Inflammation and Cancer, a New approach to Treatment, Management and Prevention.

February 27, 2016


There is a well established and researched connection between autoimmune disorders, chronic inflammation and the increased risk for development of certain cancers. Inflammatory bowel diseases (crohn's, colitis, diverticular disease, etc.) increase the risk for development of colorectal and  GI related cancers. Psoriasis and chronic inflammatory skin disorders increase one's risk for squamous and basal cell carcinomas in the skin. Autoimmune pancreatitis increases the risk for development of pancreatic cancer. Autoimmune or infectious hepatitis increases the risk for development of the primary liver cancer hepatocellular carcinoma.  Although the mechanisms have not been clearly identified, the correlations are clear.

It's fairly easy to hypothesize a mechanism as it relates to inflammation. Inflammation increases the rate of cell division and turn over, especially in epithelial tissues such as the mucous membranes of the digestive or urinary tracts, or the skin. In these tissues, cells are constantly being produced and sloughed off. When old cells are sloughed off, new cells need to be produced to replace them. These tissues are in a chronic state of "regeneration" because of this process. Inflammation in these tissues increases the rate of new cells being produced to repair the inflammation damaged tissues.

When cells divide and reproduce they need to divide the cellular DNA within the nucleus of the cell. The DNA contains the vital genetic code of the cell. DNA is a double stranded molecule similar to that shown in the diagram below. When DNA divides, one strand of the DNA "unzips" from the other strand, and new DNA fragments come in and "zip" to each strand, thus creating 2 new double stranded molecules. If the tissue containing this cell is inflamed, the cell will divide more quickly. This increased speed of DNA unzipping and zipping is potentially how some of the mutations can occur. Cancer is a mutation in the genetic code found in the DNA of the cell.

 

Imagine your winter jacket hung up on a hanger. You grab the zipper and slowly unzip the jacket to open it. Then you slowly zip it back up. You will likely have no issues with this. But then imagine grabbing the zipper, and rapidly unzipping the jacket and rapidly zipping it back up again. You will likely have issues with the fabric catching in the zipper, or the zipper could miss a link. This is what can happen when your DNA unzips and zips up too quickly. These "kinks" in the jacket can equate to mutations in your DNA. It seems logical to think that if we could slow down and better regulate the DNA replication process we could decrease the chances for mutations happening in the code. If we have an inflamed tissue, and could identify and remove the inflammatory trigger in that tissue, it's easy to see how this could decrease the chances of mutations happening in that tissue.
 

 It's easy to see the potential of anti-inflammatory interventions for cancer prevention, but what role could this concept play in active cancer treatment?

Cancer research is beginning to focus on an area referred to as the tumor micro-environment. Just as it sounds, this is the area immediately surrounding the cancer cells and or tumor mass. They are beginning to understand the critical role this micro-environment plays in the cancer's ability to survive, reproduce and metastasize. Cancer cells are able to manipulate the chemistry and structural complexity of the tissues and fluids around the cancer cell mass. This  ensure adequate delivery of blood flow for nutrients and survival. It helps to facilitate tumor cell migration and metastasis and it helps with resistance to certain chemotherapeutic agents by blocking proper delivery of the agents to the tumor mass.

Anti-inflammatory therapies are being shown to be able to alter this tumor micro-environment in a way favorable to help with treatment. Decreasing inflammation in the tissue referred to as the "stroma" has been shown to be able to improve delivery of certain chemotherapies to the tumor and thus improving potential outcomes of the treatment. Decreasing inflammation in the micro-environment has also been shown to improve functionality of the bodies innate anti-tumor systems by stimulating tumor necrosis factor and natural killer cell activity. Many of the well researched complementary medicines for cancer treatment are thought to function (in part)  through their anti-inflammatory properties in this tumor micro-environment. Curcumin (Turmeric) is  extremely well researched and studied in this regard.

 

 If pharmaceutical and complementary medicines targeting inflammation can support the anti-cancer immune system and potentially improve treatment outcomes, why couldn't a diet targeting inflammation have the same impact?

I met with a patient a couple years ago who had a diagnosis of hepatocellular carcinoma which is a primary liver cancer. Prognosis for these patients is usually very poor. Chemotherapy has proven largely ineffective for this cancer and treatment options are usually limited a chemotherapy known as sorafenib  and or various forms of radiation therapy. Once this cancer has been diagnosed, it's usually quite advanced and the prognosis of survival time is usually in terms of months. This lady had been diagnosed four and a half years prior to her visit in the hospital and she was just then beginning to investigate further treatment options. Up until this visit she had turned down conventional cancer treatments.

When she was first diagnosed, she had met with her local chiropractor who also dabbled in nutritional therapy. This patient did blood testing for food sensitivities and was advised to avoid several foods that otherwise would have been thought of as beneficial for her therapy. Dairy products, egg whites and a couple specific fruits were eliminated from her diet and that was the extent of her treatment for her condition. She presented in our clinic four and a half years later. We can't say that this diet alone is the specific reason for her survival during those years, but we can't say it didn't have a significant impact either.

Very often, cancer patients are told to eat as much as possible to ensure adequate nutrition through their conventional cancer therapy. These therapies are commonly associated with digestive side effects like nausea, diarrhea and lack of appetite. So nutritional counselors usually advise against restricted diets during these treatments. I will agree that there are cases where this approach would be recommended. I also believe there are many cases where certain dietary issues can potentiate the digestive side effects of a treatment which can ultimately lead to stoppage of the treatment or reduced dosages. If a patient has a pre-existing dairy protein issue causing mild IBS and gastritis symptoms, this patient shouldn't be told to consume nutritional support drinks which are concentrated forms of dairy protein. This would likely aggravate her gastritis symptoms.

If someone enters a conventional treatment protocol for cancer, and they have pre-existing digestive issues associated with a food sensitivity, it's logical to assume they will be more likely to have digestive side effects to their treatment. If this person identifies and removes any dietary aggravating factors prior to beginning their treatment, they will be less likely to have treatment limiting digestive side effects and can have a more positive response to their therapy.

Another key component of complementary cancer treatment and support is immune system support. This is the role for many complementary medicines with cancer care and support. Herbal medicines such as curcumin (turmeric), various mushroom extracts (maitake, reishi, shitake) and supplements such as melatonin have all been heavily researched with respect to their role in supporting the bodies innate anti-cancer immune system function. They function in various ways to support anti-cancer activity. They stimulate natural killer cell activity, potentiate tumor necrosis factors, help promote the natural cell death process known as apoptosis in cancer cells, and they also can potentiate the cell mediated (T-cell and B-cell) anti-cancer immune system. A quick search of some of these products and their potential benefits on pubmed.com (The National Institute of Health's public medical journal database) will surprise you.

This all sounds wonderful, but it does come with some drawbacks. Some cancers such as hematological cancers (cancers of the immune system) are obviously not suitable candidates for treatments which potentially stimulate the bodies immune system. Also, if the immune system is weak or deficient in some manner, there may not be enough functionality of the system to stimulate with these products to have any real benefit.

There is another way to "boost" and restore the immune system's targeting against cancer aside from supplemental medicines. We can identify what else the immune system may be fighting and reacting against that isn't cancer, remove those things and allow the immune system to focus on the cancer. If the immune system is chronically attacking a food or environmental antigen, it is being diverted away from it's other roles such as anti-cancer activity. If we identify and remove these other immunological factors, we lessen the "drain" on the immune system and allow it to shunt back to more important roles such as anti-cancer activity.

 

In the hepatocellular cancer case example earlier, if the dietary elimination was of some benefit and played a role in that patients longevity with her condition, it was likely  the  immune system "shunting" that was of benefit.

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When you begin researching complementary and integrated approaches to cancer care and treatment, seriously consider the possible benefits of an anti-inflammatory dietary protocol in conjunction with your treatment.

 

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Dr. Scott Woodworth
Naturopathic Doctor

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