How Cancer Occurs

Many research studies have shown that stressful life events, from the death of a loved one to the loss of a job, are linked to an increase in certain health problems, particularly heart disease, diabetes, and hypertension. Some people assume that similar stressful events must lead to cancer as well. Since evidence for this is unclear at best, it is important to bear in mind that you are not to blame for the onset of cancer or the course of the illness itself! In order to clarify this misperception, we must understand how cancer starts.

Most oncologists and physicians ascribe to the Surveillance Theory—a widely accepted idea that for cancer to occur, 2 events must take place simultaneously: (1) A cancer cell must appear, and (2) the body’s immune system must be too weak to destroy it. These events raise the following 2 questions. First, what causes a cancer cell to appear, and second, what factors determine how strong the immune system is? To answer those questions, we must first look at the 3 elements that affect both the production of cells and the strength of the immune system. They are (1) genetics—the body we inherit, (2) environment—the world in which we live, and (3) behavior—the ways we react to life events.

Genetics are the physical characteristics we have inherited. They determine the strength of our immune systems and the number of cancer cells we produce. We have no control over this aspect of our lives.

Environment includes the air we breathe, the food we eat, the liquids we drink, the cigarettes we might smoke and, generally, the physical circumstances in which we live. We have limited control over this aspect of our lives even if we are careful. Researchers have established that an environment high in substances such as cigarette smoke, asbestos, or certain foods, all of which are called “carcinogens,” can cause a substantial increase in the number of cancer cells produced. While environmental factors can play a significant part in the onset of an illness, there is no evidence that the environment has any effect on the strength of the immune system itself.

Behavior encompasses the way we live our lives and react to life events. Behavior and emotions can affect the strength of our immune system. Since the strength of our immune system may affect the course of the illness and behavior may affect the strength of our immune system and since we have some control over our behavior, it follows that we may have some control over the course of the illness.

The remainder of this section focuses on the relationship between behavior, stress, and immune function.

Behavior, Stress, & Immune Function

What is known about the relationship between behavior and stress and the immune system is that when we are confronted with a stressful situation, we mobilize our brain and body to deal with it. To understand the impact of behavior—our reaction to a stressful event—on immune function, we must first understand what is known as the fight-or-flight-or-frozen response.

Fight-or-Flight-or-Frozen Response

A caveman is walking down a trail when he senses that there is a tiger in the bush. He now has 3 choices—he can continue and fight the tiger, he can run away, or he can remain frozen in hopes that the tiger will ignore him. In order to assure the survival of the species, evolution has provided certain automatic physical responses—the production of brain chemicals—which makes the endangered person able to fight more fiercely, run away quickly, or remain still—the fight-or-flight-or-frozen response. You may have noticed this reaction to a frightening experience—an increased heart rate, breathing, and alertness you don’t usually have. Humans share the fight-or-flight-or-frozen response with every mammal on earth.

This fight-or-flight-or-frozen response creates a problem for modern man for 3 reasons:

1. The chemicals produced by the brain in response to fear deregulate the immune system.
2. The fight-or-flight-or-frozen response is not only evoked by fear of physical injury, it is also triggered by unpleasant emotions such as sadness, hurt feelings, or anxiety—especially if they last a long time.
3. The fight-or-flight-or-frozen reaction evoked by an emotional response to a life event can last for a very long time.

What could be important to you as a cancer patient is, as Harold Benjamin, PhD, founder of The Wellness Community, has summarized:

“If a cancer cell exists as a normal part of our physiological makeup and you are reacting to life events in ways that trigger the immune-depressing ‘fight-or-flight-or-frozen response,’ your immune system may not be as strong as it would be if your emotional responses to life events were such that the brain was not reacting as if there was a ‘tiger in the bush.’ Stress management during cancer treatment involves utilizing ways to avoid or control the ‘fight-or-flight-or-frozen’ response with the goal of strengthening your immune system.”

Of course, the inherited immune system can be so strong that no matter how many cancer cells we produce or what our environment or behavior is, we will not develop cancer. Our immune system could also be so weak that we may develop cancer even if we practice healthy behaviors and produce very few cancer cells. This is the pivotal mystery that scientists are working to unlock. So, as we emphasized at the very beginning, you are not to blame for getting cancer.

Psychoneuroimmunology (PNI)

Nevertheless, even after lung cancer has been diagnosed, the immune system can become stronger and better able to fight the cancer. The possibility that psychologic and social methods may accomplish the desired result is given credence by the research in psychoneuroimmunology. This new field explores the relationship between the brain, the hormonal or endocrine system, and the immune system—in essence, the mind-body connection. Findings from early research in PNI suggest that pleasant emotions enhance the immune system and long-term, unremitting unpleasant emotions deregulate the immune system. These findings also suggest that the more intense the emotion and the longer it lasts, the greater its effect on our immune system.

More recently, research has also indicated that the 3 most significant psychosocial stressors for people with cancer are:

• unwanted aloneness
• loss of control
• loss of hope

It is not that any particular emotion itself is “bad” or “wrong,” but rather, that the unwanted aloneness or loss of control or hopelessness that accompany these emotions may have a negative effect on your immune system.

As we have stated, while there is no clear evidence that behavior has any direct effect on the production of cancer cells, there is research conducted by David Spiegel, MD, with women with metastatic breast cancer and Fawzy Fawzy, MD, with malignant melanoma patients indicating that participating in professionally facilitated support groups not only improves quality of life, but also enhances immune function and increases survival time. There is also a recently published randomized trial that reported no effects, so there is still controversy in this area.

Can Your Efforts Enhance the Possibility of Recovery?

First and foremost, state-of-the-art medical treatment is primary to your recovery from cancer. Second, research has demonstrated that there is a mind-body connection—emotions affect hormones and immune function. You can, by your actions, behaviors and attitudes, improve your quality of life and thereby enhance immune function. Always remember that the link between these mind-body interactions and cancer is far less clear and remains unproved. Of course, even despite our best efforts, our biology may ultimately overcome our psychology. When physical healing may not be possible, the focus can become one of emotional and spiritual recovery for you and your loved ones.

The Patient Active Concept

The cornerstone of The Wellness Community (TWC) model of cancer support is the Patient Active concept. TWC’s Patient Active concept states that, if you participate in your fight for recovery from cancer along with your physician or health care team, you will not only improve your quality of life, but may enhance the possibility of recovery. TWC’s Patient Active concept incorporates the findings from PNI research and psycho-oncology and describes a series of actions, behaviors, and attitudes that people with cancer can utilize to reduce unwanted aloneness, increase control, and diminish hopelessness in order to improve quality of life and possibly enhance survival. (Please see the Being Patient Active for more information about TWC’s Patient Active concept).

The suggestions made in Frankly Speaking About Lung Cancer are intended to be tools to help people with lung cancer maximize pleasant emotions and minimize unpleasant emotions. This is done with the intent of challenging one’s immune system to become strong enough to alter the course of the disease toward health and wellness.

Summary

• The strength of our immune system may affect the course of the illness—the stronger the immune system, the more likely the possibility of recovery.
• Long-term, unremitting stress deregulates our immune system.
• The less intense the stress and the less time it continues, the less the immune system may be deregulated.
• Pleasant emotions may enhance our immune systems.
• The more intense the pleasant emotions and the longer they continue, the more the immune system may be strengthened.
• We have some control over the amplitude and duration of stress.
• We have even more control over how we react to that stressor, including the stress of diagnosis and treatment.
• Therefore, we may ultimately have some control over the course of the illness.

Notice that it is not the stressors themselves that may suppress or deregulate the immune system. It is one’s reaction to those stressors that can affect immune functioning. Stress management techniques can become valuable allies in the treatment of lung cancer as you learn ways to more effectively take charge of your reactions to the difficult challenges that cancer brings to your life.

References

1. Benjamin, PhD, Harold H. The Wellness Community Guide to Fighting for Recovery from Cancer. Putnam Books, 1995, pp. 189-195.
2. Holland, Jimmie, MD. The Human Side of Cancer: Living With Hope, Coping with Uncertainty. Harper Collins, 2000.