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 Center
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 play 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.
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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.”
- 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.”
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“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.
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.
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.”
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.”
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In addition to malignant cells, the TME contains these types of cells:
- Immune system
- Tumor blood vessels
- Lymphatics
- Fibroblasts (cells in connective tissue that produce collagen and other fibers, usually to help wounds heal)
- Pericytes (cells in linings of blood vessels that help with blood vessel formation)
- Adipocytes (fat storage cells)
All the malignant and nonmalignant cells in the TME communicate with each other through a network of biochemical mediators: cytokines, chemokines and growth factors, as well as enzymes that promote inflammation and remodel the tissue matrix.
The cells in the TME play a role in cancer’s development, spread and response to treatment.
Considering the tumor microenvironment in an integrative oncology plan is important for these reasons:
- The cells in the TME play a role in cancer’s development, spread and response to treatment.
- Treatments that target the nonmalignant cells or the biochemical communication mediators in the TME may complement treatments that remove or kill cancer cells. An example of this is using anti-angiogenic treatments such as Avastin or Sutent to block the tumor from creating its blood supply.
- Complementary integrative approaches—such as diet, physical activity, natural products and stress management—may modify the terrain and sometimes specifically the TME, making the body inhospitable to cancer. These approaches may be important contributors in reducing risks of cancer, improving response to conventional treatments, improving quality of life during treatment, and maintaining remission.
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.
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Many weeds survive better in poor soil, while the plants we want to grow thrive in healthy soil. By building a healthy soil or inner terrain, a cancerous "weed" in your body is denied the environment that allows it to thrive. You also simultaneously promote health and wellness throughout your body.
Chemotherapy, radiation therapy and surgery are focused on killing or removing the cancer weed. Gardeners know that a pesticide or weed killer won’t work if you’ve mischaracterized the weed and used the wrong pesticide, or if you used a pesticide that the 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 balance of microorganisms and biochemistry favors the growth of plants and deters weeds from taking hold.
Complementary integrative approaches— such as diet, physical activity, natural products and stress management—may modify the terrain and sometimes specifically the TME, making the body inhospitable to cancer.
Our body’s relationship with cancer is not too different. No matter how powerful our treatments are at killing the cancer (the weed), 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.
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.”
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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.”
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.
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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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Your integrative cancer care plan should include meaningful instruction and support in adopting or reinstating healthy lifestyle practices—the 7 Healing Practices. This approach has these potentials:
- Alter the tumor microenvironment
- Engage you meaningfully in your care
- Improve your quality of life on many levels
David Servan-Schreiber explains that “in patients who already have cancer, there is a ‘dose effect’ relationship between regular application of practices that improve lifestyles and the degree of protection from the disease. The more involved patients are in changing their terrain, the greater the benefits.”
Simple practices and habits, such as developing a practice of gratitude—consciously focusing on blessings—”may have emotional and interpersonal benefits” that then impact physical and psychological/spiritual well-being.
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
- 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 (BCCT's corresponding healing practices are noted in parentheses):
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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.”
In his book, Life over Cancer, Dr. Keith Block devotes an entire section on boosting your biology through using the healing power of terrain. “Your internal biochemistry can either nourish cancer cells or send them into molecular oblivion.” Block goes on to explain that the biochemical terrain is your body’s internal chemical environment, and it plays a vital role in “determining whether a tumor will regain its foothold after treatment, metastasizing to distant sites, or whether it will stay where it is without posing any threat. The internal biochemistry influences the microenvironment immediately surrounding the cancer cells. An inhospitable environment impacts the disease.” Similar to Alschuler and Gazella’s pathways, Block writes that addressing six “defining features” of your biochemical terrain is necessary. Cancer thrives on each of these when out of balance:
- Oxidation
- Inflammation
- Immunity
- Blood coagulation
- Glycemia (blood sugar)
- Stress chemistry and biorhythms
Inflammation: An Example
The immune response is a key terrain factor related to cancer growth and spread. 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..
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:
Moreover, “changes in post-treatment CRP serum levels have also shown promise in determining survival.” Reducing C-reactive protein even after diagnosis and treatment can enhance survival.
Addressing Inflammation
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:
Other symptoms such as depression and fatigue also improved.
Blood Sugar and Insulin: Another Example
Other studies and reviews investigating blood sugar and insulin find a relationship with cancer risk and progression:
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.
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.
The following list of hallmarks is “sequenced roughly in the order in which these capabilities are acquired by most cancers.”
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- Genomic instability: Unstable DNA helps cancer cells “acquire a selective advantage over neighboring cells, enabling outgrowth and dominance in the tissue microenvironment”, especially important in tumor initiation and promotion.
- Sustained proliferative signaling: Cancer cells become self-sufficient and able to grow uncontrollably.
- Evasion of anti-growth signaling (evading growth suppressors): Cancer cells no longer respond to antigrowth signals.
- Resisting apoptosis (programmed cell death): Cancer cells are able to circumvent the cycle of programmed cell death (apoptosis). Normal cells submit to apoptosis when they are no longer needed or might be harmful to the body.
- Replicative immortality: No limits exist on the cancer cell to reproduce over and over.
- Deregulated metabolism (cellular energetics): Cancer cells shift from producing energy in the mitochondria to inefficiently fermenting glucose within the cell itself.
- Tumor-promoting inflammation: The chronic inflammation microenvironment is associated with cancer formation, growth and transformation as well as apoptosis evasion, survival, invasion, angiogenesis and metastasis.
- Immune system evasion (avoiding immune destruction): Cancers evade immune attack through several mechanisms.
- Tumor microenvironment: At this point, the tumor is primed to use the microenvironment to grow and spread.
- Inducing angiogenesis: Cancer uses normal cells to create a blood supply to bring in nutrients and remove waste.
- Activating tissue invasion and metastasis: Cancer’s most deadly ability arises, spreading to other organs.
Except for the few inherited cancers derived from a genetic defect (germline mutation), most cancers start off as normal cells that eventually acquire alterations (mutations) in their DNA and essentially “learn” or acquire biological abilities that promote their growth, survival and spread.
These Hallmarks of Cancer are accepted by scientists and clinicians as the foundation for understanding the biology of cancer. Furthermore, many of today’s cancer treatments are designed to target one or more of the hallmarks of cancer. For example, agents such as Bevacizumab (Avastin) and Sunitinib (Sutent) inhibit angiogenesis.
The hallmarks are focused specifically on the biology and behavior of cells, but the tumor microenvironment is intertwined with the ability of cancer to acquire and maintain the biological abilities to seed, grow, survive and spread. Under the right conditions, the cancer can hijack the microenvironment for its own use.
Consideration of the microenvironment is so vital that an international task force of 180 scientists participating in the Halifax Project suggested that the tumor microenvironment be added as a Hallmark of Cancer. The Halifax project was concerned that our current model of cancer care is becoming completely out of reach for many people in the world. Specifically, they were honing in on the problems of conventional targeted therapies (such as Keytruda, Avastin, and so on.):
- High costs
- Short relapse-free period
- Dose-limiting and combination-limiting toxicities
In addition, they emphasized that there’s not just one “weed in the forest”, and one drug alone won’t knock out all the weeds. Finally, most tumors have some cells that don’t have the intended target for the targeted drugs; so about 90 percent of remaining cells will still flourish.
From this basis, the primary purpose of the Halifax Project was to “explore the concept of a low-toxicity ‘broad-spectrum’ therapeutic approach that could simultaneously target many key pathways and mechanisms.” Teams looked at each cancer hallmark as well as the tumor microenvironment and nominated 74 high-priority targets in a wide range that could be modified to improve patient outcomes. They then suggested low-toxicity therapeutic approaches (many were phytochemicals) for each target.
The project produced suggestions primarily for research program development, not clinical guidelines. However, the authors of a report on the project note that “lifestyle therapies appear to affect multiple molecular targets and to improve the health of cancer patients in a variety of ways, and integrative lifestyle modifications should be assessed as a health-promoting foundation for use of broad-spectrum therapeutics . . . The positive implications of dietary therapies for improvement of the metabolic hallmarks of inflammation, dysregulated metabolism, genomic instability and immune system evasion should be kept in mind. . . Clinicians choosing to use natural product supplements should attend to product quality and be familiar with advances in the formulation of poorly absorbed polyphenols and other phytochemicals.” In sum, both doctors and patients should consider lifestyle changes, and especially eating well and using quality supplements wisely, as the foundation of therapy.
Some participants in the Halifax project suggest that if patients wish to use the broad spectrum approach outlined by the project, they consider working with clinicians doing leading-edge work (some of whom participated in the Halifax Project, such as Keith Block).
Sources of information on such clinical approaches:
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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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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.
Oxidation is a good example of how eating habits and terrain are related. Oxidation creates free radicals that disable tumor-suppressor genes and/or activate tumor promoting genes (oncogenes). Oxidative stress can raise the malignant capabilities of a tumor.
Some foods are a source of oxidation, including too much fat, and especially saturated fats. Eating saturated fat, monounsaturated fat and animal fat is modestly associated with breast cancer risk and mortality, and a small study found that women with breast cancer who ate higher levels of dietary fat had more damaged DNA in their tumors compared to women on a low-fat regimen.
Favor eating foods high in antioxidants:
- Colorful fruits and vegetables
- Barley, millet and oats
- Wild-caught salmon
- Legumes, especially soy, pinto, black, broad, kidney and small red beans
- Nuts and nut oils as well as extra virgin olive oil
- Tea
- Spices: oregano, dill, garlic, ginger, rosemary, cloves, sage, cumin, paprika
Alcohol consumption, another source of oxidative stress, is also associated with a higher risk of breast cancer.
The ketogenic diet is being studied as a possible means to affect cancer’s ability to co-opt the TME to support its altered energy metabolism. See our Ketogenic Diet summary.
For more information about eating well to support a healthy biochemical terrain, see our Eating Well summary.
Moving More

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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.
Dr. Keith Block warns not to overdo exercise or abruptly change your exercise patterns, as this can actually depress the immune system. He advises to build up gradually to a healthy fitness level, be consistent and include yoga or qigong.
For more information, see our Moving More summary.
Managing Stress
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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.
For more information see our Managing Stress summary.
Sleeping Well
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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.
All of these factors can become a self-reinforcing spiral. Chronic inflammation, for example, is linked to sleep disturbance. Cancer treatment itself causes a marked increase in inflammation which can impair sleep (and also result in depression, fatigue and cognitive dysfunction). Impaired sleep can then increase inflammation.
Conversely, evidence shows that people with cancer who get adequate sleep respond better to cancer treatment, function better, have fewer disease symptoms and live longer than people with cancer who have chronic sleep disruption.
For more information, see our Sleeping Well summary.
Creating a Healing Environment
Highlighted Videos
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.
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BCCT advisorBrian Bouch, MD, explains how to boost immunity before starting conventional cancer treatments.
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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:
- Nature immersion, such as forest bathing, increases human natural killer (NK) activity, the number of NK cells, and the intracellular levels of anticancer proteins.
- 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 tobacco and wood smoke.
- Blood circulation, particularly coagulation (clotting) abnormalities, is influenced negatively by tobacco smoke, the worst “clotting offender.”
See the BCCT summary on Creating a Healing Environment for specific measures you can take to enhance positive exposures and reduce your exposures to terrain offenders in your environment.
Sharing Love and Support
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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 women with 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 in our Sharing Love and Support summary.
Exploring What Matters Now
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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).
Indeed, every one of BCCT’s integrative oncologist advisors include care of the spirit in their integrative protocols. As Keith Block writes, “Every possible factor influencing the progression of cancer should be explored when you are fighting for your survival. I have seen time after time the difference it [mind-spirit care] makes.” Some evidence indicates pleasant emotions can produce a physiological response to that can impact immune function, hormonal balance and insulin resistance—three of the five key pathways of disease mentioned above. For example, a 2006 study “revealed that an increase in secretory immunoglobulin A and a decrease in salivary cortisol were induced by pleasant emotions."
Accurately and scientifically measuring the biological effects of meaning or purpose on the tumor microenvironment is difficult, but early evidence shows a relationship between mind/spirit and survival. Researchers have postulated that a distinct personality type (sometimes called “type C”) is possibly at greater risk of developing certain cancers. This personality type is marked by being passive and submissive and minimizing or denying a person’s authentic spirit. These adaptive personality characteristics may favor the development or progression of disease. If so, then working to address these adaptive characteristics may contribute to healing.
Small studies involving people with incurable or metastasized cancer have investigated this line of thinking. Two small studies showed significant increases in survival with psychotherapy. The first correlated extended survival among those who scored higher on these scales:
- Ability to act and change
- Willingness to initiate change
- Application to self-help work
- Relationships with others
- Quality of experience
In the second study, longer-term survivors displayed a much higher degree of early involvement in their psychological self-help than did most of their nonsurviving peers. The researchers found these common qualities among the survivors:
- Authenticity, a clear understanding of what was important in one's life
- Autonomy, the perceived freedom to shape life around what was valued
- Acceptance, a perceived change in mental state to enhanced self-esteem, greater tolerance for and emotional closeness to others, and an affective experience described as more peaceful and joyous.
The authors hypothesize “to the extent that the progression of cancer, or other chronic disease, is favored by a distorted psychological adaptation such as type C, healing may be assisted by a reversal of that adaptation—in the case of cancer, toward greater authenticity of thought and action.”
Though mind and spirit will not directly attack cancer, Block asserts that they exert potent indirect influence on the growth and spread of cancer by affecting your internal biochemistry, including molecular factors, and the state of your immune system.
Meanwhile, anyone caring for and paying attention to the whole person with cancer knows that helping people find meaning and joy might very well be the thread that holds all the swatches together.
For more information, see our Exploring What Matters Now summary.
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.
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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. 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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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.”
Written by Laura Pole, RN, MSN, OCNS, and Nancy Hepp, MS; most recent update on November 3, 2020.
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- Liu ZQ, Chu L et al. Prognostic role of C-reactive protein in prostate cancer: a systematic review and meta-analysis. Asian Journal of Andrology. 2014 May-Jun;16(3):467-71; Rocha P, Morgan CJ et al. Prognostic impact of C-reactive protein in metastatic prostate cancer: a systematic review and meta-analysis. Oncology Research and Treatment. 2014;37(12):772-6; Huang J, Baum Y et al. C-reactive protein in urologic cancers. Molecular Aspects of Medicine. 2015 Nov;45:28-36.
- Huang J, Baum Y et al. C-reactive protein in urologic cancers. Molecular Aspects of Medicine. 2015 Nov;45:28-36.
- Huang J, Baum Y et al. C-reactive protein in urologic cancers. Molecular Aspects of Medicine. 2015 Nov;45:28-36.
- Irwin M. Mindful Awareness Practices to Promote Sleep Health: Inflammatory Mechanisms. Keynote Presentation: Society for Integrative Oncology Conference, 2016, Miami, Florida; Irwin MR, Olmstead R et al. Tai chi chih compared with cognitive behavioral therapy for the treatment of insomnia in survivors of breast cancer: a randomized, partially blinded, noninferiority trial. Journal of Clinical Oncology. 2017 Aug 10;35(23):2656-2665; Irwin MR, Olmstead R et al. Tai chi, cellular inflammation, and transcriptome dynamics in breast cancer survivors with insomnia: a randomized controlled trial. Journal of the National Cancer Institute. Monographs. 2014 Nov;2014(50):295-301.
- Sciacca L, Cassarino MF et al. Biological effects of insulin and its analogs on cancer cells with different insulin family receptor expression. Journal of Cellular Physiology. 2014 Nov;229(11):1817-21.
- Djiogue S, Nwabo Kamdje AH et al. Insulin resistance and cancer: the role of insulin and IGFs. Endocrine-Related Cancer. 2013 Jan 7;20(1):R1-R17; Wairagu PM, Phan AN et al. Insulin priming effect on estradiol-induced breast cancer metabolism and growth. Cancer Biology & Therapy. 2015;16(3):484-92; Gallagher EJ , LeRoith D. Minireview: IGF, insulin, and cancer. Endocrinology. 2011 Jul;152(7):2546-51.
- Djiogue S, Nwabo Kamdje AH et al. Insulin resistance and cancer: the role of insulin and IGFs. Endocrine-Related Cancer. 2013 Jan 7;20(1):R1-R17; Gallagher EJ , LeRoith D. Minireview: IGF, insulin, and cancer. Endocrinology. 2011 Jul;152(7):2546-51.
- Djiogue S, Nwabo Kamdje AH et al. Insulin resistance and cancer: the role of insulin and IGFs. Endocrine-Related Cancer. 2013 Jan 7;20(1):R1-R17.
- Djiogue S, Nwabo Kamdje AH et al. Insulin resistance and cancer: the role of insulin and IGFs. Endocrine-Related Cancer. 2013 Jan 7;20(1):R1-R17.
- Djiogue S, Nwabo Kamdje AH et al. Insulin resistance and cancer: the role of insulin and IGFs. Endocrine-Related Cancer. 2013 Jan 7;20(1):R1-R17; Chakraborty C, George Priya Doss C, Bandyopadhyay S. miRNAs in insulin resistance and diabetes-associated pancreatic cancer: the 'minute and miracle' molecule moving as a monitor in the 'genomic galaxy'. Current Drug Targets. 2013 Sep;14(10):1110-7.
- Djiogue S, Nwabo Kamdje AH et al. Insulin resistance and cancer: the role of insulin and IGFs. Endocrine-Related Cancer. 2013 Jan 7;20(1):R1-R17; Gallagher EJ , LeRoith D. Minireview: IGF, insulin, and cancer. Endocrinology. 2011 Jul;152(7):2546-51.
- Block KI. Life Over Cancer: The Block Center Program for Integrative Cancer Treatment. New York: Bantam Dell. 2009. p. 294.
- Hanahan D, Weinberg RA. Hallmarks of cancer: the next generation. Cell. 2011 Mar 4;144(5):646-74.
- Block KI, Gyllenhaal C et al. Designing a broad-spectrum integrative approach for cancer prevention and treatment. Seminars in Cancer Biology. 2015 Dec;35 Suppl:S285.
- Block KI, Gyllenhaal C et al. Designing a broad-spectrum integrative approach for cancer prevention and treatment. Seminars in Cancer Biology. 2015 Dec;35 Suppl:S285.
- Block KI, Gyllenhaal C et al. Designing a broad-spectrum integrative approach for cancer prevention and treatment. Seminars in Cancer Biology. 2015 Dec;35 Suppl:S288.
- Hanahan D, Weinberg RA. Hallmarks of cancer: the next generation. Cell. 2011 Mar 4;144(5):646-74.
- Block KI, Gyllenhaal C et al. Designing a broad-spectrum integrative approach for cancer prevention and treatment. Seminars in Cancer Biology. 2015 Dec;35 Suppl:p.S276-S304.
- Block KI, Gyllenhaal C et al. Designing a broad-spectrum integrative approach for cancer prevention and treatment. Seminars in Cancer Biology. 2015 Dec;35 Suppl:p.S276-S304.
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- Farvid MS, Cho E, Chen WY, Eliassen AH, Willett WC. Premenopausal dietary fat in relation to pre- and post-menopausal breast cancer. Breast Cancer Research and Treatment. 2014 May;145(1):255-65; Mourouti N, Kontogianni MD, Papavagelis C, Panagiotakos DB. Diet and breast cancer: a systematic review. International Journal of Food Sciences and Nutrition. 2015 Feb;66(1):1-42; Makarem N, Chandran U, Bandera EV, Parekh N. Dietary fat in breast cancer survival. Annual Review of Nutrition. 2013;33:319-48.
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- Mourouti N, Kontogianni MD, Papavagelis C, Panagiotakos DB. Diet and breast cancer: a systematic review. International Journal of Food Sciences and Nutrition. 2015 Feb;66(1):1-42.
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View All References
More Information
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
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
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
- Jade Beutler: Exploring the Endocannabinoid System
- World Cancer Research Fund and the American Institute for Cancer Research: Food, Nutrition, Physical Activity and the Prevention of Cancer: a Global Perspective
- Editors: Iris F. F. Benzie and Sissi Wachtel-Galor: Herbal Medicine, 2nd Edition: Biomolecular and Clinical Aspects
- Jeanne Achterberg: Imagery in Healing: Shamanism and Modern Medicine
- American Academy of Anti-Aging Medicine and Metabolic Medical Institute: Integrative Cancer Therapy Fellowship Modules
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