This is derived from chemicals in food. Cats need a system to deliver chemicals (food nutrients like amino acids, carbohydrates, fats, vitamins and minerals) to all parts of their body. These are the blood vessels. Growth factors take a kitten into a lazy old cat, all the while helping it to function normally.

The body and its cells are mostly made up of protein. The building blocks of proteins are substances called amino acids that in the form of enzymes and hormones literally control every chemical reaction within the cells. When these are modified, different messages are sent to a complex control system that can alter their function. There are twenty different kinds of amino acids that are essential to life. Twelve of these can be synthesized within the body however; eight must be supplied by the daily diet.

 

What are symptoms of cancer of the esophagus?

Very small tumors in the esophagus usually do not cause symptoms. As the tumor grows, the most common symptom is difficulty in swallowing. The person may have a feeling of fullness, pressure, or burning as food goes down the esophagus. Also, it may feel as if food gets stuck behind the breastbone. Problems with swallowing may come and go. At first, they may be noticed mainly when the person eats meat, bread, or coarse foods, such as raw vegetables. As the tumor grows larger and the pathway to the stomach becomes narrower, other foods,even liquids, can be hard to swallow, and swallowing may be painful. Cancer of the esophagus can also cause indigestion, heartburn, vomiting, and frequent choking on food. Because of these problems, weight loss is common.

Sometimes a tumor in the esophagus causes coughing and hoarseness. It can also cause pain behind the breastbone or in the throat.

Any of these symptoms may be caused by cancer or by other, less serious health problems. People with symptoms like these often see a gastroenterologist, a doctor who specializes in diseases of the digestive tract.

The process used to find out if cancer cells have spread within the esophagus or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The following tests and procedures may be used in the staging process:

• Bronchoscopy: A procedure to look inside the trachea and large airways in the lung for abnormal areas. A bronchoscope (a thin, lighted tube) is inserted through the nose or mouth into the trachea and lungs. Tissue samples may be taken for biopsy.


• Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.


• Laryngoscopy: A procedure in which the doctor examines the larynx (voice box) with a mirror or with a laryngoscope (a thin, lighted tube).


• CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This test is also called computed tomography, computerized tomography, or computerized axial tomography.


• Endoscopic ultrasound (EUS): A procedure in which an endoscope (a thin, lighted tube) is inserted into the body. The endoscope is used to bounce high-energy sound waves (ultrasound) off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. This procedure is also called endosonography.


• Thoracoscopy: A surgical procedure to look at the organs inside the chest to check for abnormal areas. An incision (cut) is made between two ribs and a thoracoscope (a thin, lighted tube) is inserted into the chest. Tissue samples and lymph nodes may be removed for biopsy. In some cases, this procedure may be used to remove portions of the esophagus or lung.


• Laparoscopy: A surgical procedure to look at the organs inside the abdomen to check for signs of disease. Small incisions (cuts) are made in the wall of the abdomen, and a laparoscope (a thin, lighted tube) is inserted into one of the incisions. Other instruments may be inserted through the same or other incisions to perform procedures such as removing organs or taking tissue samples for biopsy.


• PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radionuclide glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells. The use of PET for staging esophageal cancer is being studied in clinical trials.

How is cancer of the esophagus diagnosed?

To find the cause of any of these symptoms, the doctor asks about the patient's personal and family medical history and does a complete physical exam. In addition to checking general signs of health, the doctor usually orders x-rays and other tests.

An esophagram (also called a barium swallow) is a series of x- rays of the esophagus. To prepare for this test, the patient drinks a barium solution. The barium, which shows up on x-rays, coats the inside of the esophagus. The esophagram shows changes in the shape of the esophagus. The doctor can also use a special x-ray machine called a fluoroscope to watch the barium move down the esophagus to the stomach as the patient swallows.

Most patients also have a test called esophagoscopy. For this procedure, the patient's throat is sprayed with a local anesthetic to reduce discomfort and gagging. The doctor then passes a thin, flexible, lighted instrument called an endoscope through the mouth and down the throat into the esophagus. The scope lets the doctor see the lining of the esophagus and the place where the esophagus joins the stomach. If an abnormal area is found, the doctor does a biopsy (removal of a small amount of tissue through the endoscopy). Also, cells can be brushed or washed from the walls of the esophagus through the scope. A pathologist examines the samples under a microscope to see whether cancer is present.

If cancer is found, the pathologist can tell what type of cancer it is. Cancer that occurs in the middle or upper part of the esophagus is usually squamous cell carcinoma. When cancer develops at the lower end of the esophagus, near the stomach, it is usually adenocarcinoma. (Carcinoma is another name for cancer in the lining of tissues.)

If the pathologist finds esophageal cancer, the patient's doctor needs to know the stage, or extent, of the disease. Staging is a careful attempt to find out what parts of the body are affected by the cancer.

Treatment decisions depend on these findings. Staging usually involves a physical exam, with special attention to the neck and chest, blood tests, additional x-rays, and other tests. The results show whether the cancer is just in the esophagus or has spread.

The doctor usually order CT (or CAT) scans of the chest and upper abdomen. During a CT scan, many x-rays are taken and a computer combines them to create detailed pictures. Some patients also have an MRI scan, which produces pictures using a huge magnet linked to a computer.

The doctor uses special instruments to check the organs near the esophagus. For example, the doctor can look through a laryngoscope to see whether the cancer has spread to the larynx (voice box). A bronchoscope lets the doctor see into the trachea and bronchi (airways that lead into the lungs).

If lymph nodes near the esophagus are enlarged, the surgeon may perform a biopsy to find out whether they contain cancer cells. Sometimes, the surgeon also removes samples of other tissues in the area to see whether the cancer has spread.

How is cancer of the esophagus treated?

Treatment for esophageal cancer depends on a number of factors. Among these are the exact location, size, and extent of the tumor, and the type of cancer cells. The doctor also considers the person's age and general health to develop a treatment plan to fit each person's needs.

The patient's doctor may want to discuss the case with other doctors who treat cancer of the esophagus. Also, the patient may want to talk with the doctor about taking part in a research study of new treatment methods. Such studies, called clinical trials, are designed to improve cancer treatment.

Many patients want to learn all they can about their disease and their treatment choices so they can take an active part in decisions about their medical care. People with cancer have many questions and concerns about their health. The doctor is the best one to answer them. Most patients want to know the extent of their cancer, how it will be treated, how successful the treatment is likely to be, and how much it will cost.

Many people find it helpful to make a list of questions before they see the doctor. Taking notes can make it easier to remember what the doctor says. Some patients also find that it helps to have a family member or friend with them when they talk to the doctor, either to take part in the discussion or just to listen.

There is a lot to learn about cancer and its treatment. Patients should not feel that they need to understand everything the first time they hear it. They will have many chances to ask the doctor to explain things that are not clear.

The following stages are used for esophageal cancer:

Stage 0 (Carcinoma in Situ)

In stage 0, cancer is found only in the innermost layer of cells lining the esophagus. Stage 0 is also called carcinoma in situ.

Stage I

In stage I, cancer has spread beyond the innermost layer of cells to the next layer of tissue in the wall of the esophagus.

Stage II

Stage II esophageal cancer is divided into stage IIA and stage IIB, depending on where the cancer has spread.

• Stage IIA: Cancer has spread to the layer of esophageal muscle or to the outer wall of the esophagus.


• Stage IIB: Cancer may have spread to any of the first three layers of the esophagus and to nearby lymph nodes.

Stage III

In stage III, cancer has spread to the outer wall of the esophagus and may have spread to tissues or lymph nodes near the esophagus.

Stage IV

Stage IV esophageal cancer is divided into stage IVA and stage IVB, depending on where the cancer has spread.

• Stage IVA: Cancer has spread to nearby or distant lymph nodes.


• Stage IVB: Cancer has spread to distant lymph nodes and/or organs in other parts of the body.

Stage 0 Esophageal Cancer (Carcinoma in Situ)

Treatment of stage 0 esophageal cancer (carcinoma in situ) is usually surgery.

Stage I Esophageal Cancer

Treatment of stage I esophageal cancer may include the following:

• Surgery.


• Clinical trials of chemotherapy plus radiation therapy, with or without surgery.


• Clinical trials of new therapies used before or after surgery.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied.

Stage II Esophageal Cancer

Treatment of stage II esophageal cancer may include the following:

• Surgery.


• Clinical trials of chemotherapy plus radiation therapy, with or without surgery.


• Clinical trials of new therapies used before or after surgery.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied.

Stage III Esophageal Cancer

Treatment of stage III esophageal cancer may include the following:

• Surgery.


• Clinical trials of chemotherapy plus radiation therapy, with or without surgery.


• Clinical trials of new therapies used before or after surgery.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied.

Stage IV Esophageal Cancer

Treatment of stage IV esophageal cancer may include the following:

• External or internal radiation therapy as palliative therapy to relieve symptoms and improve quality of life.


• Laser surgery or electrocoagulation as palliative therapy to relieve symptoms and improve quality of life.


• Chemotherapy.


• Clinical trials of chemotherapy.

TREATMENT METHODS

Cancer of the esophagus usually cannot be cured unless it is found in the earliest stages, before it has begun to spread. Unfortunately, early esophageal cancer causes few symptoms, and the disease is usually advanced when the diagnosis is made. However, advanced esophageal cancer can be treated and symptoms can be relieved.

Esophageal cancer is usually treated with surgery, radiation therapy (also called radiotherapy), or chemotherapy. The doctor may use just one treatment method or combine them, depending on the patient's needs.

In some cases, the patient is referred to doctors who specialize in different kinds of cancer treatment. Often, specialists work together as a team to plan and carry out the patient's care. The medical team may include a gastroenterologist, surgeon, oncologist (cancer specialist), radiation oncologist, nurse, dietitian, and social worker.

Surgery is often part of the treatment plan. Many patients with esophageal cancer have an operation called esophagectomy. Generally, the surgeon removes the tumor along with a portion of the esophagus, nearby lymph nodes, and other tissue in the area. Usually, it is possible to connect the stomach to the remaining part of the esophagus. In a few cases, the surgeon forms a new passageway from the throat to the stomach, using tissue from another part of the digestive tract (such as the colon) to replace the esophagus.

If a tumor blocks the esophagus but cannot be removed, the surgeon may be able to create a bypass, a new pathway to the stomach. In some cases, the surgeon can dilate (widen) the esophagus. This procedure may have to be repeated as the tumor grows. Sometimes, the doctor puts a tube into the esophagus to keep it open. Recently, some surgeons have used a laser to destroy cancerous tissue and relieve blockages.

Radiation therapy is the use of high-energy rays to damage cancer cells and stop them from growing. Like surgery, radiation therapy is local therapy; it affects cells only in the treated area. Radiation therapy can be used to shrink a tumor before surgery or to destroy cancer cells that may remain in the area after surgery. Radiation may also be used instead of surgery, especially if the size or location of the tumor would make an operation difficult. In some cases, radiation therapy is recommended for patients who cannot have surgery for other health reasons. Even if the tumor cannot be removed by surgery or destroyed entirely by radiation therapy, radiation therapy can still help relieve pain and make swallowing easier.

In radiation therapy for esophageal cancer, the energy usually comes from a machine outside the body (external radiation). Some patients also need treatment with radioactive materials placed in the tumor (implant radiation). Usually, patients receive external radiation therapy 5 days a week for several weeks. Most patients can stay at home and go to the hospital or clinic each day for this treatment. For implant radiation, patients must stay in the hospital for a short time. More information about radiation therapy can be found in the National Cancer Institute booklet Radiation Therapy and You.

Chemotherapy is the use of drugs to kill cancer cells. The doctor may suggest one drug or a combination of drugs. Chemotherapy may be used alone or combined with radiation therapy to shrink a tumor before surgery or to destroy cancer cells that remain in the body after surgery. Chemotherapy may also be used if surgery is not possible and for patients whose cancer returns after surgery or radiation therapy.

Most anticancer drugs for esophageal cancer are given by injection into a vein or muscle. Some may be taken by mouth. Chemotherapy is systemic therapy, meaning that the drugs travel through the bloodstream and can reach cancer cells all over the body. Often, the drugs are given in cycles: a treatment period followed by a rest period, then another treatment and rest period, and so on. Many patients have their chemotherapy as outpatients at the hospital, in the doctor's office, or at home. Depending on the drugs, the treatment plan, and the patient's general health, a hospital stay may be needed.

The most common signs of esophageal cancer are painful or difficult swallowing and weight loss.

These and other symptoms may be caused by esophageal cancer or by other conditions. A doctor should be consulted if any of the following problems occur:

• Painful or difficult swallowing.


• Weight loss.


• Pain behind the breastbone.


• Hoarseness and cough.


• Indigestion and heartburn.

Tests that examine the esophagus are used to detect (find) and diagnose esophageal cancer.

The following tests and procedures may be used:

• Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.


• Barium swallow: A series of x-rays of the esophagus and stomach. The patient drinks a liquid that contains barium (a silver-white metallic compound). The liquid coats the esophagus and x-rays are taken. This procedure is also called an upper GI series.


• Esophagoscopy: A procedure to look inside the esophagus to check for abnormal areas. An esophagoscope (a thin, lighted tube) is inserted through the mouth or nose and down the throat into the esophagus. Tissue samples may be taken for biopsy.


• Biopsy: The removal of cells or tissues so they can be viewed under a microscope to check for signs of cancer. The biopsy is usually done during an esophagoscopy. Sometimes a biopsy shows changes in the esophagus that are not cancer but may lead to cancer.

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) and treatment options depend on the following:

• The stage of the cancer (whether it affects part of the esophagus, involves the whole esophagus, or has spread to other places in the body).


• The size of the tumor.


• The patient’s general health.

When esophageal cancer is found very early, there is a better chance of recovery. Esophageal cancer is often in an advanced stage when it is diagnosed. At later stages, esophageal cancer can be treated but rarely can be cured. Taking part in one of the clinical trials being done to improve treatment should be considered. Information about ongoing clinical trials is available

What are the side effects of treatment for cancer of the esophagus?

The methods used to treat cancer are very powerful. It is hard to limit the effects of therapy so that only cancer cells are removed or destroyed. Because healthy cells also may be damaged, treatment often causes unpleasant side effects.

The side effects of cancer treatment vary. They depend mainly on the type and extent of the treatment. Also, each person reacts differently. Attempts are made to plan the therapy to keep side effects to a minimum. Patients are carefully monitored so that any problems which occur can be addressed.

Surgery for cancer of the esophagus is a major operation. Patients who have had trouble eating and drinking may need intravenous (IV) feedings and fluids for several days before and after the operation. They may need antibiotics to prevent or treat infections. Patients are taught special coughing and breathing exercises to keep their lungs clear. Discomfort or pain after surgery can be controlled with medicine. Patients should feel free to discuss pain relief with the doctor.

Patients receiving radiation therapy may become tired as treatment continues. Resting as much as possible is important. It is also common for the skin in the treated area to become red or dry. The skin should be exposed to the air but protected from the sun, and the patients should avoid wearing clothes that rub the area. Good skin care is important at this time. The doctor may suggest certain kinds of soap, and patients should not use any lotion or cream on the skin without the doctor's advice. Radiation to the chest and neck can cause a dry, sore throat or a dry cough. Drinking extra liquids can be helpful, and doctors sometimes suggest cough medicine. If burning, tightness, or other pain makes it hard to swallow, the doctor may suggest a local anesthetic or soothing gargle for use before meals. Some patients find that antacids help relieve feelings of indigestion. A small number of patients feel short of breath during radiation therapy. The doctor may prescribe medicine to relieve this problem.

The side effects of chemotherapy depend on the drugs that are given. In general, anticancer drugs affect cells that divide rapidly. These include blood cells, which fight infection, cause the blood to clot, or carry oxygen to all parts of the body. When blood cells are affected by anticancer drugs, patients can have a lowered resistance to infection, bruise or bleed easily, and have less energy. Cells in hair follicles and cells that line the digestive tract also divide rapidly. Chemotherapy can therefore cause hair loss and other problems such as poor appetite, mouth sores, nausea, and vomiting. These side effects usually go away gradually after treatment stops.

The patient's weight is checked regularly because weight loss can be a serious problem for patients with cancer of the esophagus. Swallowing food can be difficult, and patients may not feel hungry if they are uncomfortable or tired. Yet, well- nourished patients generally feel better, have more energy, and are often better able to withstand the side effects of their treatment, so good nutrition is important. Patients with esophageal cancer are usually encouraged to have several small meals and snacks throughout the day, rather than to try to eat three large meals. It often helps to sit up for a while after eating, and the doctor may prescribe medicine to control nausea and vomiting and to relieve discomfort.

When swallowing is difficult, many patients can still manage soft, bland foods moistened with sauces or gravies. It can be helpful to prepare other foods in a blender. In addition, puddings, ice cream, and soups are nourishing and easy to swallow. Doctors, nurses, and dietitians may have other suggestions to help patients and their families choose foods that supply enough calories to control weight loss and enough protein to keep up strength and rebuild normal tissues. For example, they may suggest liquid dietary supplements or milkshakes made with extra protein powder or dry milk for patients who cannot swallow solid foods.

The health care team can explain the effects of esophageal cancer and its treatment, and they can suggest ways to deal with them.

INTEGRATIVE THERAPY

THE SCIENTIFICALLY FORMULATED AMINO ACID THERAPY

(Keep in mind, CAAT is much more than just a “diet”; it is an amino acid, carbohydrate, & glucose REDUCTION protocol which strategically uses the chemical reactions of amino acids, foods, and nutritional supplements to impair the development of cancer cells, thus starving them to death.) Clinical trials have already been done with humans using amino acid depravation formulas, and with much success. (Journal American Medical Association. 1967; 200:211)

CAAT is a course of therapy to control a patient’s amino acid intake. This is achieved by taking certain foods out of a persons’ daily food plan for a short time and by replacing them with a scientifically supported formula of amino acids. It is also important to emphasize that the food plan that accompanies the amino acid formula needs to be followed so not to offset any of the benefits we are creating by depriving the cancer cells the nutrients they need to grow. Also, it is important to realize that the patient does not need to abandon their conventional cancer treatment, (surgery, chemotherapy, radiation, hormone treatments) nor is it recommended that they do so unless it has already failed them. CAAT works synergistically with chemotherapy and/or radiation to enhance their benefits (see study by Dr. Marco Rabinowitz of the National Cancer Institute). His report on amino acid deprivation, such as with Controlled Amino Acid Therapy (CAAT), proven to inhibit phosphofructokinase which shuts down the energy supply to cancer cells, simultaneously enhancing the benefits of chemotherapy while lessening their toxic side effects. CAAT has also proven to work successfully alone.

Phase 1: CAAT Formulation

The most important component of CAAT is the scientifically formulated amino acids. Based on the specific formula for each cancer, it consists of separate amino acids, citric acid, and small amounts of sodium benzoate. Each formula replaces most of the regular daily proteins found in meats, dairy, fish, beans and nuts, which cancer cells can derive their energy from. The CAAT formula taken two times per day will nourish the healthy cells while causing the cancer cells to starve to death. Of course each individual has specific needs concerning their diet, and this is explained in the second phase of the protocol as well as with a specialist at the Institute when beginning the CAAT therapy.

Phase 2: Daily Food Intake

DISCLAIMER: The following food program SHOULD NOT be consumed without the amino acid formula and without consent from your doctor and our Institute.

Breakfast:
*1/2 Grapefruit or 1-orange or 6-ounces of fresh orange juice.
Whey Enhanced Protein (Vanilla Flavor – Vitamin Shoppe Brand) approximately
10 – 12 grams of protein – read label carefully, based on 150 lb. person ].
A serving of Grits (Butter, cinnamon and other spices are okay).
1 cup of green or black tea (Fructose is sweetener of choice).
* Do Not have ½ grapefruit if taking Chemotherapy

Explanation: ½ Grapefruit or 1 orange or 6 ounces of fresh orange juice are rich in the natural nutrients called Limonene and Citric Acid. Limonene helps shut down the Ras cancer gene which is over active in 90 percent of all cancers. Citric Acid helps shut down glycolosis which in turn helps starve cancer cells to death.

Whey Enhanced Protein (Vanilla Flavor – Vitamin Shoppe Brand) Phosphorus is a nutrient that cancer cells must utilize in order to grow and reproduce. This brand of whey protein is very low in phosphorous and contains no additional vitamins, so when using approximately 10 – 12 grams of protein per 150 lb. person, it helps to protect normal cells, maintain a normal appetite, and also helps to fight edema. (Edema is the swelling or water build up in the legs or other sites in the body)
Whey protein is included in the daily menu of all advanced or metastatic cancer patients. When treating cancers that are stable or have regressed in size, patients then have the option of including other protein foods at their breakfast meals such as cottage cheese, yogurt, or soy foods. Eggs are allowed in the diets of patients with lymphoma and brain cancers.

Grits or Cream of Wheat or 1 slice of white toast or ½ plain bagel or ½ English muffin (Butter is okay)
Grits or white rice is the preferred carbohydrate food at each meal. The other choices are options once the patient’s cancer is stable or reduced in size. Unrefined carbohydrates are included in the CAAT menu instead of whole grains to deprive cancer cells of a certain B-complex vitamin called Pyridoxine (Vitamin B-6). Cancer cells require this vitamin to manufacture certain amino acids that we keep away from through CAAT’s amino acid reduction formula and diet.
Grits is the preferred carbohydrate food at all meals instead of rice, corn, or pasta because it helps deplete Tryptophan in the body, which is essential for the growth and spreading of cancer cells.

1 cup of green or black tea, using fructose as the sweetener of choice. These teas are rich sources of several compounds that help shut down glycolosis and cut off the energy supply to cancer cells. Also, green or regular tea helps to prevent certain hormones and tumor growth factors from stimulating cancer cells to grow and metastasize to other parts of the body. Brassica teas can also be taken because they contain sulphorane, a nutrient that inhibits cancer growth, and also shuts down the cancer genes.
* Why we use fructose as the sweetener of choice will be explained in detail at the end of this phase of the CAAT protocol.

Lunch:

Amino acid formula (4 level plastic scoops) mixed with any of the following: Water & Fructose; Sugar free Kool-Aid; Diet ginger ale; Fresh lemonade & Fructose; Chicken or Beef broth; V8 juice.
Generous amounts of One cooked vegetable or a combination of the following: asparagus, broccoli, cabbage, brussell sprouts, spinach, squash, string beans.
One serving (1/2 cup)of fresh fruit. Choice of: pear, orange, blueberries, raspberries, strawberries.
1 serving (moderate) of grits or corn or rice or pasta (Add tomato sauce or butter)
1 tablespoon of coconut oil
8 to 10 black or green olives
2 tablespoons of vinegar (minimum of 5% acidity) add to vegetables or food
1 cup of green or black tea (Fructose as desired)

Explanation:

This Amino Acid Reduction Formula (4 level plastic scoops may vary) combined with the special diet, allows the CAAT Protocol to reduce certain amino acids in the daily diet of the cancer patient, and is designed to replace most of the animal protein in the diet. Cancer cells require the amino acids glycine, serine, glutamic acid, and aspartic acid to synthesize DNA, build new blood vessels or duplicate its entire contents of proteins. Also, cancer cells require these and certain other amino acids in order to synthesize other proteins that act as growth promoting hormones or tumor growth factors. CAAT impairs the synthesis of a protein called elastin, which is absolutely essential to the manufacture of new blood vessels. The Amino Acid Reduction Formula, diet, certain phytochemicals and herbs work efficaciously to attack cancer cells at each and every biological front.

The generous amounts of one cooked vegetable or a combination of such helps keep normal cells healthy. They are low in carbohydrates and proteins, and high in phytochemicals, compounds which help fight cancer. Patients are allowed to eat these vegetables and salads whenever desired.

The 8 to 10 olives are rich in squalene and oleic acid, nutrients that have been reported to inhibit certain cancer growth factors. The calories in olives also help control body weight and increases ketones in the blood. Ketones help fight cancer by impairing glycolosis – a process in which cancer cells depend almost exclusively upon for their daily supply of energy. Vinegar (and fructose) are two natural products that increase the production of both ACETIC ACID and CITRIC ACID in the body.

Acetic acid and citric acid also help fight cancer by shutting down the process of glycolosis.
Normal cells derive most of their daily energy supply from acetic acid and citric acid, where as cancer cells derive most of their daily energy from glycolosis.

Dinner:

Amino acid formula (4 plastic level scoops) mixed with any of the following: Water & fructose; Sugar free Kool–Ade; Diet Ginger Ale; Fresh lemonade & Fructose; Chicken or Beef broth; V8 Juice.
Generous amounts of One cooked vegetable or a combination of the following: asparagus, broccoli, cabbage, brussel sprouts, spinach, squash, string beans.
One serving (1/2 cup) of stewed plums with fresh cream & fructose; use 4-ounces of orange juice if plums are not in season.
Avacado salad with lettuce, tomatoes, celery, onions, with lemon juice and coconut oil or olive oil.
2 tablespoons of vinegar (minimum of 5% acidity) add to vegetables or food.
1 serving of grits or corn or pasta or rice (Add garlic and butter or tomato sauce)
1 cup of green or black tea (Fructose as desired)

Mid Evening Snack: Ketogenic Cocktail – 2 ounces of fresh cream, ½ ounce each of both coconut & olive oil, 1 tablespoon of Fructose.
Sugar free Jell-O with whipped cream & Fructose or 1 plum or 4 ounces of orange juice.

Explanation: The sugar free jell-o helps to appease the appetite. Plums contain quinlic acid, which is converted into benzoic acid in the body and which in turn helps to deplete the availability of the amino acid Glycine (Glycine is essential to the synthesis of DNA for cancer cells) and the proteins that cancer cells require to build new blood vessels and their tumor growth factors. If underweight take two ounces of light cream and one ounce of olive oil/coconut oil as needed to maintain weight.

Optional Meal:

3 to 4 ounces of Veal, Fish of choice, Beef, Chicken breast, and 1-slice of white bread.

Consume this meal with a minimum of 3 hours before or after taking the amino acids.

Explanation: If the patient is 10 or more pounds underweight or if their albumin levels are below normal is when the optional meal is allowed. This meal should be eaten a minimum of 3 hours before or after taking the amino acids. CAAT provides sufficient protein to maintain the health of normal cells and adequate amounts of calories to maintain desired body weight. Any proteins taken in excess of amounts recommended in the diet will counter act the benefits of the CAAT protocol.

Special Diets: A special diet will be created for any cancer patient whose ability to consume food and liquids has placed them in a critical situation. When a patient is using a feeding apparatus, or they have become too weak or lethargic to eat and drink the daily minimum amount for survival, we will break up the total breakfast, lunch, and dinner over a period of every 2 hours during the entire day until the patient is capable of returning to a daily diet as outlined above.

Carbohydrate and glucose reduction in this diet: CAAT’S dietary menu provides approximately 20 percent of its calories in the form of carbohydrates. Calories need not be a focal point or counted daily. It is recommended that all patients combat their cancers by keeping their body weight at normal or slightly below normal levels. A patient’s desired body weight is regulated by their rate of metabolism, which in turn is regulated by their blood levels of thyroxine, cortisone, insulin, and the amounts of fats and oils in the diet. Studies with human cancer patients and laboratory animals show that reducing the calories of carbohydrates (glucose) in their daily diet by only 10 percent reduced the size of cancerous tumors. When carbohydrate (glucose) calories were reduced 40 percent, the cancers disappeared. It is recommended that those patients who are obese gradually and systematically lose their excess weight to increase the efficiency of the CAAT protocol. Those patients who are underweight shoudn’t gain weight unless they are more than 10 pounds below normal levels. When a patient is underweight due to anorexia or cachexia, such illnesses must be addressed before the CAAT protocol can begin.

Why we use Fructose and Vinegar to treat cancer:

Nobel Prize winner Dr. Otto Warburg discovered more than 50 years ago that all cancer cells produce inordinate amount of lactic acid but he couldn’t explain why.

In 2001 our Institute published the first study to show that cancer cells produce excess amounts of lactic acid because they could not access the oxygen in compartments in the cells called the mitochondria. This provided evidence that cancer cells depend almost exclusively upon glycolosis or the metabolism of glucose as their major source of energy.

Dr. Spitz and Dr. Lee with other cancer researchers published studies showing that when cancer cells are deprived glucose, their energy supply is cut off which causes these cancer cells to commit suicide.

Therefore shutting down glycolosis would be one means of destroying cancer cells because energy can only be derived from glucose through the metabolic process called glycolosis.

Recently our Cancer Institute discovered that both acetic acid and citric acid could inhibit the activity of a key enzyme in glycolosis called phosphofructokinase, which in turn shuts down the process of glycolosis. Our cancer Institute is the first to introduce both fructose and vinegar as treatments for cancer because they either contain or produce acetic acid.

In conclusion, fructose and vinegar are added as supplements to the CAAT protocol because of their acetic acid properties that help shut down glycolosis, shutting off cancer cells energy supply and causing them to die off.

Phase 3: Nutritional Supplements

Nutritional supplements are based on each unique situation. For example, slow-growing cancers produce low levels of toxic free radicals. Tumor cells that grow aggressively produce large amounts of toxic free radicals. The patient will be instructed whether or not to take anti-oxidants (in a nutritional supplement), and at what dosage, according to the levels of toxic free radicals produced in the cancerous cells.

An example of how nutritional supplements can help manipulate cancer cells involves vitamin B-6 (pyroxidine) There are four amino acids essential to the synthesis of DNA. However, those amino acids cannot be synthesized without a certain enzyme, which includes vitamin B-6 among other components. Any supplement containing vitamin B-6 SHOULD NOT be taken during the first 2 months of the CAAT protocol.

The patient will be instructed as to which nutritional supplements or phytochemicals should be purchased and at what dosage strength. Keep in mind that each supplement only complements the CAAT protocol. However, when they are combined they augment the therapeutic benefits of the aminoacid, carbohydrate, and glucose reduction diet.

Parsley: Contains ingredients that can help shut down certain enzymes called Epithelial Growth Factors, which stimulate the growth and spread of cancer. ( CAAT’S amino acid reduction diet works in the same manner )

Vitamin D: Helps activate in many kinds of cancers enzymes called Phosphotases, which literally shut down the activities of other enzymes called Kinases, which are essential to the growth and reproduction of cancer cells.

Green Tea Extract: Phytochemicals in tea help shut down glycolosis (cancer cell’s main supplier of energy) and thereby help to starve cancer cells to death. These effects help complement the effects of CAAT’S carbohydrate reduction.

Anti-Oxidants: The controversy as to whether or not to treat cancer with anti-oxidants is slowly resolving with the current understanding of how they affect the activity of genes and enzymes in cancer cells. The prevailing data shows that the benefits or lack of benefits depend upon the oxidative state the cancer cells are in. Anti-oxidants taken when the cells are in a very high oxidative state may prevent cancer cells from entering apoptosis ( apoptosis is when a cancer cell commits suicide) When oxidative stress in cancer cells is only slightly above normal, anti-oxidants are then expected to stop their growth and reproduction.

Blood Chemistry: Blood tests are usually taken every 6 to 8 weeks, depending upon the results of each test. Not only is it important to monitor the tumor markers but equally important to keep abreast of the overall health of normal tissues and organs. For example, it is important to learn of the health of the kidneys and liver, whether the body is producing sufficient red and white blood cells, etc. Low albumin levels most often indicate insufficient intake of proteins in the diet and this problem would have to be addressed. CAAT is designed to attack cancer but keep the normal cells and tissues functioning harmoniously.

Whey Protein: This protein food is recommended at the breakfast meal to help meet the daily needs of amino acids for the normal cells of the body, and to help keep albumin levels normal and to help prevent edema. We recommend Whey protein purchased from the Vitamin Shoppe because it is the only brand that we have seen with no phosphorous or additional vitamins added to it.

Grits: Grits are also recommended at the breakfast meal in place of whole grains because it is low in vitamin B-6. Cancer cells require B-6 to manufacture the amino acid Glycine, which is required for DNA synthesis. Grits, instead of whole grains, therefore helps prevent cancer cells from manufacturing DNA and building new blood vessels.

Calcium D-Glucurate: This phytochemical helps the body to retain a compound called Glucuronic acid. This is necessary to eliminate both estrogen and testosterone from the body. This is why Calcium D-Glucurate is added to the regiments of patients with breast & prostate cancers. Calcium D-Glucurate is not to be confused with calcium carbonate, which is nothing more than a calcium supplement.

D-Limonene: This phytochemical found mostly in citrus fruits blocks the process called Isoprenylation, which is necessary for tumor growth factors such as the RAS gene, Epithelial Growth factor, Tyrosine Kinase, and Insulin-Like-Growth-factor, to send their signals into the nucleus of a cancer cell and directs them to grow and divide into more cancer cells.

Tocotrienols: This member of the Vitamin E family also helps shut down Isoprenylation and assists D-Limonene in blocking the actions of the various tumor growth factors. More specifically, tocotrienols shut down an enzyme called HMG-2, which is essential to the synthesis of the building blocks that form the Isoprenylation process.

Niacin: This B-Complex vitamin works with D-limonene and the Tocotrienols to shut down the process of Isoprenylation, which as mentioned above prevents the cancer promoting RAS genes from sending signals into the nucleus of the cell. Niacin also helps deplete thee amino acid Glycine, which cancer cells need to synthesize DNA. And by reducing cholesterole in the body, Niacin helps lower the production of estrogen and testosterone.

Choline: This B-complex vitamin is included in our supplement list to help the liver metabolize Niacin and other compounds and to help fight fatigue that accompanies most forms of cancer.

Selenium: Numerous studies show that this mineral can interfere with the activity of certain genes that promote the growth of cancer and to induce cancer cells to commit suicide (apoptosis)

Perilla Oil: This oil is rich in Alpha Linolenic Acid which can inhibit the growth of cancer cells in several ways. One way is to inhibit the synthesis in the body of a tumor growth promotin hormone called Prostaglandin-2, also, Alpha Linolenic Acid inhibits the actions of certain genes that promote the growth of cancer cells. Linolenic acid is not to be confused with linoleic acid, which is a bad fat that stimulates the growth of cancer cells. This bad fat, linoleic acid, is found in all vegetable oils and nuts (With the exception of coconut oil). Olive oil has the least amount of this bad fat.

Super Miraforte: This herb impairs the synthesis of estrogen from testosterone in the body and is included in the regiments of women with breast cancer.
Licorice Root Extract & Pantothenic Acid: This herb and vitamin are added to the regiment when it is desirable to produce steroid like actions in the body. Also used to help patient’s gain weight and to inhibit the growth of lymphomas and leukemia’s.

Resveratrol: This phytochemical blocks the actions of a number of a number of cancer promoting genes thereby causing cancer cells to enter into apoptosis (cell death) and is included in the treatment of all cancers.

Indole-3 Carbinol & D.I.M.: These two phytochemicals block the actions of both estrogen and testosterone and are included in the regiments of both breast and prostate gland cancer.

Melatonin: Numerous studies show that this hormone blocks the synthesis of the cancer promoting chemicals in the body called Leukotrienes, and is included in the treatment of all cancers.

Artho Pro System: This combination of herbs and phytochemicals inhibits the synthesis of the cancer promoting hormone called Prostaglandin-2 and the Leukotriens and replaces the drug celebrex when liver problems are present. The Prostaglandin hormone is over active in most cancers and stimulates cancer growth. The body manufactures the Prostaglandin hormone from the bad fat, Linoleic acid, mentioned above.

Licorice Root Extract & Pantothenic Acid: This HERB and VITAMIN are added to the regiment when it is desirable to produce steroid like actions in the body. Used also to help patients gain weight and ti inhibit the growth of Lymphomas and Leukemias.

CAAT is designed to attack cancer, while keeping normal cells and tissues functioning harmoniously.

* When considering any type of complementary cancer treatment or alternative cancer treatment, always consult with your physician first, as possible interactions could reduce your regimen’s efficacy.

If this information has generated any questions you would like answered.