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.
“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 and BCCT advisor 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
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. Let's think of the cancer seed as one from a thorny or even poisonous weed—not one we want growing in our soil/body.
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.
Modifying the Terrain
Naturopathic oncologist and BCCT advisor Lise Alschuler, ND, FABNO, 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
- 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 (BCCT's corresponding healing practices are noted in parentheses):
- Enhance your spirit (Exploring What Matters Now)
- Let’s move (Moving More)
- Enrich your diet (Eating Well)
- Utilize dietary supplements
- Create rejuvenation
The immune response is a key terrain factor related to cancer growth and spread.16 While we want an active immune response against tumors, we also do not want an inflamed state. Inflammation is associated with the development and malignant progression of most cancers..17
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 cancer18
- Colorectal cancer risk19 and mortality20
- Kidney cancer (Renal cell carcinoma)21
- Lung cancer and all cancers combined22
- Prostate cancer23
- Urologic cancers: bladder, penile and upper tract urothelial carcinoma24
Moreover, “changes in post-treatment CRP serum levels have also shown promise in determining survival.”25 Reducing C-reactive protein even after diagnosis and treatment can enhance survival.
Michael Irwin, MD, of the UCLA Department of Psychiatry and Biobehavioral Sciences prefers not to use anti-inflammatory drugs to reduce inflammation in cancer patients due to multiple side effects. He has researched several mind-body approaches and found these are useful in improving or reversing insomnia and subsequently improving inflammatory markers:
Blood Sugar and Insulin: Another Example
Other studies and reviews investigating blood sugar and insulin find a relationship with cancer risk and progression:
- All cancer27
- Breast cancer28
- Colorectal cancer29
- Endometrial cancer30
- Melanoma (lower risk)31
- Pancreatic cancer32
- Prostate cancer risk (both higher and lower) and mortality33
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.34
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.35
The following list of hallmarks is “sequenced roughly in the order in which these capabilities are acquired by most cancers.”36
The 7 Healing Practices: Modifying the Terrain
The 7 Healing Practices can actually modify many of the terrain factors that nourish the tumor microenvironment.
Creating a Healing Environment
BCCT advisor Brian Bouch, MD, explains the importance of toxicity and genes in integrative cancer care, plus a functional medicine approach to diagnosis and care.
BCCT advisorBrian Bouch, MD, explains how to boost immunity before starting conventional cancer treatments.
Sharing Love and Support
Exploring What Matters Now
Terrain Is Important but Not a Panacea
Anticancer Lifestyle Program
Using expert videos, animation, text and interactives, the Change Module of the Anticancer Lifestyle Program introduces you to the course, and help you make lasting lifestyle changes that will decrease inflammation and enhance your immune system’s ability to fight disease.
This course is offered on a “pay-what-you-can” basis for 90-day access to all course modules.
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.61 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.
Written by Laura Pole, RN, MSN, OCNS, and reviewed by Nancy Hepp, MS; most recent update on September 23, 2020.
- 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.
- 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.
- 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."
- 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
More from Our Resources Database
- Gurdev Parmar and Tina Kaczor: Textbook of Naturopathic Oncology
- Lise Alschuler and Karolyn Gazella: Managing Stress during Difficult Times
- American Institute for Cancer Research: New American Plate Challenge
- Block KI, Block PB, Gyllenhaal C: Integrative Treatment for Colorectal Cancer
- Barbara MacDonald, ND, LAc: The Breast Cancer Companion: A Complementary Care Manual: Third Edition
- Keith Block and others: A Broad-Spectrum Integrative Design for Cancer Prevention and Therapy
- The New School at Commonweal: Keith Block, MD: Life over Cancer—Achieving A Survivor’s Edge
- Patrick Quillin, PhD, with Noreen Quillin: Beating Cancer with Nutrition (Fourth Edition)
- The New School at Commonweal: Dwight McKee, MD: 40 Years Practicing Integrative Cancer Medicine, Part 1
- The New School at Commonweal: Dwight McKee, MD: 40 Years Practicing Integrative Cancer Medicine, Part 2
- EmpowHER: Keith Block: My Activity
- Henry Mayo Clinic: Keith Block: New Roads to Health: Life over Cancer
- Raymond Chang, MD: Beyond the Magic Bullet: The Anti-Cancer Cocktail
- Donald I. Abrams, MD, and Andrew T. Weil, MD: Integrative Oncology, 2nd Edition
- Neil McKinney, BSc, ND: Naturopathic Oncology, 3rd Edition
- Clifton Leaf: The Truth in Small Doses: Why We're Losing the War on Cancer—and How to Win It
- Keith I. Block, MD: Life over Cancer: The Block Center Program for Integrative Cancer Treatment
- Lorenzo Cohen and Alison Jefferies: Anticancer Living: Transform Your Life and Health with the Mix of Six
- World Cancer Research Fund and the American Institute for Cancer Research: Food, Nutrition, Physical Activity and the Prevention of Cancer: a Global Perspective
- American Academy of Anti-Aging Medicine and Metabolic Medical Institute: Integrative Cancer Therapy Fellowship Modules
- Jade Beutler: Exploring the Endocannabinoid System
- Jeanne Achterberg: Imagery in Healing: Shamanism and Modern Medicine
- Editors: Iris F. F. Benzie and Sissi Wachtel-Galor: Herbal Medicine, 2nd Edition: Biomolecular and Clinical Aspects