Body Terrain and the Tumor Microenvironment

Cancer cells do not act alone. They enlist the body’s normal cells, molecules, and blood vessels in their efforts to survive, metastasize, and acquire drug resistance.

Memorial Sloan Kettering Cancer Center1

Key Points

  • The recognition of the whole body's role and interactivity with cancer cells is an ancient concept that is currently gaining traction in mainstream medicine.
  • Malignant and nonmalignant cells interact to create the tumor microenvironment.
  • Cells in the tumor microenvironment plan a key role in cancer’s development, spread and response to treatment.
  • Modifying your body terrain to make it inhospitable to cancer is one of the most important actions you can take. However, these actions alone are not enough to control or cure cancer.

Definitions

  • Terrain: from the French word terrein—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.”2
  • 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.”3

“The study of terrain is beginning to gain traction in mainstream cancer research.”4 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.

Integrative oncologist Keith Block, MD, more specifically focuses on the “biochemical terrain” and whether or not that biochemistry is balanced or disrupted and therefore inhospitable or hospitable to cancer.5

For the purposes of this summary, we consider the terrain as the internal environment of the human host and the tumor microenvironment existing within and influenced by the host’s terrain.

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.”6

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.”7 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.”8

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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.

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Same Soil, Different Outcome?

“Cancer is not an isolated group of errant cells waiting passively to be annihilated by a wonder drug. . . Cancer does not present a single target for a magic bullet; a tumor is merely the most obvious symptom of an altered, unbalanced system. . .And that’s why both the new targeted therapies and the older weapons of surgery, radiation and old-line chemotherapy so often fail to prevent the spread or recurrence of the disease. . . They neither pick up renegade cancer cells, strengthen the body’s biological balance, nor reach all of the underlying molecular accidents that initiated cancer in the first place. . . As a result, even if the original tumor is gone, this biological imbalance creates an environment for cancer to recur: tumor cells use the body’s healthy resources to grow and multiply.”9

Our Soil, Ourselves

We’ve tended to focus on the cancer, but its host tissue—the soil, rather than the seed—could help us predict the danger the cancer poses. If we look at the soil, as well as the seed, “it would return us to the true meaning of ‘holistic’—to take the body, the organism, its anatomy, its physiology—this infuriatingly intricate web—as a whole . . .It would help us understand when you have cancer and when cancer has you. It would encourage doctors to ask not just what you have but what you are.”10

This profound quote from Dr. Mukherjee, author of The Emperor of All Maladies, provides a remarkable insight: If we come to know a person’s soil, their terrain, we can understand why cancer could take hold in them in the first place, predict how dangerous that cancer is to the patient if things don’t change, and then create an individualized treatment approach that targets the seed while it tends the soil.

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.

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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

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Inflammation: An Example

Using inflammation as a subject, studies and meta-analyses have found that those with the highest pre-diagnostic levels of C-reactive protein (CRP)—a marker of chronic inflammation—have higher rates of cancer than those with lower levels:

  • Breast cancer16
  • Colorectal cancer risk17 and mortality18
  • Lung cancer and all cancer19
  • Prostate cancer20
  • Renal cell carcinoma21
  • Urologic cancers: bladder, penile and upper tract urothelial carcinoma22

Moreover, “changes in post-treatment CRP serum levels have also shown promise in determining survival.”23 Reducing C-reactive protein even after diagnosis and treatment can enhance survival.

Blood Sugar and Insulin: Another Example

Other studies and reviews investigating blood sugar and insulin find a relationship with cancer risk and progression:

  • All cancer24
  • Breast cancer25
  • Colorectal cancer26
  • Endometrial cancerD27
  • Melanoma (lower risk)28
  • Pancreatic cancer29
  • Prostate cancer risk (both higher and lower) and mortality30

Balancing each of the above six terrain features, according to Block, helps to deal with the five major challenges of having cancer:

  • Reducing tumor growth and spread
  • Reducing tumor bulk and improving treatment response
  • Tolerating conventional treatment
  • Optimizing daily functioning
  • Reducing the risk of life-threatening complications

Dr. Block describes how to determine which aspects of your internal terrain you most need to target, providing protocols for addressing each terrain feature as well as a general protocol for broad-spectrum terrain support supplementation.31

The Hallmarks of Cancer and the Tumor Microenvironment

Scientists Douglas Hanahan and Robert Weinberg created a framework called the Hallmarks of Cancer. These hallmarks are the biological capabilities that cancer cells acquire as they go through a multi-step process of developing into tumors.32

The following list of hallmarks is “sequenced roughly in the order in which these capabilities are acquired by most cancers.”33

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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

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Moving More

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Managing Stress

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Sleeping Well

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Sharing Love and Support

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Creating a Healing Environment

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Exploring What Matters Now

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Terrain Is Important but Not a Panacea

Both cancer treatment to address the tumor and terrain modification to make the body less hospitable to recurrence are called for.

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.58 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.

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Written by Laura Pole, RN, MSN, OCNS, and reviewed by Nancy Hepp, MS; most recent update on January 7, 2019.

Highlighted Video


Brian Bouch discusses integrative oncology, part 1

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View All References

More Information

Articles

Books

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."

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