institute for cancer research

What is Pancreatic Cancer?

The pancreas is a pear-shaped gland located in the abdomen between the stomach and the spine. It is about 6 inches in length and it makes hormones and enzymes that help the body digest and break down food. One of the hormones the pancreas produces is insulin, which is an important substance that helps control the amount of sugar in the blood.

Pancreatic canceris a disease in which normal cells in a gland called the pancreas malfunction and begin to grow out of control. If not treated or removed, these cancerous cells will eventually form a growth or tumor, which can interfere with proper functioning of the pancreas and spread to cause cancer in other parts of the body.

The enzymes produced by the pancreas are released into ducts, which lead to the common bile duct and then into the small intestine. It is in these ducts that most pancreatic cancers begin and this type of cancer is referred to as pancreatic cancer or carcinoma of the pancreas. Most of the cancers that occur in these cells are called adenocarcinomas. Other cancers that occur in these cells are adenosquamous carcinomas, squamous cell carcinomas, and giant cell carcinomas.

In some cases, cancer will begin in the cells of the pancreas that produce insulin and other hormones. This is referred to as islet cell cancer. Tumors that are not cancerous also occur in these cells and they are known collectively as neuroendocrine tumors, or more specifically, islet cell tumors.

However, most cases of pancreatic cancer are not detected until the cancer has metastasized or spread beyond the pancreas to other areas of the body, such as the liver, the lungs or the peritoneum, which is the tissue lining the abdomen. At this stage, pancreatic cancer can be very difficult to treat because medications and surgical procedures are not very effective at stopping the cancer once it has spread beyond the pancreas.

Regardless, all cancers occur due to the out-of-control growth of abnormal cells.

The pancreas has two main jobs in the body:

• To produce juices that help digest (break down) food.


• To produce hormones, such as insulin and glucagon, that help control blood sugar levels. Both of these hormones help the body use and store the energy it gets from food.

The digestive juices are produced by exocrine pancreas cells and the hormones are produced by endocrine pancreas cells. About 95% of pancreatic cancers begin in exocrine cells.

Pancreatic cancer is difficult to detect (find) and diagnose early.

Pancreatic cancer is difficult to detect and diagnose for the following reasons:

• There aren’t any noticeable signs or symptoms in the early stages of pancreatic cancer.


• The signs of pancreatic cancer, when present, are like the signs of many other illnesses.


• The pancreas is hidden behind other organs such as the stomach, small intestine, liver, gallbladder, spleen, and bile ducts.

Cancers of the exocrine pancreas are a very serious health issue in the United States where approximately 27,000 patients are diagnosed annually with pancreatic cancer while about the same number die annually from this disease. Due to difficulties in diagnosis, the intrinsic aggressive nature of pancreatic cancers, and the sparse systemic treatment options available, only approximately 4% of patients diagnosed with pancreatic adenocarcinoma will be alive five years after diagnosis. Pancreatic cancer is the fifth leading cause of cancer deaths following breast cancer; lung cancer, colon cancer, and prostate cancer. Because of the extremely poor prognosis for the majority of individuals with pancreatic cancer, it is very important that patients be offered the opportunity to participate in clinical trials. If you or someone you love has been diagnosed with pancreatic cancer, speak with your physician regarding any trials in which you or your loved one may be eligible to participate.

Am I at Risk For Pancreatic Cancer?

The incidence of pancreatic cancer is highest between 60 and 80 years of age, and is only rarely seen in people under 40. It is seen about equally in men and women, although the rates in women have risen in recent years, which may be due to higher rates of smoking in women. Cigarette smokers are two to three times more likely to develop pancreatic cancer. It is slightly more common in blacks and members of the Jewish community. It is seen more commonly in people who have diabetes, but this link is not yet well understood. Certain occupational exposures are thought to put a person at higher risk. These include chemists, coal, gas, and metal industry workers, and industries where pesticides are used more frequently. A person's risk triples if their mother, father, or siblings have had the disease. A family history of breast or colon cancer also increases risk. This increased risk is due to inherited mutations in cancer causing genes (changes that allow cancer to develop). The actual cause of this disease is not known, but is thought to be a result of a combination of inherited genetic changes and changes caused by environmental exposures.

Risk Factors

The risk of developing cancer of the pancreas is usually low before the age of 40, but the risk subsequently increases sharply, with most people diagnosed between their sixties and eighties. Risk factors for the development of this disease include environmental factors, medical/surgical factors, genetic factors, and occupational exposures.

The presence of a risk factor does not necessarily mean that an individual will develop cancer, nor does the absence of risk factors mean that an individual will not develop cancer.

Age: The incidence of pancreatic cancer is relatively low in individuals up to age 50, after which it increases significantly. The age group 65 - 79 has the highest incidence of cancer of the pancreas.

Smoking: Smokers develop pancreatic cancer more than twice as often as nonsmokers.

Diet: Frequency of pancreatic cancer may be associated with high intakes of meat and fat.

Medical factors: Pancreatic cancer is more common among individuals with histories of the following conditions: cirrhosis (a chronic liver disease), chronic pancreatitis, diabetes and a history of surgery to the upper digestive tract.

Environmental factors: Long-term exposure to certain chemicals, such as gasoline and related compounds, as well as certain insecticides, may increase the risk of developing cancer of the pancreas.

Genetic predisposition: Possibly 3% of cases of pancreatic cancer are related to genetic disorders.

Signs and Symptoms

The diagnosis of pancreatic cancer is usually delayed because symptoms are nonspecific. Jaundice, which causes yellowing of the skin, is present in approximately 50% of patients at the time of diagnosis and may be associated with less-advanced disease. Other symptoms include weight loss, fatigue, discomfort in the abdomen, loss of appetite, and glucose intolerance.

In addition, the patient may experience pain in the abdomen and back. The pancreas may produce too much insulin, causing such symptoms as dizziness, weakness, diarrhea, chills, or muscle spasms.

The patient may not even notice the gradual onset of these relatively nonspecific symptoms. The doctor may interpret them as being caused by something else.

If a physician suspects pancreatic cancer, the first step is to evaluate the patient with a series of tests. Imaging tests produce a picture of a patient's organs and tissues. If an abnormality is noted and the patient appears to have resectable disease (see the Staging section) surgery is often the next step. Additional tests which may be of benefit in the work-up include the tumor marker CA 19-9 (cancer antigen).

Tests that examine the pancreas are used to detect (find), diagnose, and stage pancreatic cancer.

How is cancer of the pancreas diagnosed?

To diagnose pancreatic cancer, the doctor does a complete physical exam and asks about the patient's personal and family medical history. In addition to checking general signs of health (temperature, pulse, blood pressure, and so on), the doctor usually orders blood, urine, and stool tests. The doctor may also ask for a "barium swallow," or "upper GI series." For this test, the patient drinks a barium solution before x-rays of the upper digestive system are taken. The barium shows an outline of the pancreas on the x-rays.

Pancreatic cancer is usually diagnosed with tests and procedures that produce pictures of the pancreas and the area around it. The process used to find out if cancer cells have spread within and around the pancreas is called staging. Tests and procedures to detect, diagnose, and stage pancreatic cancer are usually done at the same time. In order to plan treatment, it is important to know the stage of the disease and whether or not the pancreatic cancer can be removed by surgery. 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.



• Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.



• 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 procedure is also called computed tomography, computerized tomography, or computerized axial tomography. A spiral or helical CT scan makes a series of very detailed pictures of areas inside the body using an x-ray machine that scans the body in a spiral path.



• MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).



• 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.



• 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.



• 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.



• Endoscopic retrograde cholangiopancreatography (ERCP): A procedure used to x-ray the ducts (tubes) that carry bile from the liver to the gallbladder and from the gallbladder to the small intestine. Sometimes pancreatic cancer causes these ducts to narrow and block or slow the flow of bile, causing jaundice. An endoscope (a thin, lighted tube) is passed through the mouth, esophagus, and stomach into the first part of the small intestine. A catheter (a smaller tube) is then inserted through the endoscope into the pancreatic ducts. A dye is injected through the catheter into the ducts and an x-ray is taken. If the ducts are blocked by a tumor, a fine tube may be inserted into the duct to unblock it. This tube (or stent) may be left in place to keep the duct open. Tissue samples may also be taken.



• Percutaneous transhepatic cholangiography (PTC): A procedure used to x-ray the liver and bile ducts. A thin needle is inserted through the skin below the ribs and into the liver. Dye is injected into the liver or bile ducts and an x-ray is taken. If a blockage is found, a thin, flexible tube called a stent is sometimes left in the liver to drain bile into the small intestine or a collection bag outside the body. This test is done only if ERCP cannot be done.



• Biopsy: The removal of cells or tissues so they can be viewed under a microscope to check for signs of cancer. There are several ways to do a biopsy for pancreatic cancer. A fine needle may be inserted into the pancreas during an x-ray or ultrasound to remove cells. Tissue may also be removed during a laparoscopy (a surgical incision made in the wall of the abdomen).

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

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

• Whether or not the tumor can be removed by surgery.


• The stage of the cancer (the size of the tumor and whether the cancer has spread outside the pancreas to nearby tissues or lymph nodes or to other places in the body).


• The patient’s general health.


• Whether the cancer has just been diagnosed or has recurred (come back).

Pancreatic cancer can be controlled only if it is found before it has spread, when it can be removed by surgery. If the cancer has spread, palliative treatment can improve the patient's quality of life by controlling the symptoms and complications of this disease.

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.

 

Tests and procedures to stage pancreatic cancer are usually done at the same time as diagnosis.

When the physicians talk about staging, they are referring to determining the size of the tumor and if it has spread or not. This information is then used to determine the best treatment. In the case of pancreatic cancer, the size of the tumor and if it involves important blood vessels determines if it can be surgically removed. Pancreatic cancer is staged on the TNM system (also called tumor - node - metastasis system). This describes the size of the tumor (T), if the lymph nodes are involved (N), and if it has spread to other areas of the body (M).

The following stages are used for pancreatic cancer:

Stage I

In stage I, cancer is found in the pancreas only. Stage I is divided into stage IA and stage IB, based on the size of the tumor.

• Stage IA: The tumor is 2 centimeters or smaller.

Stage IB: The tumor is larger than 2 centimeters.

Stage I Pancreatic Cancer

Treatment of stage I pancreatic cancer may include the following:

• Surgery alone.


• Surgery with chemotherapy and radiation therapy.


• A clinical trial of surgery followed by radiation therapy with chemotherapy. Chemotherapy is given before, during, and after the radiation therapy.


• A clinical trial of surgery followed by chemotherapy.

Stage II

In stage II, cancer may have spread to nearby tissue and organs, and may have spread to lymph nodes near the pancreas. Stage II is divided into stage IIA and stage IIB, based on where the cancer has spread.

• Stage IIA: Cancer has spread to nearby tissue and organs but has not spread to nearby lymph nodes.

Stage IIB: Cancer has spread to nearby lymph nodes and may have spread to nearby tissue and organs.

Stage IIA Pancreatic Cancer

Treatment of stage IIA pancreatic cancer may include the following:

• Surgery with or without chemotherapy and radiation therapy.


• Radiation therapy with chemotherapy.


• Palliative surgery to bypass blocked areas in ducts or the small intestine.


• A clinical trial of surgery followed by radiation therapy with chemotherapy. Chemotherapy is given before, during, and after the radiation therapy.


• A clinical trial of surgery followed by chemotherapy.


• A clinical trial of biologic therapy with radiation therapy and/or chemotherapy.


• A clinical trial of radiation therapy combined with chemotherapy and/or radiosensitizers (drugs that make cancer cells more sensitive to radiation so more tumor cells are killed), followed by surgery.

Stage IIB Pancreatic Cancer

Treatment of stage IIB pancreatic cancer may include the following:

• Surgery with or without chemotherapy and radiation therapy.


• Radiation therapy with chemotherapy.


• Palliative surgery to bypass blocked areas in ducts or the small intestine.


• A clinical trial of surgery followed by radiation therapy with chemotherapy. Chemotherapy is given before, during, and after the radiation therapy.


• A clinical trial of surgery followed by chemotherapy.


• A clinical trial of biologic therapy with radiation therapy and/or chemotherapy.


• A clinical trial of radiation therapy combined with chemotherapy and/or radiosensitizers, followed by surgery.


• A clinical trial of radiation therapy given during surgery or internal radiation therapy.

Stage III

In stage III, cancer has spread to the major blood vessels near the pancreas and may have spread to nearby lymph nodes.

Stage III Pancreatic Cancer

Treatment of stage III pancreatic cancer may include the following:

• Surgery with or without chemotherapy and radiation therapy.


• Radiation therapy with chemotherapy.


• Palliative surgery or stent placement to bypass blocked areas in ducts or the small intestine.


• A clinical trial of surgery followed by radiation therapy with chemotherapy. Chemotherapy is given before, during, and after the radiation therapy.


• A clinical trial of surgery followed by chemotherapy.


• A clinical trial of biologic therapy with radiation therapy and/or chemotherapy.


• A clinical trial of radiation therapy combined with chemotherapy and/or radiosensitizers, which may be followed by surgery.


• A clinical trial of radiation therapy given during surgery or internal radiation therapy.

Stage IV

In stage IV, cancer may be of any size and has spread to distant organs, such as the liver, lung, and peritoneal cavity. It may have also spread to organs and tissues near the pancreas or to lymph nodes.

Stage IV Pancreatic Cancer

Treatment of stage IV pancreatic cancer may include the following:

• Chemotherapy.


• Palliative treatments for pain, such as nerve blocks, and other supportive care.


• Palliative surgery or stent placement to bypass blocked areas in ducts or the small intestine.


• Clinical trials of chemotherapy or biologic therapy.

There are different types of treatment for patients with pancreatic cancer.

Different types of treatment are available for patients with pancreatic cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. Before starting treatment, patients may want to think about taking part in a clinical trial. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.

Four types of standard treatment are used:

1. Surgery

One of the following types of surgery may be used to take out the tumor:

• Whipple procedure: A surgical procedure in which the head of the pancreas, the gallbladder, part of the stomach, part of the small intestine, and the bile duct are removed. Enough of the pancreas is left to produce digestive juices and insulin.


• Total pancreatectomy: This operation removes the whole pancreas, part of the stomach, part of the small intestine, the common bile duct, the gallbladder, the spleen, and nearby lymph nodes.


• Distal pancreatectomy: The body and the tail of the pancreas and usually the spleen are removed.

If the cancer has spread and cannot be removed, the following types of palliative surgery may be done to relieve symptoms:

• Surgical biliary bypass: If cancer is blocking the small intestine and bile is building up in the gallbladder, a biliary bypass may be done. During this operation, the doctor will cut the gallbladder or bile duct and sew it to the small intestine to create a new pathway around the blocked area.


• Endoscopic stent placement: If the tumor is blocking the bile duct, surgery may be done to put in a stent (a thin tube) to drain bile that has built up in the area. The doctor may place the stent through a catheter that drains to the outside of the body or the stent may go around the blocked area and drain the bile into the small intestine.


• Gastric bypass: If the tumor is blocking the flow of food from the stomach, the stomach may be sewn directly to the small intestine so the patient can continue to eat normally.

2. Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

3. Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Treatment of Pain

In pancreatic cancer, as well as in other cancers, the growth of tumors can result in abnormal levels of pressure on nerves. Therefore, pain is a major concern for patients. Cancer treatments can result in pain reduction when the reduction of the tumor relieves pressure on the nerves.

The doctor can prescribe pain-relief medications, which can be successful singly or in combination. The most common side effects of pain medications are fatigue and constipation. Rest and laxatives can moderate these side effects.

In cases where pain medication alone is not enough to make the patient comfortable, the treatment team may decide on treatments that affect the nerves directly. These include alcohol injection in a nerve to inhibit pain response and surgically severing nerves to prevent transmission of pain impulses.

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

The methods used to treat pancreatic cancer are very powerful. It is hard to limit the effects of treatment so that only cancercells are destroyed. Healthy tissue may also be damaged. That is why treatment often causes unpleasant side effects. Side effects depend on the type of treatment used and on the part of the body being treated.

Surgery for cancer of the pancreas is a major operation. While in the hospital, the patient will need special medications and may be fed only liquids. During recovery from surgery, the patient's diet and weight will be checked carefully.

During radiation therapy, the patient may become very tired as the treatment continues. Resting as much as possible is important. Skin reactions (redness or dryness) in the treated area are also common. Good skin care is important at this time, but the patient should not use any lotions or creams on the skin without checking with the doctor. Radiation therapy to the upper abdomen can cause nausea and vomiting. Usually, dietary changes or medications can ease these problems.

The side effects of chemotherapy depend on the drugs that are given. In addition, each person reacts differently. Chemotherapy affects rapidly growing cells, such as blood-forming cells, those that line the digestive tract, and those in the skin and hair. As a result, patients can have side effects such as a lowered resistance to infection, less energy, loss of appetite, nausea, vomiting, or mouth sores. Patients may also lose their hair.

Weight loss can be a serious problem for patients being treated for cancer of the pancreas. Researchers are learning that well- nourished patients usually feel better and may be better able to withstand the side effects of their treatment. Therefore, nutrition is an important part of the treatment plan, and doctors may have a number of suggestions to help their patients get enough calories and protein. In many cases, patients feel better if they take food and beverages in very small amounts. Many patients find that eating several small meals and snacks throughout the day is easier than having three large meals.

In addition, treatment for cancer of the pancreas may interfere with production of insulin and pancreatic juices. The patient must take medicines to replace these; otherwise the level of blood sugar may be wrong and digestion may be affected. Even so, taking these medicines can often upset digestion. Careful planning and checkups are important to help the patient avoid weight loss and the weakness and lack of energy caused by poor nutrition.

Patients and family members are often afraid that cancer will cause pain. Cancer patients do not always have pain, but if it does occur, there are many ways to relieve or reduce it. It is important for the patient to let the doctor know about pain, because uncontrolled pain can cause loss of sleep and poor appetite. These problems can make it difficult for the patient to respond to treatment.

The side effects that patients have during cancer therapy vary for each person. They may even be different from one treatment to the next. Attempts are made to plan treatment to keep problems to a minimum. Fortunately, most side effects are temporary. Doctors, nurses, and dietitians can explain the side effects of cancer treatment and can suggest ways to deal with them.

Summary

Despite many advances over the years in the treatment of a broad range of cancer types, pancreatic cancer remains a hard tumor to treat. The causes for this are multifactorial and include tumor-related reasons (i.e., low chemotherapy sensitivity, early metastasis, and low likelihood of resection at time of presentation), treatment-related reasons (i.e., limited effective chemotherapeutic agents, non-optimal use of available modalities of treatment and high side-effect profiles for available therapies, and poor participation in therapeutic protocol trials. There are many new and exciting avenues of therapy that are being looked at, ranging from gene therapy to monoclonal antibodies to new combinations of chemotherapeutic agents. Some of these may be beneficial, and others may show no significant improvement over today's therapies. However, without participation in clinical trials, we may continue to wade through a haze without ever really obtaining the clear insight needed to obtain an optimal treatment regimen.

If you have pancreatic cancer, help yourself and future patients by participating in clinical trials if they are available and you are eligible. Speak with your physician about trials in which you may be able to participate.

Prevention

As with most cancers, the prevention of pancreatic cancer involves moderating the lifestyle and avoiding environmental exposure or other risk factors that seem to be associated with pancreatic cancer.
Quitting smoking, eating a low fat and low sugar diet, and minimizing long-term exposure to petroleum derivatives may have some effect on a person's likelihood of developing pancreatic cancer. However, these lifestyle and environmental exposure precautions are not necessarily specific to pancreatic cancer. Rather, they are generally considered prudent long-term health decisions. Addressing these issues alone will not guarantee freedom from pancreatic cancer.

Future research may shed more light on the causes of cancer of the pancreas and possibly lead to more effective preventive measures.

Follow-up Treatment

In pancreatic cancer cases, it is essential that the patient receive effective follow-up care. Regular examinations are necessary to determine whether the cancer has returned or has advanced.

Many of the same methods used to diagnose the cancer may be used to evaluate the patient's recovery. These may include CAT scans, MRI tests, and X-rays, among others.

In addition, the treatment team will need to monitor the patient's hormone replacement therapy or other ongoing treatments.

Patients with pancreatic cancer have special nutritional needs.

Surgery to remove the pancreas may interfere with the production of pancreatic enzymes that help to digest food. As a result, patients may have problems digesting food and absorbing nutrients into the body. To prevent malnutrition, the doctor may prescribe medicines that replace these enzymes.

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.