CBD oil and cancer: 9 things to know
BY Cynthia DeMarco
CBD oil (cannabidiol) is everywhere these days. Once available only at novelty or vitamin shops, it’s now also at your local grocery store, pharmacy or even yoga studio.
It comes in many forms: oils that are dropped under the tongue, roll-ons that are applied to the skin and even solutions for vaping. Some producers extract CBD oil and add it into foods to create edible products.
But what is CBD oil exactly, and how does it affect cancer patients? Can it really treat — or even cure — cancer or relieve its symptoms? To separate fact from fiction, we spoke with our Kimberson Tanco, M.D. Here’s what he wants cancer patients to know.
What is CBD oil, and how does it differ from marijuana and hemp?
Marijuana and hemp are both varieties of the cannabis sativa plant. Both contain cannabidiol (CBD) and tetrahydrocannabinol (THC) — the two most-common, known active ingredients.
The main difference is that hemp has far less THC than a typical marijuana plant. And unlike THC, CBD is not a psychoactive agent, so there’s less possibility that it will cause the same mental confusion, drowsiness or hallucinations that often come with THC.
Is there any truth to the claims that CBD oil can cure cancer?
Right now, no. There is no evidence that CBD oil can cure cancer.
What, if anything, can CBD oil do to alleviate the symptoms of cancer or the side effects of cancer treatment?
It’s hard to say if CBD oil can alleviate cancer symptoms or cancer treatment side effects, because the studies are pretty mixed and even fewer are standardized.
There have been reports that cannabinoids like THC and CBD may be helpful for nausea and vomiting and anorexia, as well as neuropathy, anxiety, depression and insomnia. Synthetic cannabinoids like dronabinol have been approved for use with chemotherapy-induced nausea and vomiting, but have not been shown to be superior to conventional anti-nausea medications.
Have any CBD-oil derived products been approved by the U.S. Food and Drug Administration (FDA) to treat cancer, its symptoms, or the side effects caused by its treatment?
Have any products using CBD-oil been approved by the FDA to treat anything?
Yes. Epidiolex. It was originally approved in 2018 for the treatment of two conditions, both related to epilepsy: Lennox-Gastaut syndrome and Dravet syndrome. But aside from Epidiolex, no CBD product has been approved by the FDA for any other medical purpose.
What are the dangers of using CBD oil?
Quality, cleanliness and regulation are the biggest concerns.
All drugs and dietary supplements are regulated by the FDA. But as long as CBD oil is not marketed as a medicine or a dietary supplement, producers can get around that policy. So right now, CBD oil is very unregulated. That means it’s hard to know how much CBD or THC is really in any given product. Certain hemp CBD products have been found to contain significantly less CBD or more THC than advertised.
In terms of purity, THC and CBD are both extracted from hemp and marijuana using essentially similar processes. But trace amounts of THC could still end up in CBD oil. And if the THC is at a high enough concentration, it could produce the psychoactive effects that THC is known for.
Second, if a lab produces both CBD and THC products, there can be cross-contamination — whether it’s through extraction, handling or packaging.
Third, the plant itself may have higher levels of THC than expected. This could be due to its environment, prolonged flowering periods or cross-contamination and pollination between male and female plants, resulting in offspring with higher THC content. This especially affects hemp plants, which should have less than 0.3% THC levels.
Finally, there have been some reports of people getting infections after using CBD and cannabis products. This is especially concerning for immunocompromised patients, who are already susceptible to bacterial and fungal infections.
Studies on a certain CBD manufacturer showed its products were contaminated with a chemical known as 5F-ADB, which mimics THC. 5F-ADB is classified by the U.S. Drug Enforcement Administration as illegal, potentially addictive and with no accepted medical use.
Other sorts of substances have been found in CBD products, too, such as dextromethorphan, which is an ingredient in cough medicines. Heavy metals like lead and arsenic, pesticides and mold have also been found in CBD products.
Does CBD oil have any side effects?
CBD oil can adversely affect liver function. In fact, this is on the warning label for Epidiolex.
And in lab studies, CBD has been shown to inhibit certain enzymes responsible for the metabolism of drugs, such as CYP2D6 and CYP3A4. This can affect how drugs work and affect our bodies, either by reducing their efficiency or making them more dangerous. This includes chemotherapy and other medications.
This is very important for cancer patients to understand, as many people think CBD oil is not a medicine. They think of it more as a vitamin or a supplement, so they might not let their doctors know they’re using it. Patients might not realize it can be potentially harmful. So, it’s very important to tell your doctor if you’re using CBD oil.
Is CBD oil even legal?
CBD has a very complex legal status right now.
At the national level, any product of marijuana — including CBD — is still technically illegal when used medically. Although the 2018 Farm Bill legalized the production of hemp nationally, that’s only permitted if it’s not marketed for medical use or as a dietary supplement. CBD products intended for medical use should undergo an FDA review process.
State laws vary. In Texas, the Compassionate Use Act allows for the use of medical marijuana for certain conditions. Originally only for intractable epilepsy, the law was expanded this year to include cancer and certain neurodegenerative conditions, such as Parkinson’s and multiple sclerosis.
But the application of this law is pretty jumbled right now. So, while it may be legal to use CBD in a state like Colorado or Alaska, if an employer follows federal regulations, the standardization and quality of a CBD product matters. Because if there’s even a small percentage of THC in that product, then a drug test might come back positive. And this could result in legal issues for the user.
What’s the most important thing cancer patients should know about CBD oil?
There’s still a lot to learn. So always let your health care team know if you are using CBD oil. That way, we can make sure nothing interacts adversely with your cancer treatments or other medications.
Also, avoid products with health-related claims on their labels. The only product approved by the FDA for its medical value is Epidiolex.
Wondering whether you should use CBD oil to cope with cancer treatment and its side effects? We spoke with Kimberson Tanco, M.D., to separate fact from fiction.
Updated on April 1, 2020. Medical content reviewed by Dr. Joseph Rosado, MD, M.B.A, Chief Medical Officer
Although cancer is a medical disease researchers study heavily, it’s still complex in terms of its definitive cause, symptom management, optimal treatment and potential cure. Recently, however, multiple studies worldwide have tapped into the therapeutic healing benefits medical marijuana for liver cancer provides patients, particularly for symptoms occurring from conventional cancer treatments.
Liver Cancer Video Transcript:
The liver is the largest organ inside the body and is located just below the ribs on the right side. The liver has many functions. It filters waste and other harmful materials from the blood. It produces enzymes and bile that help with digestion. And it produces chemicals and hormones necessary for regulating many body functions. Liver cells are called hepatocytes. Liver cancer is classified as either primary, starting in the liver, or secondary, spreading to the liver from cancer in another part of the body. Hepatocellular carcinoma is the most common form of primary liver cancer. It develops in the liver cells and damages other healthy liver cells. Continuous growth of cancerous hepatocytes can cause malignant or cancerous tumors to form. In its early stages, liver cancer does not produce many symptoms and is hard to detect. As the cancer grows, symptoms such as abdominal pain and bloating, weight loss, nausea, vomiting, fatigue and jaundice or yellowing of the skin and eyes may appear. While doctors do not know exactly what causes liver cancer, chronic liver infections such as viral hepatitis B and C and cirrhosis of the liver can increase a person’s risk for developing the disease. Men are more likely to develop liver cancer as are people over the age of 60. There are different treatment options available depending on the type and stage of the cancer. Surgery or a liver transplant are options only if the tumor is small and contained within the liver. If the tumor is very large or has spread beyond the liver, chemotherapy or radiation may relieve symptoms and prolong life, but this is not a cure. Learn more below about how medical marijuana can help treat liver cancer.
What Is Liver Cancer?
When you have cells in your body that start growing out of control, this is how cancer begins. Just about any cell in any area of your body can turn into cancer, spreading to other body parts. Liver cancer is the only cancer that begins in your liver. To gain an understanding of liver cancer, you’ll benefit from knowing about the normal function and structure of your liver.
Your liver is your biggest internal organ. It sits beneath your right lung under your right ribs. It’s separated into lobes. You can’t live without this essential organ, and it serves some important functions, such as:
- Breaking down and storing various nutrients your intestine absorbs that your body requires for functioning. Your liver needs to metabolize, or change, certain nutrients to repair and build body tissues before you can use them for energy.
- Secreting bile into your intestines to assist in absorbing nutrients, particularly fats.
- Making the majority of the clotting factors that slow profuse bleeding when you’re injured or cut.
- Breaking down toxic wastes, alcohol and drugs in your blood before they move from your body through your stool and urine.
Hepatocytes, or cells, make up most of your liver. Other types of cells make up your liver as well, including cells that line your bile ducts, the small tubes in your liver, and cells that line your blood vessels. Bile ducts stretch out of your liver carrying bile to your gallbladder or intestines.
These various cell types in your liver may form benign, or noncancerous, and malignant, or cancerous, tumors. The tumors each have their own cause, treatment and prognosis.
Types of Liver Cancer
Hepatocellular carcinoma (HCC), also referred to as hepatoma, represents the most common type of cancer of the liver in adults. It starts in your hepatocyte, or main liver cell. Other less-common liver cancers include hepatoblastoma and intrahepatic cholangiocarcinoma.
Hepatocellular Carcinoma (HCC)
There are different growth patterns in hepatocellular carcinoma that include:
- One tumor that grows bigger and may spread to other areas of your liver late in the disease.
- Smaller cancer nodules in your liver seen particularly in individuals with chronic liver damage (cirrhosis). It’s also the most common pattern observed in the U.S.
Hepatoblastoma develops in children and is a rare type of cancer. It afflicts children younger than four years of age. Hepatoblastoma cells are comparable to fetal liver cells. Chemotherapy and surgery successfully treat around two out of three children who have these tumors. When the tumors begin spreading outside the liver, they’re harder to treat.
Intrahepatic cholangiocarcinomas make up between 10 to 20 percent of liver cancers, according to the American Cancer Society. They begin in your small bile duct cells in your liver. The majority of cholangiocarcinomas start outside your liver in the bile ducts.
History of Liver Cancer
Throughout the African black population south of the Sahara and in the Far East, primary liver cancer is common, as reported in the book “Liver Cancer.” Caucasians in southern Africa have a lower occurrence of primary liver cancer compared to U.S. incident rates.
Cholangiocellular carcinoma and hepatocellular have their maximum prevalence and occurrence of primary large bowel cancer.
Secondary cancer incident rates in the liver are equivalent to the occurrence of primary cancer. In the U.S. and Europe, primary large bowel cancer with a consequence of metastases to the liver is common. Lung, stomach, breast and pancreas cancer are also common and lead to metastases to the liver.
Effects of Liver Cancer
Common physical symptoms of liver cancer may include:
- Unplanned weight loss
- Upper abdominal pain
- Appetite loss
- White or light chalk-like stools
- Jaundice, or yellowing of the white area of eyes or the skin
A liver cancer diagnosis can also bring about social and emotional effects, like:
You may have issues expressing how you feel to your family and friends. Others might not know how to respond to you.
It can help to open up and share your feelings with your family and friends or a health care professional. Although emotions can affect some individuals differently than others, everyone can benefit from support and help through family and friends, professional counselors, support groups, religious groups or others.
Liver Cancer Statistics
Estimates by the American Cancer Society for intrahepatic bile duct cancer and primary liver cancer in 2017 in the U.S. are:
- Around 40,710 individuals will receive a diagnosis — 11,510 women and 29,200 men.
- Around 28,920 people will die because of these cancers — 9,310 women and 19,610 men.
- Since 1980, liver cancer occurrences have more than tripled.
- Among the approximate 43 percent of individuals who receive an early diagnosis, 31 percent will survive for at least five years.
- Around 11 percent of these people will survive for five years if their liver cancer has spread to regional lymph nodes or surrounding organs or tissues.
Current Treatments Available for Liver Cancer and Their Side Effects
The treatment you receive for liver cancer depends on several factors, including your age, the severity of the disease, your general health and your personal preference. Common liver cancer treatments may include the following.
Surgery for Liver Cancer
Surgeries surgeons use to treat liver cancer include:
- Tumor Removal Surgery: In some cases, your surgeon may suggest surgery to remove your cancer and a small sample of healthy liver tissue surrounding your tumor if your liver function is good and your tumor is small.
- Liver Transplant Surgery: To replace your liver with a healthy one from a donor, your surgeon removes your diseased liver in this operation. Several factors affect your candidacy for a liver transplant, including whether your cancer has spread outside the liver, the size of the tumors and the number of tumors. Side effects of liver transplantation include organ rejection, infection and recurrence of liver cancer.
Side effects of surgery may include swelling and pain around the incision site, appetite loss, bleeding, numbness or drainage from the surgery site.
Localized Treatments for Liver Cancer
Your doctor administers localized treatments directly to your cancer cells and the area that surrounds them. Some options of localized treatments to treat your liver cancer may include the following.
Freezing Cancer Cells to Treat Liver Cancer
To destroy cancer cells with extreme cold, your doctor uses cryoablation. Your physician places a cryoprobe that contains liquid nitrogen directly on your liver tumor. Using ultrasound images to guide and monitor, they freeze the cells. Side effects of this treatment may include irritation or redness of your skin and tingling or numbness.
Heating Cancer Cells to Treat Liver Cancer
Your doctor performs the radiofrequency ablation procedure to heat cancer cells with electric current and destroys them. He uses a CT scan or ultrasound as his guide while he inserts a thin needle into your abdomen through a small incision. Side effects may include bleeding, nerve injury, infection, paralysis or long-term numbness.
Chemotherapy Drugs to Fight Liver Cancer
Through a procedure known as chemoembolization, your doctor injects potent anti-cancer chemotherapy drugs into your liver. Side effects may include nausea or vomiting, pain and fever.
Alcohol Injection to Treat Liver Cancer
Your doctor injects pure alcohol directly into your tumor during surgery or through your skin. Alcohol kills the tumor cells. Side effects may include muscle weakness, numbness, nerve pain or tingling.
Radiation Therapy to Treat Liver Cancer
To shrink tumors and destroy cancer cells through radiation therapy, your doctor uses high-powered energy sources like protons and X-rays. The machine directs the energy carefully to your liver while preserving the healthy tissue that surrounds it.
You’ll lie on a table during the external beam radiation treatment while your doctor guides the machine that directs energy to a particular point on your body. If your physician uses stereotactic radiosurgery therapy, they’ll use a machine that focuses many radiation beams at one point in your body simultaneously. Side effects may include dry mouth, shoulder stiffness, fever, nausea, diarrhea and vomiting. There can be both short-term and long-term side effects of radiation therapy.
Targeted Drug Therapy to Treat Liver Cancer
Targeted drugs interfere with certain tumor abnormalities. They slow down or stop cases of hepatocellular carcinoma from getting worse. Treatment lasts a few months. Side effects may include blood clotting, skin problems, gastrointestinal perforation or high blood pressure.
Supportive Care During Liver Cancer
Supportive, or palliative, care provides relief from pain and other symptoms. It focuses on improving quality of life. It’s a specialized medical care where you’ll be working closely with a palliative care specialist. Palliative care complements other aggressive treatments, like surgery, radiation therapy or chemotherapy.
Medical Cannabis for Liver Cancer
Researchers over the past couple years have brought to light new evidence that supports the therapeutic potential of marijuana in different types of cancer, including glioma, bladder, breast and leukemia. Now, a group of researchers is studying the benefits of marijuana for liver cancer, particularly hepatocellular carcinoma.
Alternative and Complementary Medicine
When you have advanced liver cancer, alternative treatments can ease your pain. Different types of alternative medicine include:
- Deep breathing
- Music therapy
How and Why Marijuana Can Be an Effective Treatment for Liver Cancer
To date, studies on cannabinoids and their effect on liver cancer show that cannabinoids not only can prevent the dividing of tumor cells but may even kill cancer cells. Besides potentially stopping proliferation, there are several ways cannabinoids may help to tackle cancer. They are by:
- Providing anti-metastastic actions: Preventing distant tumor masses from forming in animal models.
- Preventing the formation of blood vessels: Over the past 10 years, published research shows that both CBD (non-psychoactive) and THC (psychoactive) prevent tumors from generating blood vessels.
- Stimulates programmed cell death: Both animal and laboratory models indicate that both CBD and THC may cause a programmed death of cells inside tumor cells.
Liver Cancer & Medical Marijuana Research
Since liver cancer is a leading cause of cancer death and difficult to treat in late stages, the authors of this 2011 paper covering the effect of cannabinoids on liver cancer cells wanted to explore alternative treatments. Building off previous research on cancer and cannabinoids, they focused on liver cancer’s response to cannabis.
The team observed THC and the CB2 receptor in their methods. To simulate their effect on liver cancer, they administered THC to isolated cells. Applying THC lowered the viability of the cancer cells, implying the CB2 receptor could be involved. They verified its connection by repeating the process and adding a CB2 blocker. During this second attempt, the THC had no effect, indicating that the CB2 receptor inhibited the cancer cells.
After observing THC’s anticancer benefits, the researchers investigated how it worked with the CB2 receptor to take effect. Previous research showed cannabis kills cancer cells by triggering autophagy, or cell turnover. When the team exposed the cancerous tissue to THC, they found an increase in substances responsible for autophagy. They then blocked autophagy-related substances and examined if cannabis-related cell death still happened. Blocking them severely reduced cell death, showing autophagy was related to the process.
What Symptoms of Liver Cancer Can Medical Marijuana Treat?
Several smaller studies of smoking cannabis found it reduces or stops nausea and vomiting in patients receiving chemotherapy.
As mentioned, some symptoms of liver cancer are upper abdominal pain, appetite loss, anxiety, sadness and stress. Marijuana and liver cancer treatment can be an effective in addressing these symptoms. Certain strains help with certain symptoms, as you will see below.
Best Strains of Marijuana to Use for Liver Cancer
Patients with liver cancer have experienced improved well-being when using medical weed. Medical cannabis often helps patients who react adversely to conventional treatments, like chemotherapy or radiation.
Chemo and radiation trigger adverse side effects like nausea, vomiting, lack of appetite, extreme body pain and fatigue, whereas marijuana doesn’t. Thankfully, you have medical weed strains available to you that can relieve specific symptoms of cancer and its treatment’s unpleasant side effects so you may get back to normal life. Beneficial cannabis strains include:
- ACDC (Hybrid): ACDC provides pain relief from the horrible side effects systemic treatments like chemo impose.
- Northern Lights (Indica): When dealing with nausea or vomiting due to radiation or chemo treatments, this strain offers relief.
- Cannatonic (Hybrid): Cannatonic is high in CBD, leaving you feeling relaxed and happy without the buzz. It’s great for relieving anxiety, sadness and depression that cancer can bring about.
- Granddaddy Purple (Indica): When suffering from appetite loss or extreme weight loss due to cancer treatment, this strain brings your appetite back.
- Sour Tsunami: (Hybrid): A perfect strain to fend off stress and depression.
- Chocolope (Sativa): When worn out and experiencing fatigue, you may gain more liveliness and energy to get you back to life by using this strain.
- Charlotte’s Web (Sativa): Another CBD-rich strain that provides relief from multiple cancer symptoms without leaving that psychoactive effect.
Best Methods of Marijuana Treatment to Use to Treat Liver Cancer Symptoms
The effects of cannabis for liver cancer can depend on how the weed enters your body. When you take it orally, like in baked goods such as edibles, your body absorbs the THC poorly, and it may take several hours before you find any relief. Once absorbed, your liver processes it and generates a second compound that’s psychoactive. This compound acts on your brain and changes your consciousness and mood affecting your brain differently than THC.
When you smoke or vaporize, or inhale, cannabis, THC enters your bloodstream and quickly moves to your brain. The effects generated by inhaling weed fade faster than when you take it orally because your liver produces that second psychoactive compound in smaller amounts.
Patients who find success with medical cannabis use highly concentrated cannabis oil. Cannabis oil is made into a whole-plant extraction separating all marijuana resin from plant material. Other methods of cannabis and liver cancer treatment may include:
- Transdermal patches
- Juicing fresh cannabis
Getting Started With Medical Marijuana and Liver Cancer
When seeking relief from your liver cancer symptoms, you can begin by searching for a medical marijuana dispensary or doctor. After you find one, your doctor can help you find the right strains for your symptoms.
See how medical marijuana could help relieve your liver cancer symptoms. Find patient reviews on local doctors and information on treatment options.