Cancer is officially the second leading cause of death in the U.S., killing approximately 500,000 people (more than 20 percent of all deaths) every year. Although the 2004 study “Death by Medicine” was never published in a medical journal, it ranks cancer as the third leading cause of death behind medical treatment and heart disease. Since 1958, the incidence of cancer in men has increased 55 percent. The curve of cancer incidence rises steeply after the age of sixty. A number of potential contributing causes have fueled the increase.
Cancer is a distorted, wild, uncontrolled growth of portions of body tissues or organs in which cells multiply rapidly without restraint, producing a family of descendants that invade and destroy the structure and function of adjacent normal tissues in the organ where the tumor originated. Cancerous cells can also travel through the bloodstream or lymph channels to lodge elsewhere in the body, starting new growths (metastases) and compromising the function of organs to which the cells spread.
The initial phase of cancerous growth is triggered by a distortion in the DNA command apparatus of the nucleus of body cells. Many researchers believe that human beings in a single lifetime experience cancer many times and that on most occasions the chemical and cellular immune defenses defeat the new growth so quickly that no symptoms ever make themselves known. It is recommended that we pay more attention to the state of our immune system, which for a variety of reasons occasionally fails to recognize and eliminate these early growths before they can become a threat. Damage to DNA in cell nuclei from free radical proliferation appears to play a key role in the initiation and growth of cancer.
Although this chapter’s focus is on relieving cancer pain, effective treatment of the cancer itself will usually result in a reduction of pain. For this reason I will address, to a limited extent, cancer treatment in both the MMJ and HMTP sections.
Most cancer pain is caused by the tumor pressing on bones, nerves, or other organs in your body. Sometimes pain is related to cancer treatment, such as surgery, chemotherapy, or radiation. For example, some chemotherapy drugs can cause numbness and tingling in your hands and feet or a burning sensation at the place where they are injected. Radiation can also cause pain as a result of inflammation of the surrounding normal tissue.
Chronic pain associated with cancer is also caused by changes to nerves, which may occur due to the cancer pressing on the nerves, or due to chemicals produced by a tumor.
The recommendations for alleviating cancer pain overlap with the recommendations for treating the cancer itself. Much of the research for treating cancer with cannabis comes from Israel and to a lesser extent from Spain. Both THC and CBD have been shown to have cancer cell–killing properties. The combination of both cannabinoids into a substance called Rick Simpson Oil (RSO) or Phoenix Tears (see Chapter 4) is widely considered to be the single most effective MMJ product for treating cancer. It is also an excellent combination for pain relief.
This thick, dark brown, sticky hash oil is most often dispensed in a syringe, but is also available in capsules and rectal suppositories. The recommended dose is an amount approximately the size of one grain of rice. I suggest starting with less if you are someone who is particularly sensitive to THC (or pharmaceutical drugs). Depending on who makes it, there is a wide range of RSO composition with respect to the amount of THC. The most therapeutic for cancer seem to be those that have approximately 10 percent or more of THC. The THC is nearly always present in greater amounts than CBD, and it will therefore have a fairly strong psychoactive effect. For some cancer patients, this is a significant liability of RSO. However, this effect can possibly be minimized by using the rectal suppositories. To learn more about this method of administration, visit http://phoenixtears.ca/dosage-information/.
I recommend ingesting RSO or the rectal suppositories rather than vaporizing, since its duration of action is roughly twice as long when ingested (six to eight hours). This amount (one grain of rice) should be ingested twice a day. In addition, vaporizing the oil requires a vaporizer that accommodates oil which requires much higher temperature than flower (440 degrees Fahrenheit versus 375). It is therefore much more harsh on the mucous membrane lining the respiratory tract.
I suggest ingesting the oil with a fatty food—e.g., avocado or peanut butter—since marijuana is fat-soluble and this will allow for more rapid absorption, sometimes as quickly as thirty to forty-five minutes. The suppositories have an even more rapid onset—ten to fifteen minutes. Otherwise it might take one to even two hours before you feel a strong therapeutic effect. Since the oil is so sticky, it helps to push it out of the syringe onto a relatively hard surface, such as a cracker, and then you can scrape off the remaining oil at the opening of the syringe onto the cracker. After the dose of oil has been dispensed, then add your fatty food, and eat the whole thing. I don’t recommend eating a sizable meal along with the oil, unless it’s an especially fatty meal. A big meal will significantly delay the onset of the hash oil effect. For fastest absorption an empty stomach (other than the fatty food) is best.
If your focus is greater on treating the pain than on the cancer itself, in addition to RSO, the MMJ recommendations are essentially the same as those for musculoskeletal pain (Chapter 11) and osteoarthritis pain (Chapter 6), with the exception of a greater emphasis on treating inflammation for those suffering with arthritis. Most people’s cancer pain has an inflammatory component, but it is not quite as severe as it is with arthritis.
• Topicals—localized (apply to painful area), especially Apothecanna Extra Strength or Mary’s Medicinals CBC.
• Topicals—generalized (apply to wrist or ankle for rapid absorption) transdermal patches, especially 1:1/CBD:THC, 3:2/CBDa:THCa, THCa; also Mary’s Medicinals transdermal gel pens, CBD, THC, or CBN.
• Vaporizing high-CBD strains of flower—especially Harlequin (a 50:50/S:I hybrid), Lucy (a 70:30/I:S indica), Cannatonic (a 50:50 hybrid), or other hybrids (either 50:50, 60:40/S:I, or 60:40/I:S).
• High-CBD tinctures—1:1, 2:1, or 3:1/CBD:THC.
• High-CBD hash oil—1:1, 3:1, or 6:1/CBD:THC.
• Juicing raw cannabis leaves.
• Indica strains of flower—with an I:S of 70:30 or above (also good for sleep).
• Indica and hybrid edibles—gluten-free, without sugar or dairy (also good for sleep).
• Any strain or MMJ product containing CBG.
NOTE: Avoid sativa strains above 60:40/S:I and high-THC products. Although THC has both analgesic and anti-inflammatory properties, it can also increase anxiety, which has the potential to increase pain.
• Nerve pain—caused by pressure from the tumor on nerves or the spinal cord, or by damage to nerves. This is also neuropathic pain (see Chapter 12). People often describe nerve pain as burning, shooting, tingling, or as a feeling of something crawling under their skin. It can be difficult to describe exactly how it feels, and it is often more difficult to treat than other types of pain.
Some people have long-term nerve pain after surgery. Nerves may be cut during an operation, and they take a long time to heal because they grow very slowly. Some people may have pain around their scar for two years or more after their surgery, but it eventually goes away. Nerve pain can also occur after other cancer treatments, such as radiation or chemotherapy.
• Bone pain—Cancer can spread into the bone and cause pain. The cancer may affect one specific area of bone or several areas. The cancer cells within the bone damage the bone tissue and cause the pain. People often describe this type of pain as aching, dull, or throbbing.
• Soft tissue pain—pain from a body organ or muscle. For example, you may have pain in your back caused by tissue damage to the kidney. You can’t always pinpoint this pain, but it is usually described as sharp, cramping, aching, or throbbing. Soft tissue pain is also called visceral pain.
• Phantom pain—pain in a part of the body that has been removed. For example, pain in an arm or leg that has been amputated due to sarcoma or osteosarcoma. Or pain in the breast area after mastectomy. Phantom pain is very real, and people sometimes describe it as unbearable.
Between 60 and 70 percent of people who have had an arm or leg removed feel phantom pain. About one-third of women who have had a breast removed feel phantom breast pain. The pain usually lessens after the first year, but some people can still feel phantom pain after a year or more. In most people it will go away after a few months. It is as though your brain has to realize that part of your body is gone.
• Referred pain—pain from an organ in the body that is felt in a different part of the body. For example, a swollen liver may cause pain in the right shoulder, even though the liver is under the ribs on the right side of the body. This is because the liver presses on nerves that pass through the shoulder.
The following recommendations will help reduce cancer pain by enhancing cancer management.
For cancer pain, refer to the anti-inflammatory diet in Chapter 5. Combine this diet with a macrobiotic diet, which is recommended for treating cancer. Analysis of case studies indicates that a strict macrobiotic diet, an extension of a vegetarian diet, is likely to be more effective in long-term cancer management than diets offering a variety of other foods.
Raw fruit and vegetable juices are widely recommended as part of supportive treatment for cancer; they are an easy way to take in over 95 percent of the vital phytonutrients that support the immune system. Organic fruits and vegetables are much preferred.
Although their primary focus is not on relieving cancer pain, the following vitamins, minerals, and supplements provide a wide range of support for cancer patients. And if the cancer itself improves, so too does the pain.
In addition to these, there are other products that provide a range of support for cancer patients, including:
• Antioxidants exert anti-carcinogenic, immune-stimulant, and anti-metastatic effects and act to inhibit cancer at each stage of its development. Since it is known that platelet aggregation, a free radical–mediated function, encourages implantation of bloodstream-borne cancer metastases, increasing antioxidant intake becomes important. Reasonable daily doses of antioxidants in treating cancer are: selenium, 500 mcg; vitamin E, 800 IU; and vitamin C, 4 gm. Beta carotene (125,000 IU daily) regresses oral (mouth) precancerous lesions. Studies have confirmed the benefits of high-dose antioxidants during chemo- and radiation therapy in both reducing toxicity of treatment and enhancing treatment effects.
• Lycopene: a carotenoid that substantially inhibits the growth of lung cancer cells in the test tube and has been shown to reduce progression of prostate cancer (with a dosage of 15 mg daily). Lycopene, a major tomato carotenoid, is ten times more potent than beta-carotene.
• IV vitamin C: Linus Pauling and Ewan Cameron reported benefits of intravenous vitamin C in “terminal” cancer patients in 1971. Administered intravenously in high dosages (60–100 gm over ten hours), vitamin C can induce cytotoxicity in tumor cells with negligible toxic effects to normal cells.
• Probiotics: The toxicity of chemotherapy routinely disrupts intestinal bacterial balance; restoring acidophilus and bifidus organisms in the intestine promotes normal intestinal function during treatment.
• Genistein: an isoflavone from fruits and vegetables that, as well as other flavonoids—flavone, luteolin, and daidzein—has been shown to inhibit the growth of stomach cancer cells in test tube experiments. Human squamous skin cancer cells in test tube experiments were significantly inhibited by various concentrations of quercetin (a common flavonoid found in onions, apples, and berries). Reasonable doses for these flavonoids are 400 mg twice daily. Tangeretin, a naturally occurring flavone in citrus fruit, causes cancer cell death in promyelocytic leukemia cells in the test tube. Therefore, large amounts of citrus fruits are encouraged.
• Maitake mushroom extracts: have immune-enhancing and anti-cancer properties, and are now being used in the U.S. The recommended dosage is 3 capsules three times daily.
• Silymarin (Milk Thistle): 80 percent standardized extracts are helpful in preserving liver function during chemotherapy treatment with 5-fluorouracil and other agents. The recommended dosage is 140–210 mg two to three times daily.
Anticoagulants reduce the rate of metastases in cancer patients. Some reports have cataloged great reductions in patients who were coincidentally anticoagulated for other reasons. This report has not led to widespread utilization of this observation.
The ability to synthesize the adrenal hormone dehydroepiandrosterone (DHEA) declines markedly over the third through sixth decades of life. The levels of DHEA in patients with a wide variety of cancers are found to be generally low. DHEA has been used with benefit as a treatment in some types of cancer.
Glutathione, an antioxidant synthesized by the body, added intravenously to chemotherapeutic cisplatin regimens for advanced ovarian cancer decreased toxicity and significantly improved prognosis.
There is some preliminary evidence that melatonin may be helpful in the treatment of cancer. Patients with brain metastases from solid cancers who received melatonin (20 mg daily) in addition to supportive care tripled their aggregate survival time in one year of treatment. Clear improvement in quality of life and performance status was present in 30 percent of the melatonin patients compared to none in the controls. Melatonin (10 mg daily) prevented metastases in 40 percent of patients with far-advanced cancers.
Coenzyme Q10 (100 mg daily) added to cancer treatment prevented the heart toxicity usually developing with Adriamycin (doxorubicin) chemotherapy. Women with breast cancer, advanced liver, and metastatic disease have successfully been treated with 400 mg daily.
Physical activity appears to be helpful in the treatment of cancer. In human studies, increased physical activity in cancer patients increases appetite, conserves lean tissue, improves functional capacity, slows the clinical course of the cancer, pushes back the time of death, and improves the quality of life.
Several thousand case histories of documented “spontaneous” recovery from cancer have been summarized by Brendan O’Regan and Caryle Hirshberg of the Institute of Noetic Sciences. In many case histories, the “fighting spirit,” will to live, and belief in recovery appear to be very important prognostic factors. Most patients who recover from life-threatening cancer have made a radical change in some aspect of their lives—in diet, exercise, attitude, relationships with family members, or sense of connection with God. Other characteristics frequently observed to be present in persons who cure their cancers include full acceptance of their disease and using the occasion of the disease as an opportunity to gain some sense of meaning and purpose in their lives. This introspective journey of self-discovery is often so important to them that many actually feel gratitude for the “gift” of cancer.
Confidence and belief in the program of cancer treatment undertaken seems to be essential in successfully treating cancer. Self-confidence and confidence in the treating physicians are also essential elements. It is very important for patients to participate in decisions regarding their own treatment.
• Relaxation training (9 hours): This has been shown to significantly reduce cancer pain and use of narcotics and tranquilizers. Hypnosis also greatly enhances the management of pain in cancer.
• Support groups: Patients with malignant melanoma who were enrolled in an intervention group did better than those in a “routine care” group. The intervention group met one and a half hours weekly for six weeks. Group processes and interventions included health education, cancer education, enhancement of illness-related problem-solving skills, instruction and practice in relaxation skills, psychological support, and promoting interaction between patients and health care professionals. Psychological and immunological testing at six months compared to baseline showed significant improvement in immunity compared to controls, and anxiety and depression were significantly less as well. Imagery enhanced the effects of relaxation on immunity. In a six-year follow-up, the risk of dying was 33 percent less and the risk of recurrence 50 percent less in the intervention group.
In a landmark study of late-stage female breast cancer patients, a one-year weekly support group including relaxation training greatly enhanced quality of life and more than doubled the survival time of these women. Patients with a solid support system of relatives, spouses, and significant others have a better prognosis, as do married men and men with a confidant.
• Energy medicine: In well-controlled animal studies, cancer progression has been shown to be inhibited with energy treatments by healers using therapeutic or Healing Touch, Reiki, or similar hands-on techniques.
• Mental imagery: In many of the reports of people recovering from cancer, especially advanced cancer, patients have used imagery of their immune systems overcoming or defeating the cancer cells and imagery of themselves returning to health. Authoritative research confirms that the success of imagery is highly related to the vividness and effectiveness visualized in the imagery. Guided imagery therapy with skilled professionals in this area can be very helpful and meaningful.
Studies show increases in cancer in people under chronic, excessive, unmanaged stress and especially after acutely stressful events, such as the death of a spouse or other significant losses, including loss of a job or career setbacks. A common denominator in this data is the loss of love, either from oneself or from a significant other. In several studies, the way people cope with stress has been correlated with cancer-related deaths and rate of cancer progression. I have previously made the point that stress/anxiety is a major factor for increasing pain, whether it’s cancer pain, nerve pain, or from any other source.
Depression is often associated with cancer incidence. A large number of studies have noticed the consistent significant relationship between depression, helplessness, and hopelessness and the onset of various kinds of cancer. Depressed patients have a much lower incidence of successful bone-marrow-transplant survival than non-depressed patients. Patients who express their emotions in socially acceptable ways rather than repressing them also consistently do better. Behavioral and cognitive therapy can be of enormous help in treating depression.
Medical intuitives and esoteric diagnosticians who are aware of energy fields also sense cancer as a disorder related to negative emotions of fear, guilt, self-hate/self-denial (loss of love from self); unfinished business with others with whom one has had a significant relationship (perceived loss of love from others); and resistance to change (an inability to let go of the past and feel the loss).
These issues create a major impediment to the evolution of emotional, psychological, and spiritual development. Accepting the fact that we experience change according to what our growth requires necessitates the development of a willingness to accept ourselves as we are, to let go of those issues over which we have no control, and to recognize the necessity and inevitability of change in order to grow and incorporate what we need to learn in this lifetime.
Dr. Caroline Bedell Thomas’s long-term study of fifteen hundred medical students showed that the strongest psychological predictor of cancer over the next twenty-five years was the perception of a lack of closeness with parents in childhood.
Ally F. is a twenty-nine-year-old co-owner of a medical marijuana dispensary, who was in excellent health until she was diagnosed with an aggressive form of thyroid cancer at age twenty-five. By the time it was diagnosed, it had already spread to the lymph nodes in her neck. Her treatment included a total thyroidectomy (surgical removal of the entire thyroid gland) in addition to radiation.
Her surgery was successful, with thirty-nine cancerous lymph nodes removed from her neck and upper arm, along with her thyroid. She was given an opioid for pain relief immediately following surgery, but she was not able to tolerate it (nausea and vomiting). Her doctors weren’t sure how to treat her, but since she had previously used cannabis for migraines she decided to use it for her postoperative pain.
She used indica edibles, both lozenges and lollipops, to soothe her sore throat and to help with the severe neck pain resulting from the surgery. She felt immediate relief. Several days after the surgery she started radiation. The doctors prescribed a variety of medications, including tramadol, Oxycontin, and hydrocodone, but none of them helped to relieve the pain from the radiation treatments, and each of them caused a similar reaction to the first opioid following surgery—i.e., nausea and vomiting. Once again she obtained significant relief with cannabis.
During the course of the radiation treatment, she spent countless hours vomiting and couldn’t eat or sleep: “Only cannabis provided me with both the mental and physical relief to allow me to eat and sleep. One inhale of an indica cannabis strain would allow me to fall asleep. One small candy would stop my nausea, and the topical ointment I used immediately helped with the physical pain immensely.
“After a few days the C-4 nerve in my neck went numb. Something had happened during the surgery and my nerve wasn’t talking to my brain anymore. I couldn’t use my upper arm. I couldn’t lift anything and it was like lightning bolts were running down my arm. I was scared, weak, depressed, and in constant pain. Cannabis helped immediately. I would smoke a few times a day whenever the pain got debilitating. The mental relief was unmatched, and the pain pills I tried made me feel nauseous and sick. I used topical ointments, edibles, and ingestible options to treat the pain, depending on whether I was trying to work and function or get a good night of sleep. I could not fall asleep without smoking or ingesting cannabis in some way. Ultimately cannabis saved my life and provided me with the relief I needed to fight the cancer and win. It helped me both mentally and physically and allowed me to keep working and functioning, and it has become a staple in my life as I deal with the chronic pain still in my arm on a daily basis.
“Luckily I had access to cannabis and was able to use specific strains that were high in cannabidiol (CBD) and not tetrahydrocannabinol (THC). I used these cannabinoids proportionally to the functionality I needed and I learned about treatment in varying degrees. Today I help patients all across Colorado with their chronic pain treatment plans and try to find the best options for each individual. I am confident that cannabis can help chronic pain patients just like it helped me, and I am excited to see the scientific developments rooted around the cannabis plant. I am hopeful that one day people with cancer and other illnesses can use cannabis as an herbal treatment instead of having to suffer through dangerous unnecessary surgery and radiation treatments.”