Victor was 39 when he was diagnosed with testicular cancer. After arriving at the emergency room in extreme lower-body pain, a CT scan revealed bad, worse, and terrible news. The cause of the severe pain was a kidney stone. The worse news was a dual inguinal and umbilical hernia that required surgical repair. The terrible news was stage 2 testicular cancer with infiltration into the lymph nodes in the lower back.

That diagnosis occurred on a Saturday, and after receiving a brief respite from the pain via the drug fentanyl, Victor refused further analgesic medication so that the doctors could release him from the hospital Sunday. He was released and spent a full day at work Monday before hernia repair and orchiectomy of his right testicle Tuesday. After a morning of surgical preparation, Victor entered the operating room at noon and talked his doctors into releasing him from the hospital as soon as possible. They released him at 2:15, causing him to miss his initial evaluation with an oncologist. Despite passing out in the car, he went back to the office and finished the workday.

What would drive someone to forgo recovery time after a major operation?

At age 11, Victor began working to buy his own clothes. At age 19, he worked first shift as a painter and third shift at a manufacturing job while taking 16 college credit hours. After his mother moved to Las Vegas and his father remarried, Victor was briefly homeless before given residence in the factory where he worked. He woke every morning with a nosebleed from the industrial fumes that he breathed all night long.

Swearing he would never be homeless again, Victor quit college and worked 60-plus hours a week. When his job failed to offer a career path, he took out a second mortgage on his home and opened his own business. Following the success of his initial entrepreneurial efforts, he opened another business the following year. He was in his late 20s.

The terrorist attack of 9/11 saw the abrupt end of a year’s worth of manufacturing contracts. Despite the debt accrued trying to save his businesses, Victor never filed for bankruptcy. Instead, he spent a year going to court every week to negotiate the seven-figure sum he was being sued for by multiple parties. Now working 80-plus hours a week, it took Victor seven years to settle all his debts. He slept only four hours a night and subsisted on fast food. His stress was so extreme that he would often vomit on his way to work each day.

By his late 30s Victor reclaimed his financial stability but faced inner turmoil from a troubled marriage. He pushed through exhaustion, grief, and pain until his condition became so severe that he found himself in the emergency room facing a cancer diagnosis. The eight-hour daily chemotherapy sessions for five days straight forced Victor to stop working.

Can stress contribute to cancer progression? Can stress cause cancer? The field of psycho-oncology has emerged to answer these questions, and the result of decades of research builds a firm case that both statements are true.

These are important questions to answer in oncology research, but the veracity of these inquiries is of immediate importance to a cancer patient wondering if and how stress has contributed to the diagnosis. The intent of this book is to be a guide to you—the patient or caregiver—looking for perspective during a chaotic time.

Before delving into specifics, a foundation must be laid. The cornerstone of that foundation is to define stress. There are many definitions, but for the purpose of studying its connection to cancer, stress can be defined as any stimulus that exerts a biological effect and challenges homeostasis (the state of equilibrium in the body). 

That biological effect can be physiological, such as an increase in heart rate and respiration, or psychological, generating feelings of anxiety or fear. Because the effects of stress reverberate throughout the body, mind, and emotions, it is a disservice to separate these realms of experience.

From the viewpoint of traditional forms of medicine, the body, mind, and emotions interact seamlessly as to be considered different facets of the same entity. If we amalgamate thoughts, feelings, and emotions into one container of perceptual experience, we could call that the “body-mind.” The combined beliefs, attitudes, and habits held in response to stress can be defined as mindset. Thus, a working definition of the input of stress and output of mindset is:

Stress is any stimulus that interacts with the body-mind and exerts an effect. Our response to that stress is framed by mindset.

Notice that stress is not defined as positive or negative in this definition. This is because stress can be divided into two categories, contingent upon whether the effect is beneficial. A biological stimulus that is detrimental is simply termed “stress” (or “distress”), while one that is beneficial is known as “eustress.”

Individualizing the experience, a stimulus that is innocuous to one person may be harmful to another. The distinction between effects of varying degrees can be plotted on a bell curve known as hormesis. Exercise is an example of hormesis in action. A bell curve for exercise places exhaustion from excessive activity on one extreme and being sedentary on the other. The ascending slope is inactivity moving to the peak of optimal benefit; the descending slope trends to overexertion. Each is a stress to the body-mind: Lethargy can give rise to weight gain, hypertension, and depression. Overexertion can cause fatigue and a breakdown in muscle tissue.

In between these two stresses is the eustress of adequate exercise with an appropriate recovery interval. When a weightlifter stresses the musculoskeletal system, mild muscle soreness follows. 

Then the magic happens. 

During the recovery phase, the initial signal of strain becomes an impulse to grow stronger. If sleep and nutrition are optimized, the deliberate stress of exercise placed on the body-mind becomes a eustress. The weightlifter’s physique benefits.

This eustress middle of a bell curve is a moving target, not only between people but within each individual. The curve shifts given the total of stresses one is exposed to, known as allostatic load in stress research. The eustress of exercise for that same weightlifter may be a slow short walk if sleep deprived or recovering from an upper respiratory infection.

Resiliency also changes through the seasons. A jog outside in the summer can be a eustress building endurance for an asthmatic but a stress on breathing during cold winter months.

Some substances or actions are not hormetic. Jumping off a dangerously high bridge or exposure to mercury is never helpful. Such toxic, extreme, or fatal interactions do not provide benefit at any dose.

Diet, sleep, exercise, medicines, heat and cold exposure—all could and should be viewed through the lens of hormesis. By extension, cancer etiology must be broadened to include imbalances in one’s stress-handling capacity. The type and degree of those imbalances are the stresses upending the delicate balance of homeostasis.

We begin our journey into the connection between cancer and stress by examining the history of the science of stress and then reviewing the research literature to answer the most pertinent question: Is stress a significant enough contributor in cancer formation to be considered a carcinogen?

The next part of this book highlights what stresses and emotional states are associated with cancer. Identifying these stresses is the first step in an actionable plan to holistically heal from cancer. The focus then shifts toward the strategies that could compose such a plan, with emphasis on the most important tool a patient has in the cancer journey—mindset.