Measuring Inflammation

The cancer-provoked inflammatory process is so crucial that measuring the production of inflammatory agents by tumors can predict survival time in many cancers (colon, breast, prostate, uterine, stomach, and brain).

At the Glasgow Hospital in Scotland, oncologists have been measuring inflammation markers in the blood of patients with various cancers since the nineties. They have shown that patients with the lowest level of inflammation were twice as likely as the others to live through the next several years. These markers are easy to measure, and to the astonishment of the Glasgow oncologists, they are a better indicator of the chances of survival than the patient’s general state of health at the time of diagnosis. It is as if the body’s chronic underlying state of inflammation were a major determining factor of health. This is true even when the inflammation doesn’t seem serious and gives no detectable signs such as joint pain or cardiovascular disease.

Several studies have been able to show that people who regularly take anti-inflammatory medication (Advil, Nuprofen, ibuprofen, etc.) are less vulnerable to cancer than people who do not. Unfortunately, these drugs have side effects; the risk of stomach ulcers and gastritis is significant. New anti-inflammatory medications, such as Vioxx and Celebrex, initially inspired new hope. They are inhibitors of the calamitous COX-s – the very enzyme tumors produce to speed up their expansion. Several research projects explored these drugs’ protective effects against cancer, with very encouraging results. However, in 2004 the demonstration of increased cardiovascular risks greatly dampened the early enthusiasm, and these drugs are not used clinically against cancer.

The Black Knight of Cancer

Thanks to the ongoing efforts of researchers, the Achilles’ heel of cancer’s mechanism for promoting inflammation is clearly identified today. In the laboratory of Michael Karin, PhD, professor of pharmacology at the University of California at San Diego, researchers working with a major German foundation have demonstrated it in mice. The growth and spread of cancer cells relies to a large extent on a single proinflammatory factor secreted by the tumor cells – a sort of black knight without which tumors become much more fragile. That factor is referred to as nuclear factor-kappa B (or NF-kappa B), and blocking its production makes most cancer cells “mortal” once again. It also prevents them from creating metastases. The key role played by NF-kappa B in cancer is so well identified today that Alberta Baldwin, PhD, a professor at the University of North Carolina, concluded in the journal Science that “almost every cancer preventive is an inhibitor of NF-kappa B”.

As a matter of fact, many natural approaches are capable of blocking the inflammatory action of this key substance. The same article in Science notes, not without irony, that the whole pharmaceutical industry today is looking for drugs inhibiting NF-kappa B, while the molecules known to act against it are already widely available. The article cites only two of these molecules, qualified as low-tech: catechins, found in green tea, and resveratrol, found in red wine. Actually there are a good many of these types of molecules found in food, and some are even more active.

This whole area is particularly interesting to me given my 10-year-long infected/inflamed tooth. The dentist who finally removed my tooth a couple weeks ago told me my gums were purple and very unhealthy. Apparently the dentist who performed my root canal missed a canal, which I am told by someone at Wikipedia is fairly common in upper molars.

I now take both low-dose aspirin and curcumin (turmeric) supplements for their anti-inflammatory properties. I try to drink green tea but I don’t love it, and I do take in my share of red wine.

The Vicious Circle at the Heart of Cancer

In the case of normally healing lesions, the production of inflammatory chemical substances stops when the tissue is restored. In the case of cancer, production of these substances occurs continuously. In turn, surplus inflammatory chemicals in neighboring tissues block a natural process called apoptosis – the suicide of cells. Apoptosis is genetically programmed into every cell to prevent anarchy due to overproduction of tissues. Cells naturally enter into apoptosis in response to signals indicating that enough cells have been created to form healthy tissue. Thus, at the same time that they stimulate their own growth, cancer cells are also protected from death. It is the combination of these factors that causes the tumor to gradually expand.

By adding fuel to the fire of inflammation, tumors create yet another disruption. They “disarm” the immune cells in the vicinity. In simple terms, the overproduction of inflammatory factors throws neighboring white blood cells into disarray. The natural killer cells and other white blood cells are neutralized. They don’t even try to fight the tumor, which prospers and grows in plain sight.

To a large extent, the driving force behind a tumor is the vicious cycle cancer cells succeed in creating. By encouraging immune cells to produce inflammation, the tumor gets the body to make the fuel needed for its own growth and invasion of surrounding tissues. The larger the tumor, the more inflammation it causes and the better it sustains its own growth.

This hypothesis has been amply confirmed by recent research as reviewed in the journal Science. It has been proven that the more successful cancers are in provoking local inflammation, the more aggressive the tumor and the better it is at spreading over long distances, ultimately reaching lymph nodes and creating metastases.

Rudolf Virchow, MD, was a great German physician and founder of modern pathology – the science that studies the relationship between disease and the processes that affect tissues. In 1863 he observed that several patients seemed to have developed cancer at the exact spot where they had received a blow or where a shoe or a tool had rubbed repeatedly. Under the microscope, he noticed the presence of a number of white cells in the cancerous growths. He advanced the hypothesis that cancer was a wound-repairing attempt that had gone wrong. His description seemed too anecdotal, almost too poetic, and was never really taken seriously. Some 130 years later, Harold Dvorak, MD, professor of pathology at Harvard Medical School, returned to this hypothesis. In “Tumors: Wounds That Do Not Heal,” he presented forceful arguments in support of Virchow’s original theory. In the article, he demonstrated the surprising similarity between mechanisms sparked by naturally occurring inflammation and the manufacture of cancerous growths.

Dvorak also noted that more than one cancer in six is directly linked to a chronic inflammatory state. This is true for cervical cancer, which most commonly follows a chronic infection of papillomavirus. It is true too for colon cancer, which is very often found in subjects suffering from a chronic inflammatory disease of the intestine. Cancer of the stomach is linked to infection the bacterium Helicobacter pylori (also a cause of ulcers). Cancer of the liver is related to infection by hepatitis B or C; mesothelioma to inflammation caused by asbestos; lung cancer to bronchial inflammation caused by the many toxic additives in cigarette smoke.

Nearly twenty years after Harold Dvorak’s pioneering article, the National Cancer Institute brought out a report highlighting inflammation research too often ignored by oncologists*. The report describes in great detail the processes by which cancer cells manage to lead the body’s healing mechanisms astray. Just like immune cells gearing up to repair lesions, cancer cells need to produce inflammation to sustain their growth. To this end, they begin an abundant production of the same highly inflammatory substances – cytokines, prostaglandins, and leukotrienes – seen in the natural reparation of wounds. They act as chemical fertilizers promoting cell reproduction – in this case, cancer cell reproduction. Growing tumors use these substances to help themselves develop and to make the barriers surround them more permeable. The very process that enables the immune system to repair lesions and pursue enemies in all the body’s recesses is diverted for the benefit of cancer cells. They exploit it to spread and reproduce. Thanks to the inflammation they create, they infiltrate neighboring tissues, slip into the bloodstream, migrate, and establish remote colonies called metastases.

*my emphasis

My friend Solange was retired this week. Yes, even though I still look at myself in the mirror and say, “this hair is ridiculous”, I am exposing my co-workers to the ridiculousness. Many didn’t even recognize me, but mostly everyone says it looks good. At least the weather is cooperating with some slightly warmer temperatures to protect my tender scalp. Every day is an experiment with the styling, but this is roughly how it turns out.

I had anticipated a couple queries about my motivation for “cutting” it, so I’ve had to, uh, lie a bit. “Just wanted a change”. One dude even asked if I’d coloured it. “This is more my natural colour, actually”. Yeesh.

March 18 is my “cancerversary” (hey, that’s what people call it, for real). I think I’ll ignore it. Remembering the hell of that day is not pleasant, so I see no need to re-live it. There is actually debate about which event marks the anniversary of cancer-ness. That was my diagnosis date, but if I want to start measuring years of being “cancer-free”, I’ll need to use April 22, my surgery date. (I just realized, again, how sick I am of talking about cancer.)

I’ve become a pretty serious juicer. I make and drink my “green lemonade” almost every day before work. I honestly believe this is keeping me strong and healthy, because despite my white blood cells still being on the low side (almost back to normal, apparently) and being exposed to sick people at every turn (Devin’s had TWO colds in the past month), I am not getting sick. Part of that is my absolute refusal to give in to any ailments, but I think my juicing regimen keeps me extra-strong. If you’re wondering, my juice recipe consists of two apples, half a lemon, five stalks of celery, half a cucumber, five leaves of kale or lettuce, and an inch of fresh ginger. It doesn’t look so appetizing (dark green), but it actually tastes pretty good.

If everything goes according to plan, I will be going to Cornwall tomorrow to have my port removed. They postponed it once already, but so far so good on this date. We went there last week to repeat my pre-op interview and bloodwork, so here’s hoping it’s a go. You may recall that the insertion of this port resulted in a punctured lung for me (less than 5% chance, my butt!), so let’s cross our fingers there are no comparable incidents this time. Surely the removal is easier than the original placement.

I figured I should take one last photo of my chest area with the port still there. Excuse the poor quality, both mine and Devin’s cameras have died so this is done with webcam (hint, birthday coming up, ahem…). It’s hard to tell in this shot, but the scar from the lumpectomy is really fading nicely.

That’s probably enough shots of my chest for everyone to last a lifetime. I will cease and desist now. Next time I’m wearing this bikini, I better damn well be on a beach!

Now, come on over to Twitter for the rest of my updates. You know you want to.