Biopsy and surgery are among the most important tools we have in cancer care. A biopsy can provide the diagnosis and molecular information needed to choose appropriate treatment. Surgery can remove a primary tumor, reduce tumor burden, prevent complications, and, for many localized cancers, offer the possibility of cure.
The goal of integrative care is not to avoid medically necessary biopsy or surgery.
Instead, we ask another question:
Can we support the body’s physiology before and after a procedure in ways that promote healing, preserve immune function, and potentially make the perioperative environment less favorable to residual cancer cells?
There are compelling biological reasons to have that conversation.
Surgery Is More Than a Local Event
When tissue is injured, the body immediately launches a sophisticated wound-healing program. Stress hormones rise. Inflammatory pathways activate. Blood vessels and connective tissue begin remodeling. Growth factors are released. Immune activity changes.
These responses are essential—we could not heal without them.
But cancer biology can sometimes take advantage of the same signals.
Research on the perioperative period has shown that surgical stress can increase catecholamines, prostaglandins, inflammatory cytokines, vascular growth signals, and other mediators while temporarily suppressing aspects of antitumor immunity, including natural killer (NK) cell function.
Many of these pathways—including inflammatory signaling, angiogenesis, tissue remodeling, migration, and stem/progenitor-cell programs—also participate in tumor progression. This overlap is one reason cancer has historically been described as behaving in some ways like a “wound that does not heal.”
This does not mean we should avoid biopsy and surgery. For many cancers, surgery is lifesaving and remains the cornerstone of curative treatment.
It means that the days surrounding biopsy or surgery represent a biologically active window that deserves attention.
What About Biopsy?
Needle-tract seeding has been reported with certain tumors and procedures, but it is uncommon for most cancers, and human studies have not established that routine biopsy increases distant metastasis.
At the same time, a biopsy is still a tissue injury and produces a localized wound-healing response. For that reason, we believe it is reasonable to think about supporting healthy inflammatory regulation and tissue repair around a biopsy.
The Perioperative Stress Response and Cancer Biology
Cancer surgery creates several overlapping physiological responses.
Inflammation: Tissue injury activates inflammatory mediators necessary for wound repair. In the cancer setting, some of these same pathways can also influence angiogenesis, invasion, epithelial-to-mesenchymal transition (EMT), and survival of residual tumor cells.
Stress hormones: Surgery and the psychological stress surrounding a cancer diagnosis can increase sympathetic nervous system activity and catecholamines such as epinephrine and norepinephrine.
Prostaglandins: Surgical inflammation increases prostaglandin signaling, including pathways involving COX-2 and PGE2.
Temporary immune suppression: NK cells and cytotoxic T cells are important components of immune surveillance against malignant cells. Their function may decline temporarily following major surgery.
The biological objective is therefore not to eliminate inflammation—we need inflammation to heal—but to support an appropriate, well-regulated inflammatory response while preserving immune resilience.
An Intriguing Area of Research: Beta Blockers and Anti-Inflammatory Medications
One of the most interesting areas of perioperative oncology research involves simultaneously targeting the stress and inflammatory responses.
In a randomized phase II study of 38 women undergoing breast cancer surgery, patients received the beta blocker propranolol together with the COX-2–inhibiting anti-inflammatory medication etodolac, beginning five days before surgery and continuing through the perioperative period.
Compared with placebo, treated tumors showed favorable changes in several biomarkers associated with metastatic biology, including reductions in epithelial-to-mesenchymal transition and pro-inflammatory/pro-metastatic transcriptional activity.
Another randomized phase II trial studied propranolol alone for seven days before breast cancer surgery. Researchers observed reduced expression of mesenchymal and inflammatory programs—including changes involving NF-κB and AP-1—and changes suggesting greater immune-cell infiltration into the tumor.
These are fascinating findings, but there is an important distinction:
These trials demonstrated changes in biological markers. They have not yet established that perioperative beta blockers or anti-inflammatory medications reduce cancer recurrence or improve overall survival.
These medications also have real contraindications and risks. Beta blockers can affect heart rate, blood pressure, and airway function, while anti-inflammatory medications may affect bleeding, kidney function, gastrointestinal health, and surgical planning.
They should therefore only be considered in collaboration with the patient’s oncology, surgical, anesthesia, and prescribing teams.
Nutritional and Botanical Support
At Elevate Health, perioperative planning may also include nutritional and botanical compounds selected for their potential effects on inflammatory signaling, oxidative stress, tissue repair, and cancer-related pathways.
Depending upon the individual, compounds we may consider include:
- Boswellia: approximately 1,000 mg twice daily
- Curcumin phytosome: 500–1,000 mg twice daily
- Quercetin: up to 1,000 mg twice daily
- Grape seed extract: 250–500 mg once to twice daily
- Berberine: 500 mg twice daily with meals
- Black seed/thymoquinone: dosing individualized to the product; in some protocols approximately 200 mg twice daily
These doses are examples from our clinical protocols, not universal recommendations.
Evidence for these compounds ranges from mechanistic and preclinical research to limited human data; they should not be represented as proven methods of preventing perioperative cancer spread or recurrence.
Just as importantly, “natural” does not mean appropriate immediately before surgery. Supplements can affect platelet function, glucose, blood pressure, drug metabolism, anesthesia, or other aspects of perioperative care. Your surgeon and anesthesiologist should have a complete list of everything you take, and their instructions about what to stop before surgery take priority.
Modified Citrus Pectin and Galectin-3
Another compound we consider is modified citrus pectin (MCP).
MCP has been studied as an antagonist of galectin-3, a carbohydrate-binding protein involved in cellular adhesion, inflammation, fibrosis, angiogenesis, and several aspects of cancer biology.
Preclinical studies demonstrate effects of MCP on galectin-3–related tumor adhesion, angiogenesis, invasion, and growth. Human research remains preliminary, although a phase II study in men with biochemically recurrent prostate cancer found potentially favorable changes in PSA kinetics during MCP treatment.
Our clinical protocol commonly uses:
Modified citrus pectin: 15 grams daily, beginning approximately two weeks before biopsy or surgery and continuing for at least one month afterward.
In patients with confirmed cancer, we may also follow galectin-3 and individualize continued MCP use, with a clinical target of less than 10 ng/mL.
It is important to emphasize that using a galectin-3 target of <10 in this setting is an integrative clinical strategy rather than an established oncology guideline, and evidence has not established that MCP around surgery prevents metastasis or recurrence.
For benign biopsy findings, we generally do not continue cancer-directed MCP monitoring solely for this purpose.
Our Basic Pre- and Post-Biopsy/Surgical Support Protocol
Every patient is different, and surgical instructions always take priority. Depending on the procedure, medical history, medications, laboratory findings, and cancer type, our foundational protocol may include the following.
Vitamin C
1,000 mg two to three times daily for at least two weeks after surgery.
Vitamin C plays an important role in collagen synthesis and connective-tissue repair and supports antioxidant defenses during recovery.
Modified Citrus Pectin
15 grams daily, generally beginning two weeks before the procedure and continuing for at least one month afterward.
In selected cancer patients, galectin-3 may be monitored to help individualize longer-term use.
Zinc
25 mg twice daily or 50mg once daily with food, generally for two weeks before and two weeks after surgery.
Zinc is essential for immune function, protein synthesis, and wound healing. Higher-dose zinc should generally be used for limited periods unless zinc and copper status are being monitored.
Vitamin A
Our protocol may use 20,000 IU daily of emulsified vitamin A for approximately two weeks before and two weeks after surgery, when appropriate.
Vitamin A participates in epithelial integrity, immune function, and wound healing. This dose is not appropriate for everyone—particularly during pregnancy or when liver disease, retinoid medications, or other contraindications are present.
Probiotic Support
A mixed probiotic may be started approximately two weeks before surgery and continued for at least two weeks afterward, or continued longer when otherwise indicated.
One example used in our practice is RestorFlora, one capsule in the evening.
Fish Oil
We commonly have patients discontinue supplemental fish oil approximately 72 hours before major surgery, unless the surgical team advises otherwise.
This is generally not necessary for a routine fine-needle biopsy.
Restart timing should be confirmed with the surgeon, particularly when anticoagulants or antiplatelet medications are being used.
After Surgery: Supporting Recovery
Once the procedure is complete and the surgeon has confirmed that bleeding risk is controlled, our attention shifts toward recovery, mobility, connective-tissue repair, bowel function, pain management, and restoration of normal physiology.
Proteolytic Enzymes
Selected patients may use systemic proteolytic enzyme formulas such as Wobenzym or similar products, often taken away from food.
Because some enzyme products can affect bleeding or interact with medications, they should not be started immediately after surgery without clearance from the surgical team.
Gentle Lymphatic and Recovery Support
Depending on the surgery and stage of healing, supportive strategies can include:
- Gentle walking and progressive movement
- Hydration and adequate protein intake
- Constipation prevention
- Breathing exercises
- Gentle lymphatic support when appropriate
- Acupuncture for postoperative pain, nausea, and recovery
- Castor oil packs later in recovery when appropriate and never over a fresh incision
- Sauna only after adequate healing, hydration, and medical clearance
Rather than thinking of these interventions as “detoxing anesthesia,” we prefer to think about them as supporting circulation, bowel function, mobility, lymphatic flow, relaxation, and recovery while the liver and kidneys perform the body’s normal clearance processes.
What About IV Vitamin C?
For appropriate patients, we may consider intravenous vitamin C as part of an individualized postoperative oncology plan.
Our clinical protocol may include 25–50 grams of IV vitamin C within approximately 48 hours after surgery, once the patient is medically stable, followed by several treatments during the subsequent two weeks.
IV vitamin C has pharmacologic properties very different from oral vitamin C and is being actively investigated in oncology.
High-dose IV vitamin C also requires appropriate screening and medical supervision, including consideration of G6PD status, kidney function, hydration, iron overload disorders, and medication/treatment interactions. Timing must be coordinated with the oncology and surgical teams.
Homeopathic Support
Some patients in our practice also choose homeopathic preparations around major surgery, including Arnica, Staphysagria, Phosphorus, and Hypericum. These are optional complementary therapies which have long term historical use in healing and recovery and are well regarded as safe.
The Bigger Picture: Don’t Fear the Procedure—Prepare for It
A cancer diagnosis can make every decision feel loaded with risk.
Biopsies provide information that can be essential for choosing the right treatment. Surgery cures or controls many cancers. We should not delay a medically necessary procedure out of fear of the body’s wound-healing response.
At the same time, modern tumor biology gives us an increasingly sophisticated understanding of the perioperative period.
Surgery is not merely an event that happens to a tumor. It is an event experienced by the whole person—their nervous system, immune system, inflammatory pathways, metabolism, vasculature, and healing tissues.
That creates an opportunity.
Before a biopsy or surgery, we can ask:
How can we improve nutritional status?
How can we support wound healing?
How can we maintain muscle and metabolic health?
Can we improve sleep and reduce excessive sympathetic stress?
Are there deficiencies that should be corrected?
Which supplements should be stopped for surgical safety?
And, for patients with cancer, are there evidence-informed strategies worth discussing with the medical team to support the unique biology of the perioperative window?
This is what integrative oncology can do well: not replace necessary cancer treatment, but prepare the terrain around it.
The goal is to help patients enter surgery as physiologically resilient as possible—and come out with the support they need to heal, recover, and move confidently into the next phase of treatment.
Important Safety Note
This article is educational and is not a universal pre- or postoperative prescription. Supplements and medications can interact with anesthesia, anticoagulants, chemotherapy, targeted therapies, immunotherapy, blood-pressure medications, diabetes medications, and other treatments. Some supplements may need to be stopped considerably earlier than 72 hours before surgery.
Always provide your surgeon, anesthesiologist, oncologist, and integrative clinician with a complete medication and supplement list before a procedure. Do not start or stop prescription medications—including beta blockers or anti-inflammatory medications—without the prescribing and surgical teams.
References
Hiller JG, et al. Preoperative β-Blockade with Propranolol Reduces Biomarkers of Metastasis in Breast Cancer: A Phase II Randomized Trial. Clinical Cancer Research. 2020.
Shaashua L, et al. Perioperative COX-2 and β-Adrenergic Blockade Improves Metastatic Biomarkers in Breast Cancer Patients in a Phase-II Randomized Trial. Clinical Cancer Research. 2017.
Angka L, et al. Dysfunctional Natural Killer Cells in the Aftermath of Cancer Surgery. International Journal of Molecular Sciences. 2017.
Ben-Eliyahu S. et al. Research examining catecholamines, prostaglandins, perioperative immune suppression, and metastatic biology.
Keizman D, et al. Modified Citrus Pectin Treatment in Non-Metastatic Biochemically Relapsed Prostate Cancer: Results of a Prospective Phase II Study. Nutrients. 2021.
Jiang J, et al. Synergistic and additive effects of modified citrus pectin with two polybotanical compounds in the suppression of invasive behavior of human breast and prostate cancer cells. Integrative Cancer Therapies. 2013.
Shakhar G, Ben-Eliyahu S, and subsequent investigators. Reviews of perioperative stress, immune function, and metastatic mechanisms.
