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Stage 2: Circulation In The Blood Or Lymph Channels
As previously discussed, it has been accepted that the rate of survival of metastatic cells in the bloodstream is somewhere under one percent. This extremely high mortality rate is hypothesized to be the result of several hostile factors. These include attack by the host's immune system, incapacity of the sessile (not designed for movement) cancer cells to absorb nutrients while in circulation, and trauma from continuous movement.
The relevant question for massage therapy could be stated as: Could an increase in blood or lymph flow aid the survival of circulating cancerous cells? No specific reference was found in answer to this question, but several pieces of related research and opinion would suggest not. The massive destruction of cancer cells in the blood and lymph indicates that these environments are always highly antagonistic. Given these hostile factors, increased speed or volume of flow would be as likely to jeopardize cell survival as support it.
If an increased risk does exist, massage would not be isolated in creating this type of effect. Were it to be true that stimulation of the circulation encourages metastasis, hot showers, exercise, sexual activity and many other aspects of daily life would confer equivalent risks. Individuals with cancer are almost always encouraged to exercise and remain as active they can; such advice from the medical community would seem to place other values ahead of a risk of promoting metastasis from a general circulation increase. About the role of exercise specifically, Dr. Carl Simonton makes the following statement:
"The overall picture is that people engaged in regular exercise programs tend to develop a healthier psychological profile in general
one often identified with a favorable prognosis for the course of the malignancy."8
Similar claims can likely be made about regular massage therapy. One
study9 makes reference to the following effects of repeated massage treatments for cancer clients: promotion of the relaxation response, decreased muscle tension, nausea, anxiety, and psychological distress, and reduction in feelings of isolation. |
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It also has been argued that promoting better circulatory efficiency, especially in lymph flow, may aid the host immune response, and therefore encourage better eradication of cancerous cells. These arguments are presently based on personal opinion and clinical observation. Current research on manual lymph drainage techniques may offer some answers.
Stage 3: Implantation At A Secondary Site
Here we are addressing the potential for implantation of surviving metastatic cells once they reach the capillary network of a possible secondary site. Although there is also high cancer-cell morbidity at this stage because of host immune cell activity, could the likelihood of their enduring and proliferating in the tissue somehow be increased by massage therapy?
| The possibility that such a risk exists has not been proven or disproven by research. The concern hinges on the fear that massage therapy techniques could mechanically cause more cells to lodge in capillary beds and hence increase the possibility of successful implantation.
Pushing blood in greater volume or at higher pressure toward capillary beds can result in greater arrest of tumor cells. However, it has been repeatedly shown that despite the fact that cancer cells will impact in the first small vessels encountered (as with other emboli), they do not necessarily develop at those
sites.10,11 While there is the possibility of randomized distribution of metastases in a small percentage of cancers, the pattern of metastasis is usually seen to be characteristic for each cancer and is based more on tissue affinities. Some of the reasons for this are believed to
be:12
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The "homing"
ability of some cancers they prefer certain tissue environments;
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Some cancers do not
have the enzymes needed to destroy some tissue matrices and/or
basement membranes;
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Some cancers have an
affinity for endothelium;
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Some organs do not
have the right growth factors for some cancers.
In other words, the end result does not reflect secondary tumor growth in nearest capillary beds, but rather a preference to become established in specific tissues for other reasons. Patterns of metastasis formation are well documented for most cancers, and therefore are easily researched by the massage therapist. A cautious approach to circulatory stimulation at predicted metastasis sites might be appropriate, especially if they are located superficiallyÑan example would be the axillary lymph nodes in breast cancer. This type of precaution has limited value, however, since most metastatic patterns involve the vital organs, and it is virtually impossible to limit the higher rate of blood flow these experience from an increase in the general circulation.
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