Sometimes my medical team reminds me of an ensemble of backup singers. On the daily stage of life, I’m the lead and at key moments, they chime in with a subtle chorus. I first heard it two years ago, from Dr. Radiology: “No stress.” Most recently, two weeks ago, from Dr. Lungs: “Absolutely avoid stress.” It sounds straightforward in the fluorescent clarity of their offices, but on the road home, the thought pops up: if this stress thing is important enough to be repeated over time and across the practice, why aren’t they telling me why? I set out to explain it to myself. Here’s what I found out.
What, Really, Is Stress?
A search for general information about stress, chronic or otherwise, brought up the BlahBlahBlah we’ve all heard before. Still, Yale, the Mayo Clinic, and the National Institute of Mental Health (NIMH) had my favorite info pages. To recap:
Stress is when our physical or emotional equilibrium feels– or is– threatened. We feel pressured, overwhelmed. Our body adapts and responds to get us back on an even keel. Specifically, the brain signals adrenal glands to release hormones– cortisol, noradrenaline, and adrenaline– which kick our bodies into defensive action.
Hormones changes immune system responses, e.g., suppresses the digestive system, the reproductive system and growth processes. They also reach the brain regions that control mood, motivation and fear.
Usually, the body’s response to stress is short-lived. But if we’re consistently under stress, our defensive response is always on; those stress hormones don’t shut down. This constant exposure — known as chronic stress– and the body’s ongoing defensive responses is damaging over the long term.
If you can’t control the stressors in your life, how you respond to those stressors is what’s important. (Remember our discussions about affirmations and meditation? [Cue eye roll, followed by self-scolding because that stuff does work.])
Why Are My Doctors So Insistent About Stress?
Basically, stress can activate cancer sleeper cells.
Note: Michela Perego, Ph.D., of the Wistar Institute Cancer Center emphasizes that stress can not does, and that there are actually several things that need to take place for this active growth to begin.
Perego studies how certain immune cells help cancer grow and spread. Could immune cells activate these dormant cancer cells?
She and her team genetically engineered lung cancer cells, or treated lung, ovarian, and breast cancer cells with chemotherapy. Both kinds of cells became dormant. They didn’t “wake up” when they were mixed with B or T immune cells.
But when the dormant cancer cells were mixed with “pro-tumor” neutrophils, the cancer cells started to grow.
I can hear you now. “Neutrophils? Aren’t those the white blood cells that fight infection?” Indeed they are. But tumors can turn neutrophils into bad guys that will help the tumor grow and spread. Get this– when Perego transplanted dormant lung cancer cells into mice who had no immune systems, the cells didn’t grow into tumors. But if the sleeper cells were transplanted with pro-tumor neutrophils, most of the mice developed lung tumors.
I’m sure you’re wondering, well, if there aren’t tumors left in a patient’s body, what would get the neutrophils started off to the dark side? That’s where stress comes into the picture.
Because some studies have linked chronic stress to cancer progression, Perego and her team started looking at the impact of stress on neutrophils. What did they find? Stress hormones set off a chain reaction. They cause neutrophils to give off two proteins, S100A8/A9, which, in turn, made the neutrophils produce certain lipids. These then triggered dormant cancer cells.
“It’s a cascade,” Dr. Perego explained. “One component of this cascade alone doesn’t work. Neutrophils alone, [the proteins] alone, and stress hormones alone don’t work” to wake up dormant cells. It takes the chain of events.
They found that mice who were more stressed had more neutrophils in their lungs and spleens than unstressed mice. Stressed mice also had more of the S100 proteins. Formerly dormant lung cancer cells formed tumors in stressed mice but not in unstressed mice.
The researchers then looked at levels of the trigger S100 proteins in lung cancer patients who had had tumors removed. Patients who had higher levels of S100 proteins or stress hormones in their blood were more likely than other patients to have an earlier recurrence of tumors.
Dr. Perego stresses that their work shows only one mechanism for triggering tumor cells to grow. (Other studies, here and here, report a relationship between stress and breast cancer for example; different mechanisms are at work in these.)
What Do I Make of This?
Researching this topic when CT and MRI scans are not far in the future does not qualify as stress prevention. Contributing to my current pre-scan grimness is sobering news of disease progression in members of my cancer group and in one of my online communities. I’m pulling out all the big coping guns…but I digress.
The more I practice meditation, the more aware I become of the amount of time I can spend in a state of low-level anxiety. I had a mammogram last week; about six days before, I noticed my nerves had ratcheted up from typical daily stresses to a thrumming of electricity.
I have scans coming up next week and the anxiety has slowly spread into a something like a combination of white lightning and the screech of nails across a blackboard. I dove into my go-to defense: research, this time on my way-uncommon EGFR S768i mutation in Exon 20. The good news: there is some research. (Not that much, and not of much consequence right now, but the fact that it’s there is relevant.) With this information under my belt, anxiety should dissipate before the scans (Monday) and the visit with Dr. Oncology (Wednesday).
I’m not alone. Among the patient community, a mention of pre-scan anxiety has a name of its own: scanxiety. Any mention of that is greeted with shudders and an outpouring of compassion.
Is anxiety another form of stress? Sure. But it’s also a reality. After all, lung cancer is just…bad. When I periodically reawaken to that reality, like now, a big part of me looks my docs in the eyes and says, “Avoid stress– you’re joking, right?”
I exercise, meditate, eat the stuff that counteracts free radicals (which is a topic for another day.) I’ve eased some toxic people from my life and anticipate more of that. My new affirmation is I step away from stress. I have big plans for living.
And I have my Screensaver of Excellent Quotes to boost me. Here are two for today:
Thanks for reading. And remember, cake makes everything better– including stress.
