Body Terrain and the Tumor Microenvironment

“The study of terrain is beginning to gain traction in mainstream cancer research.”However, the concept is not new: traditional Chinese medicine (TCM) has viewed terrain as important for millennia. Viewing cancer as a systemic disease and the tumor as a symptom of that disease, TCM considers that to heal the disease, the underlying constitution must be altered.

Definitions

Terrain:

From the French word terrain—ground or land, especially their physical features. In integrative medicine circles (especially in Europe) terrain denotes the physical features and state of a person’s body and the influence of that state on health and disease prevention. “It is the sum total of diet, lifestyle, metabolism, environmental exposures and stress.”

Tumor Microenvironment (TME):

“The normal cells, molecules, and blood vessels that surround and feed a tumor cell. A tumor can change its microenvironment, and the microenvironment can affect how a tumor grows and spreads.

Importance of the Microenvironment

In recent years, we’ve had to let go of the notion that cancer is just a mass of malignant cells or simply a disease of aberrant genes—if so, we would have long ago succeeded in eliminating or curing cancer by removing or destroying cells or targeting genetic mutations. Rather, cancers are “complex ‘rogue’ organs, to which many other cells are recruited and can be corrupted by the transformed cells.”

Malignant and nonmalignant cells interact to create the tumor microenvironment (TME). “The nonmalignant cells of the TME have dynamic and often tumor-promoting functions at all stages of carcinogenesis.” More simply put: “Cancer is a complex mixture of cancer cells, normal blood cells, tissue and immune cells. Tumor cells themselves alter the microenvironment to secrete things that help tumors grow.”

Terrain as Soil

When it comes to understanding the tumor microenvironment and how to create a body in which cancer can neither thrive nor survive, a few gardening concepts provide a good analogy. Cancer is the seed and the body is the soil that cancer might try to use as a growth medium. Your terrain is the body’s/soil’s internal environment.

Chemotherapy, radiation therapy and surgery are focused on killing or removing the cancer seed, which we treat like a weed or pest. Gardeners know that a pesticide or weed killer won’t work if you’ve mischaracterized the pest or weed and used the wrong pesticide, or if you used a pesticide that the pest or weed was resistant to. Successful gardeners know that if the soil is healthy, there’s less need to use pesticides and chemical fertilizers, because the soil’s healthy microorganism and biochemical balance favors the growth of plants and deters pests from taking hold.

Our body’s relationship with cancer is not too different. No matter how powerful our treatments are at killing the cancer (the seed), they will not succeed as long as the body provides the food and fodder for cancer to do what it does best: grow, circumvent programmed cell death, and spread.

Tending Your Terrain

Many of our therapy summaries include references to tending the terrain, the seed and soil, the tumor microenvironment and making the terrain inhospitable to cancer. Indeed, many of the healing practices that are part of a healthy lifestyle contribute to making the body inhospitable to cancer, and therein may lie their value in helping delay or reduce risks of cancer recurrence. In addition, these practices may also stave off other conditions or illnesses typically spawned from treatment toxicity, such as cardiotoxicity.

Modifying the Terrain

Naturopathic oncologist Lise Alschuler and co-author Karolyn Gazella write about creating a body that cancer doesn’t like. They describe five key pathways that have the greatest impact on whether we are healthy or become sick:

The immune system
Inflammation
Hormonal balance
Insulin resistance
Digestion and detoxification

They go on to describe five core strategies and corresponding action steps that positively influence the key pathways:

Enhance your spirit
Let’s move
Enrich your diet
Utilize dietary supplements
Create rejuvenation

They explain that through these strategies we train our cells to retain their optimal resistance and effectiveness over cancer while also creating an environment that is inhospitable to cancer growth. First, the authors describe how cancer develops. Although cancer is characterized as a disease of genetic mutations, most of them don’t start with inherited gene mutations. Rather, the mutations are a result of mutated gene expression that develops over time.

“Cancer promoter genes are turned on, while cell repair and cancer-suppressor genes are switched off. This aberrant gene expression changes cell behavior, causing cells to divide too quickly, to spread into the surrounding tissue and to make proteins that call in new blood vessels. These changes, in turn, sustain the aberrant cells while maintaining a tissue environment that supports their continued growth. . . ultimately forming a cancerous tumor, or in the case of cancers of the blood, they circulate in malignant cell clusters. . . . Our lifestyle actually sends molecular messages to cell membranes that are then translated inside the cell and delivered to its very core, the nucleus, the home of DNA. There, these molecular signals interact with the DNA and become genetic switches that turn genes on and off. The on-and-off pattern determines the behavior of the cell and will ultimately move the cell toward improved function and health, or toward deviant behavior and disease.”

Your Microbiome

Many trillions of microorganisms live in and on us, many of which are in our gut―in fact, non-human microbe cells in our bodies outnumber our human cells. Over thousands of years, our bodies have developed a symbiotic relationship with these organisms, generally supporting each other’s health and well-being. In exchange for food and lodging, these microorganisms

Help with digestion and produce essential vitamins and minerals

Support intestinal wall integrity
Influence our sleep cycles and immune system
Signal to each other to affect functions

- Metabolism
- Inflammation system
- Brain and nervous system
- Immune system

Both direct and indirect effects of an out-of-balance microbiome can make our terrain (body) hospitable to cancer:

Hyperinsulinemia
Obesity
Inflammation
Excess estrogen
Compromised immune function
Depression

The connection between the microbiome and cancer is strong enough that the microbiome has been proposed as a screening tool for early stages of colorectal cancer. Early evidence shows that the pancreatic microbiome is substantially different in cancer patients and that antibiotic alteration of the pancreatic microbiome can slow disease progression in mice.

The 7 Healing Practices: Modifying the Terrain

The 7 Healing Practices can actually modify many of the terrain factors that nourish the tumor microenvironment.

Eating Well

Eating well affects many of the factors defining one’s terrain. Dr. Keith Block reviews “terrain offenders” in his book Life Over Cancer. Some dietary offenders:

Oxidation is increased by consuming alcohol, unhealthy fats, high levels of dietary iron, and eating more calories than you burn.

Inflammation is increased by alcohol consumption, unhealthy dietary fats and carbohydrates, and unhealthy cooking methods.

Immune surveillance is hampered by alcohol consumption, poor nutrition, unhealthy dietary fats, dairy foods, and iron-rich foods.

Glycemia is tipped toward elevated blood sugar by eating too much, especially high glycemic-index foods and inflammation-producing foods, and by eating infrequent large meals.

Stress biochemistry is thrown off balance by caffeine, alcohol, a low-carbohydrate and high-fat or high-protein diet, eating a high ratio of omega-6 to omega-3 fats, and overeating. Read more about Eating Well here.

Moving More

Moving more is another powerful means of modifying your terrain to reduce the factors that nourish cancers, probably the reason it is included in every protocol we have investigated. For instance, being sedentary is associated with lower natural killer (NK) cell activity and impaired T cell function, both of which are necessary in finding and killing cancer cells (immune surveillance). Regular moderate activity such as walking, running and other exercises including resistance training can counter age-related decline in helper T cells and boost the number of NK cells in elderly men and in breast cancer survivors. Read more about Moving More here.

Managing Stress

The biochemical alterations of chronic, unmanaged stress have widespread effects on terrain. As Dr. Block writes, “With your stress machinery stuck on high, continued exposure to stress hormones can severely damage your body and disturb your vital reserves of nutrients, enzymes, hormones, antibodies and immune cells, all of which are essential to your recovery.”

Effects of chronically elevated stress hormones:

Increased blood glucose, insulin resistance and blood clotting factors
Suppressed immune system
Increased biochemicals that help tumors grow and spread.

High levels of stress hormones are associated with faster cancer progression, quicker relapse, reduced NK cell function and shorter survival.

Sleeping Well

Sleep and stress are closely linked. Cancer incidence, progression and mortality are linked to stress and disruption of the circadian (daily) rest and activity cycle. Hormone levels, especially cortisol and melatonin, rise and fall with sleep and wakefulness. When these normal cycles are disrupted, the terrain is more hospitable toward cancer:

Abnormally elevated cortisol caused by disrupted sleep pushes several cancer processes forward, especially metastasis.
Melatonin, the “sleep hormone”, rises at night, but is either depressed or suppressed with disrupted sleep. Melatonin is instrumental in eliminating cancer cells and reducing the side effects of chemotherapy.

Disrupted sleep is also associated with a number of other cancer-hospitable terrain imbalances:

Weakened immunity
Insulin resistance
Inflammation
Impaired digestion and detoxification
Changes in gut bacterial balance
Obesity

Sleep disturbance, sleep deprivation and sleep duration are each associated with increases in markers of systemic inflammation. Chronic inflammation is linked to higher cancer mortality. Read more about Sleeping Well here.

Sharing Love and Support

Having good social support shows up time and again as tipping the balance toward a longer life. How that might influence one’s terrain and the TME is suggested by studies such as one looking at social support, psychological distress and natural killer cell activity in ovarian cancer. Compared to those who felt alone, helpless and emotionally distraught, women who felt loved and supported and who kept up their morale had more combative NK cells.

Conversely, social isolation appears to contribute to the chronic stress response. Social support may create a more favorable balance of stress chemistry.

Read more about Sharing Love and Support here.

Creating a Healing Environment

When we speak of balancing our terrain so that it is inhospitable to cancer, we are referring to our internal environment. The state of our terrain, however, is greatly dependent on exposures and factors from our external environment-

Oxidation is increased by tobacco smoke and by both ionizing and nonionizing radiation.
Inflammation is increased by smoking and by indoor and outdoor air pollution.
Immune surveillance is hampered by smoking.
Blood circulation, particularly coagulation (clotting) abnormalities, is influenced negatively by smoking, the worst “clotting offender.”

Read more about Creating a Healing Environment here.

Exploring What Matters Now

Those of us who have worked for years guiding people with cancer and carefully observing what really matters agree that finding joy, finding meaning, or finding purpose seems to be the essence of living well (and in many cases, living longer than the doctors predicted)

Read more about Exploring What Matters Now here.

Terrain Is Important but Not a Panacea

Modifying your biochemical terrain, alone, is not enough to control or cure cancer. On the other hand, conventional cancer treatments alone will not consistently keep the cancer from coming back. Generally, both cancer treatment to address the tumor and terrain modification to make the body less hospitable to recurrence are called for. Over and over again, we return to the point that an integrative approach may provide the best chance of exploiting cancer’s weaknesses.

A flawed myth often promoted by the alternative medicine community is that boosting your immune system through natural or other approaches can eradicate cancer. Dr. Block illustrates this when describing the link between immunity and cancer. He replays the all-too-common scenario of a patient saying, “I’m concerned about the side effects of chemo and radiation. I want to do everything possible to get well, but I would much prefer to treat my cancer naturally, by boosting my immune system. Can you help me?

Block explains that the immune system is just one of a number of factors influencing cancer. Nor does the immune system automatically identify cancer as a potential threat . . .the longer the tumor has been growing, the more adept it is at escaping the surveillance of the immune system. Furthermore, even if the immune system does recognize cancer cells, the normal immune response may not be adequate to get rid of the cancer. “Since most cancers have been growing for years by the time they are diagnosed, most alternative and even experimental immune-based treatments are ineffective at best, and could delay effective treatment.”

Dr. Block cautions that “you may place yourself at serious risk if you avoid appropriate conventional therapies in the misguided hope that immune manipulation will eradicate your cancer. In most cases, if your cancer is accessible, you are best off having the tumor treated conventionally, and only then exploiting the immune system’s resources . . . the more active immune strategies do have an important role, but to date they are more for containing growth or sustaining a remission than shrinking or eliminating tumors.”

More Information

Credit: Beyond Conventional Care Therapies
ZenOnco.io Integrative Oncology Cancer Care

Articles

Balkwill FR, Capasso M, Hagemann T. The tumor microenvironment at a glance. Journal of Cell Science. 2012 Dec 1;125(Pt 23):5591-6.
Quail D, Joyce J. Microenvironmental regulation of tumor progression and metastasis. Nature Medicine, 2013 Dec 1;19(11), 1423–1437.
Wang M, Zhao J et al. The role of the tumor microenvironment in tumorigenesis. Journal of Cancer 2017; 8(5):761-773.
Cole SW, Nagaraja AS, Lutgendorf SK, Green PA, Sood AK. Sympathetic nervous system regulation of the tumour microenvironment. Nat Rev Cancer. 2015 Sep;15(9):563-72.
Moss Reports (purchase required): Excellent discussion of the hallmarks of cancer in general and how each complementary therapy affects the hallmarks. Select from the list of cancers down the left side of the page for a report describing uses of conventional, complementary, alternative and integrative therapies related to that cancer. Ralph Moss is among the most knowledgeable and balanced researchers of integrative cancer therapies. The cost of his Moss Reports is not negligible, but many patients find them of considerable value. Moss is also available for consultations.

Books

Alschuler LN, Gazella KA. The Definitive Guide to Thriving after Cancer. Berkeley, California: Ten Speed Press. 2013.
Lemole G, Mehta P, McKee D. After Cancer Care: The Definitive Self-Care Guide to Getting and Staying Well for Patients with Cancer. New York, New York: Rodale, Inc. 2015.
LeShan L. Cancer as a Turning Point, Revised Edition. New York, New York: Penguin Group. 1994.
Servan-Schreiber D. Anti-Cancer: A New Way of Life. New York: Penguin Group. 2008.

Professional Journals on the Tumor Microenvironment

Tumor and Microenvironment: a quarterly open access journal published by Wolters Kluwer|Medknow on behalf of the Primary Co-Development Institute of Medical Research, Beijing.
Cancer Microenvironment: Cancer Microenvironment is the official journal of the International Cancer Microenvironment Society (ICMS).
Journal of Translational Medicine: Cancer Microenvironment Section: The Cancer microenvironment section publishes research on the cellular and molecular components of the cancer microenvironment, with a particular focus on translational research that has important implications for the prevention, diagnosis and treatment of human neoplasms.

Video

The C-Word: neuroscientist David Servan-Schreiber discovered his own brain tumor during MRI research. He set out to gather as “much information as I could to see what I could do to help my body fight and resist cancer.”

Websites

Dr. Hyman: 5 Strategies to Prevent and Treat Cancer
Jeannine Walston: Functional Medicine and Cancer
Personalized Lifestyle Medicine Institute: Cancer, the Tumor Microenvironment, and Personalized Lifestyle Medicine