Annona Muricata For The Treatment Of Cancer Biology Essay

Published:

Abstract:

Cancer is a leading cause of death worldwide. Whilst significant progress has been accomplished in the treatment and management of cancer in general, vital areas need addressing. Adverse side effects from chemotherapy, radiotherapy and surgery treatment can occur. Herbal medicine and the use of plant-derived products in cancer treatment may lessen undesirable side effects and support the body holistically. Presently, some herbal remedies are being used to treat cancer. However, the promising anti-cancer properties found in countless herbs and shown in vitro tests, are yet to be evaluated and endorsed by human studies. Further investigations are warranted to determine the efficacy and safety of these herbs in treating human cancers.

Aims:

This evaluative review seeks to assess whether research studies corroborate or refute the use of Annona muricata for the treatment of cancer.

Method:

A computerised search of relevant databases.....................

Results:

Conclusion:

Contents page

1 - Introduction................................................................................

2 - The literature review ................................................................

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2.1 Cancer: An overview ....................................................

2.1.1 Aetiology and Pathophysiology .....................................

2.1.2 Signs and Symptoms ....................................................

2.1.3 Risk factors ....................................................................

2.1.4 Diagnosis .......................................................................

2.1.5 Prevalence and costs ....................................................

2.2 Orthodox treatment ........................................................

2.3 Botanical description of Annona muricata .....................

2.3.1 Constituents, mode of action and safety .......................

2.3.2 Traditional use ...............................................................

2.3.3 Current use ...................................................................

2.3.4 Annona muricata for the treatment of cancer ...............

3 - Methodology .............................................................................

3.1 Computerised literature search ......................................

3.1.1. Inclusion and Exclusion criteria ......................................

4 - Studies .......................................................................................

4.1 Results ...........................................................................

5 - Discussion .................................................................................

6 - Conclusion .................................................................................

Acknowledgments

Glossary of terms

p53- A tumour suppressor gene located on the short arm of the chromosome 17 that encodes a nucleophosphoprotein that binds DNA and negatively regulates cell division; frequently measured as a marker of malignant diseases (Stedman's Medical Dictionary, 2008).

1. Introduction

Cancer leads worldwide death, and the number of cases globally is on the increase. According to the World Health Organization (WHO) the number of global cancer deaths is projected to increase due to an ever growing and aging population. WHO estimates cancer deaths to rise 45%, from 7.9 million to 11.5 million deaths, between 2007 and 2030. According to Gabriel (2007) one in three people in the United Kingdom will develop a malignant tumour by the time they reach the age of seventy with the occurrence rising with age. During the second half of the 20th century, life expectancy increased significantly in developed countries and cancer has now become one of the most common causes of death in the UK, second only to coronary artery disease (Gabriel, 2007).

2. Literature review

2.1. Cancer: An overview

Cancer is the prevailing term used to describe a broad group of diseases that arise from uncontrolled cell proliferation, caused by changes in gene expression. A failure in cell division control is indicated by the presence of a tumour. Tumours originate in different tissues, act in a variety of ways and respond diversely to treatment. However, all cancers share a common element, their invasive growth. Abnormal cell growth can ultimately evolve into a population of cells that may possibly invade tissues and metastasize to distant sites causing significant morbidity (Ruddon, 2007). Other terms such as, malignant tumour, growth and neoplasm are also used to describe cancer. Cancer covers a wide range of diseases that vary in their age of onset, rate of growth, state of cellular differentiation, diagnostic detectability, invasiveness, metastatic potential, response to treatment and prognosis (Ruddon, 2007). Cancers are classified in a variety of ways; carcinomas are the most common cancers of adults, deriving from epithelial cells. Leukemias and lymphomas arise from blood-forming cells and lymphoid cells, respectively. Sarcomas are derived from melanocytes, other cancers can originate in stem cells of the retina, neurons and glia, giving rise to retinoblastomas and glioblastomas, correspondingly. Vogelstein and Kinzler (2002) suggest that there are as many tumour types as there are cell types in the human body. Despite the variety of cancer types, four of them - breast, lung, colorectal and prostate- account for over half (54%) of all new cases (Office for National Statistics, 2009). Cancer is a leading cause of death in the UK. In 2006, approximately 293,000 new cases were diagnosed.

The following table shows the statistics for the most commonly diagnosed cancers in the UK for 2006, excluding non-melanoma skin cancer (NMSC).

Gender

 

 

Cancer site

Male

Female

Persons

% of total

Other

16,380

13948

30,328

10.33%

Mesothelioma

1942

385

2,327

0.79%

Cervix

0

2873

2,873

0.98%

Liver

2015

1178

3,193

1.09%

Multiple myeloma

2174

1813

3,987

1.36%

Brain with CNS

1921

2611

4,532

1.54%

Oral

3540

1785

5,325

1.81%

Ovary

0

6596

6,596

2.25%

Uterus

0

7045

7,045

2.40%

Leukaemias

4229

3008

7,237

2.46%

Pancreas

3731

3929

7,660

2.61%

Stomach

4970

2743

7,713

2.63%

Oesophagus

5034

2790

7,824

2.66%

Kidney

4879

2961

7,840

2.67%

Bladder

7307

2957

10,264

3.50%

Melanoma

4803

5607

10,410

3.55%

N-H-L

5658

4911

10,569

3.60%

Prostate

35515

0

35,515

12.10%

Colorectal

20430

17084

37,514

12.78%

Lung

22381

16646

39,027

13.29%

Breast

314

45508

45,822

15.61%

all excluding NMSC

147223

146378

293,601

 

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Table 1.1: statistics for the most common cancers in the UK, 2006, excluding non-melanoma skin cancer (NMSC).

2.1.1. Aetiology and Pathophysiology

Carcinogens continuously bombard healthy cells. Physical and chemical agents that can cause mutations act constantly on DNA molecules and that may lead to cancer (Mader. 2001). Most faulty genes are repaired and occasionally, with progressive damage the repair process fails and this may cause the cell to function abnormally and eventually become cancerous. The most recognised mutagenic carcinogens are radiation (including ultraviolet light, radon gas, X rays and accidental emissions by power plants), organic chemicals in tobacco smoke, certain foods, herbicides and pesticides and some viruses (Mader, 2001). The p53 ⃰ gene typically stops the cell cycle when DNA mutates and is in need of repair. The cell cycle will start up again only if repair is possible. If the repair of DNA is not possible, the p53 protein (the product of the p53 gene) will promote apoptosis. Mader (2001) states that the occurrence of apoptosis is normally crucial for good functioning of the organism and a lack of apoptosis allow cancer to develop. Very often cancer occurs when p53 is absent or non-functional (Mader, 2001). If the cell is not destroyed it will multiply uncontrollably, a cancerous tumour begins, as a single cell. Mader (2001) suggests that a cell may become cancerous more rapidly if a faulty gene is inherited. Cancer cells show features that indicate a severe failure in cell cycle regulation. Cancer cells are non-specialized, they do not look like a differentiated muscle, nervous, or connective tissue cell and have abnormal shapes. According to Mader (2001), cancer cells can enter the cell cycle for about 50 times and eventually die, however, cancer cells are " immortal" as they are able to enter the cell cycle repeatedly, dying only if they become deficient of nutrients or are killed by their own toxic waste products. Cancer cells lack organisation as they mount up on top of one another and grow in multiple layers. A cancer cell divides to produce a tumour, this growth is termed neoplasia, and is made up of cells that are disorganized, a condition known as anaplasia. A benign tumour does not invade adjacent tissue. The significant feature of a malignant tumour is its ability to metastasize, not only locally but also to distant sites in the body forming new tumours. In metastasis, a cancerous cell travels in the blood or lymph, after becoming detached from the original tumour. Certain sites in the body that have a good blood supply such as the liver, lungs, bone and brain are targeted by cancer cells. A particularly common site is the liver, as it receives blood from the heart and intestines. Enlarging tumours use different methods to obtain nutrients: by invasion of existing blood vessels and by angiogenesis, the formation of new blood vessels stimulated by chemicals produced by tumour cells. In order for a tumour to survive and grow it must be able to stimulate angiogenesis effectively. Cancer cells continuously grow and divide freely, spreading, eventually throughout the body, interfering with the function of normal tissues and organs and progressively leading to death (Cooper, 1992). Cancer is more prevalent among older people, mainly because their cells have been exposed to genetic damage longer and also because the body's defences against cancer become, gradually, less efficient with age. In addition, it often takes many years for some type of tumour to grow large enough to produce noticeable symptoms.

2.1.2. Signs and Symptoms

Occasionally, cancer can be detected during a routine screening test and prior to symptoms manifesting. However, the diagnosis of cancer happens more commonly after symptoms develop, usually over a period of time and after becoming apparent, propelling a visit to a doctor. The symptoms of cancer depend on where the cancer arises and how it develops. A lump or swelling, a change in skin colour or a wound that does not heal, amongst other signs and symptoms, may be indicators of tumours located near the surface of the body. If tumours originate deep within the body, symptoms may not manifest until the tumour becomes large enough to press on other structures causing obstructions. For example, a tumour blocking an airway in the lungs may produce a cough, obstructions in the intestines may cause constipation or vomiting and jaundice can be the result of a blocked bile duct. Also, tumours can cause pain, as a result of pressure, and fluid that accumulates within the body. Kelvin and Tyson (2005) suggest that symptoms may not develop until the cancer has metastasized. The symptoms of cancer are varied and may include the following:

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A firm and painless lump in or beneath the skin

Changes in a mole appearance

Blood in the urine or sputum

Changes in bowel habits

A non-healing wound

Bowel discharge containing blood

Persistent abdominal pain

Changes in the voice or hoarseness

Difficulty swallowing

Recurrent and severe headaches

Cancer can alter the body's normal metabolic functions, which can lead to general and common symptoms, these include:

Unexplained cachexia

Unexplained fatigue

Loss of appetite and nausea

Fever/sweats

2.1.3. Risk factor

2.1.4. Diagnosis

The early diagnosis of cancer can happen randomly with routine screening, which aims to detect disease before symptoms appear. Commonly used screening tests are colonoscopy, mammography and cervical smear test. Cancer may be diagnosed as a result of investigations carried out based on presenting symptoms. These tests include imaging tests, such as X rays, ultrasound scanning, CT scanning or MRI. In some cases, blood tests that indicate a particular tumour marker may be performed. According to McKinnell et al. (2006), clinical and pathologic data forms the basis of cancer diagnosis. Furthermore, McKinnell et al. (2006) suggest that the right diagnosis depends on the knowledge, skill and experience of the physicians that comprise the diagnostic team. The team normally includes oncologists, radiologists, surgeons, and pathologists. The diagnosis and prognosis for the patient is provided by the pathologist that will analyse all type of information concerning the patient, including history, age and sex, presenting signs and symptoms, clinical diagnosis, the organs involved and so on. A biopsy is often performed in order to confirm if the tumour is benign or malignant. The gross specimen is analysed by the pathologist that freezes selected parts of it in a cryostat ⃰, sections and stains it, examining the tissue with a microscope. The pathologist looks for evidence of disorganization of the normal histological features by neoplastic cells. Further confirmation of malignancy is the invasion into capillaries or lymphatics suggesting that distant metastasis may have occurred. The stage of spread of the tumour is further confirmed with the microscopic examination as it allows the tumour to be graded. The pathological and clinical assessment of the size of the tumour and its spread into the normal tissues will form the basis of tumour staging (McKinnell et al., 2006). The TNM staging system is the mostly used as it takes into account the size of the tumour (T), the absence or presence of metastases in the lymph nodes (N) or distant metastases (M) (McKinnell et al., 2006). The pathologist aims to determine if the tumour is well differentiated or is distinctly different from the tissue of origin, as in a high degree on anaplasia, grading it on a scale from 1 to 3, well differentiated (grade 1), moderately well differentiated (grade 2) or poorly differentiated (grade 3). Tumour grading and tumour staging data are merged, in clinical practice, before therapy is normally recommended. McKinnell et al. (2006) suggest that the stage of the tumour at the time of diagnosis is the most significant prognosis indicator for most human tumours, as it can generally predict the likelihood of cure.

2.1.5. Prevalence and costs

2.2. Orthodox treatment

2.3. Botanical description of Annona muricata

2.3.1. Constituents, mode of action and safety

2.3.2. Traditional use

2.3.3. Current use

2.3.4. Annona muricata for the treatment of cancer

3 - Methodology

3.1. Computerised literature search

3.1.1. Inclusion and Exclusion criteria

4 - Studies

4.1. Results

5 - Discussion

6 - Conclusion