Cancer is the 2nd leading cause of death in America. Learn why what you do matters.

1. Cancer 101
a Primer and Review
Stephan Esser MD
Follow me @ EsserHealth
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2. Tenets of the a Healthy Life
• Clean Food
• Clean Water
• Exercise
• Sleep
• Emotional Poise
• Sunlight
• ( Avoidance of Toxins)

3. Goals
• Review definitions and tenets
• Overview of the Statistics
• Visit the classroom: anatomy, physiology
• Brief review of common cancers
• Propose some models for cause
• Review the influence of Lifestyle
• Discuss opportunities for prevention

4. What this is!
• The beginning…….not the end
• Incomplete…..
• More questions than answers

5. Definition
– Etymology: Middle English, from Latin, literally,
crab; akin to Greek karkinos crab
– a northern zodiacal constellation between Gemini and Leo b (1) :
the fourth sign of the zodiac in astrology
–A malignant tumor of potentially
unlimited growth that expands locally
by invasion and systematically by
metastasis
– Something evil or malignant that spreads destructively

6. “Cancer is a term used for diseases in
which abnormal cells divide
without control and are able to
invade other tissues.”

7. Levels of the Organism
• Atomic: Oxygen
• Molecular: DNA
• Organelle: Nucleus of the cell
• Cellular: Cell
• Tissue: Cells function together
• Organ: multiple Tissues work together
• Organ System: respiratory, circulatory etc.
• Organism: Human Being

9. Cell Cycle
G1: Growth and
function
S: DNA Replication
G2: Preparation
M: Mitosis

10. Cancer Growth

11. Cell Cycle
G1: Growth and
function
S: DNA Replication
G2: Preparation
M: Mitosis

12. Cancer Operatives
• 1: Initiation: Turning on of Cancer and failure
to slow/block abnormal growth
• 2: Proliferation: Acceleration of growth (ie: to
an abnormal level)

14. Cancer Subtypes
• Carcinoma: skin or tissues that line/cover
internal organs
• Sarcoma: begin in bone, cartilage, fat, muscle
blood vessels or other connective tissues
• Leukemia: blood forming tissue. Eg: bone
marrow
• Lymphoma/Myeloma: cells of the immune
system
• Central Nervous System: in the brain and spinal
cord

15. Valuable Terminology
• Staging: evaluates the extent of a
persons cancer
• Grading: how abnormal a tumor looks
under a microscope

16. What we know!
• Cancer is an abnormal state of the cell
• It is often caused by dysfunction in the cell
cycle
• Overgrowth/inappropriate growth at the
cellular level = dysfunction at the
tissue/organ = dysfunction at the organism
level

17. Basic Epidemiology

18. Mortality Statistics

19. Cancer deaths per year

20. Cancer deaths per year

23. Cancer Risk
Total
1:3
Total
1:3
Breast 1:8Breast 1:8
Uterus 1:37Uterus 1:37
Cervix 1:117Cervix 1:117

24. Prostate Cancer Risk
Total 1:6Total 1:6

25. In Review
• Cancer is the 2nd
leading cause of death
• Breast Cancer is 2nd
leading cause of cancer death in
women
• Cancer mortality:
– Breast Cancer ≈ recent slight reduction
– Uterine Cancer < 1930
– Ovarian Cancer ≈ unchanged
– Cervical Cancer < 1930
• Prostate Cancer is the 2nd
leading cause of cancer death
in men
• Cancer risk is quite significant

26. Mini- Med School

27. The Power of Hormones
• Glands and hormonal response
Gland: Prostate, Breast Ducts,
ovarian tissue, endometrium,
Colon etc.
Organ or gland: adrenals, thyroid,
pituitary etc.

28. “Amenable” Cancer Types
• Colon Cancer
• Prostate Cancer
• Breast Cancer
• Cervical Cancer
• Uterine Cancer
• Other ?

29. In Review
• Cancer is more common in hormonally
responsive tissues
• The relationship is a complex, multi-factorial
one

30. Transition

31. What can Ido?

32. Risk Factors
• Non-Modifiable
– Age/Gender/Race/FH/PMH/Previous Exposures
• Modifiable
– Food, Exercise, Stress, Sleep, Toxic Exposures

33. Lifestyle Measures
• Nutrition
– Foods to eat
– Foods to Avoid
• Exercise
• Toxic Exposures
• Sleep
• Stress
• Other

34. Stress
• The results of this retrospective study do not suggest any important associations
between stressful life events and breast cancer risk. Self‐reported stress and risk
of breast cancer Cancer 1996;77:1089-93.
• Findings from this study indicate that job stress is not related to any increase in
breast cancer risk. Job Stress and Breast Cancer Risk: The Nurses’ Health Study
American Journal of Epidemiology2004
• Site-specific analyses indicate that psychosocial factors are associated with a
higher incidence of lung cancer and poorer survival in patients with breast,
lung, head and neck, hepatobiliary, and lymphoid or hematopoietic
cancers. These analyses suggest that stress-related psychosocial factors have an
adverse effect on cancer incidence and survival Do stress-related psychosocial
factors contribute to cancer incidence and survival? ce of publication bias and
results should be interpreted with caution. Nature Reviews 2007
• “Strong evidence for links between chronic stress, depression and social
isolation and cancer progression. By contrast, there is only limited evidence
for the role of these behavioral factors in cancer initiation. Impact of stress on
cancer metastasis Future Medicine 2010
-Impairs Healing Mechanisms/Immune
Function
-Increases cellular inflammation
-Less time/energy for “self” care at cellular
and organism level
-Impairs Healing Mechanisms/Immune
Function
-Increases cellular inflammation
-Less time/energy for “self” care at cellular
and organism level

35. Sleep
• Emerging data in the human and animal literature suggest that circadian regulation may be an
important prerequisite for the maintenance of host defenses against cancer. Thus, stress-related
circadian disruption may have negative implications for cancer prognosis. Psychosocial effects on
cancer progression may be measured, and possibly mediated, by disruption of circadian function.
Circadian disruption in cancer: a neuroendocrine‐immune pathway from stress to disease? Brain,
Behavior and Immunity 2003
• We found no consistent association between self-reported sleep duration or sleep disruption
and any of our prostate cancer outcomes. Impact: We did not find support for a consistent
association between self-reported sleep and risk of advanced or lethal prostate cancer in this
large cohort of men. Sleep duration and disruption and prostate cancer risk: a 23‐year
prospective study Cancer Epidemiology and Research 2015
• Our meta‐analysis demonstrates that circadian disruption is associated with an increased
BrCA risk in women. Circadian disrupting exposures and breast cancer risk: a meta-analysis
International Archives of Occupational and Environmental Health 2015
-Melatonin Production impaired
- Increased inflammation
-Impaired Cellular Function
-Inadequate “restoration”
-Alters function at cellular and
organism level
-Melatonin Production impaired
- Increased inflammation
-Impaired Cellular Function
-Inadequate “restoration”
-Alters function at cellular and
organism level

36. Body Habitus
• Our study confirms previously reported findings that generalized obesity is an
important risk factor for postmenopausal breast cancer, but only among women
who have never taken HRT. Lifetime weight gain is also a strong predictor of
breast cancer. Obesity, body size, and risk of postmenopausal breast cancer: the
Women's Health Initiative (United States) Cancer Cause and Control 2002
• Women with breast cancer, who are obese, have poorer survival than women
with breast cancer, who are not obese. Effect of obesity on survival of women
with breast cancer: systematic review and meta-analysis Breast Cancer Research
and Treatment 2010
• Current adiposity, excess weight at the age of 18, metabolic syndrome, and adult
weight gain are all associated with substantial increased lifetime risk of Uterine
Cancer risk. Lifestyle Interventions to Reduce the Risk of Obesity-Associated
Gynecologic Malignancies: A Focus on Endometrial Cancer FOGM 2017
Hormonal Precursors……..Aromatase………….Estrogen IncreasedHormonal Precursors……..Aromatase………….Estrogen Increased

37. Body Habitus
• Obesity at the time of diagnosis was associated with increased risks of
prostate cancer metastasis and death. The increased risk of prostate
cancer death or metastasis associated with obesity largely was
independent of key clinical prognostic factors at diagnosis. Obesity is
associated with increased risks of prostate cancer metastasis and death
after initial cancer diagnosis in middle‐aged men Cancer 2007
IL1, IL6, TNF AlphaIL1, IL6, TNF Alpha

38. Body Habitus
• Colon Cancer: Thus, up to approximately the age of menopause, obesity, including in
adolescence, is a strong risk factor for CRC for both men and women
and, if anything, is stronger in women. The sex divergence occurs for weight gain after menopause, or
approximately after age 50 years. In support of this, a meta‐analysis8 demonstrated that high body weight
gain versus stable weight in adulthood was more strongly related to CRC risk in men than in women
Adolescent body mass index and risk of colon and rectal cancer in a cohort of 1.79 million Israeli men
and women: A population‐based study Cancer 2017
• Pancreatic Cancer: Obesity has been increasingly recognized as a
strong but modifiable risk factor of pancreatic cancer. In this
article, we aim to review the literature regarding weight loss on prevention of pancreatic cancer.
Epidemiological and laboratory studies have shown that obesity is associated with increased incidence
of pancreatic cancer and potentially worse cancer outcome. Obesity and Pancreatic Cancer: Overview of
Epidemiology and Potential Prevention by Weight Loss Pancreas 2018
• Multiple Other Cancer Relationships

39. Body Habitus and Cancer
• Obesity = Low Level Chronic Inflammation
• Fat Tissue increases production of estrogen
which increases risk of Breast/Uterine/Ovarian
Cancer
• Obese individuals increase production of IGF‐1
and Insulin and these promote production of
colon, kidney, prostate and uterine cancer

40. • Toxins

41. Smoking and Cancer
• Lung Cancer
• Oral Cancer
• Others

42. Alcohol and Cancer
• Alcohol consumption and site‐specific cancer
risk: a comprehensive dose–response meta‐
analysis BJC 2015
– Alcohol increases risk of cancer of oral cavity and
pharynx, oesophagus, colorectum, liver, larynx
and female breast. There is accumulating
evidence that alcohol drinking is associated with
some other cancers such as pancreas and prostate
cancer and melanoma.

43. Alcohol and Breast Cancer
• 4% of the breast cancers in developed countries are attributable to alcohol Alcohol, tobacco
and breast cancer – collaborative reanalysis of individual data from 53 epidemiological
studies, including 58515 women with breast cancer and 95067 women without the disease
BJC 2002
• Taking 0 to 5 g/day as reference, alcohol intake of >5 to 15 g/day was related to a 5.9%
increase in breast cancer risk (95% CI: 1–11%). Significant increasing trends were observed
between alcohol intake and ER+/PR+, ER−/PR−, HER2− and ER−/PR−HER2− tumors.
• This prospective study supports previous findings that light to moderate alcohol
consumption increases breast cancer risk, and demonstrates this association in several ethnic
groups besides whites, independent of ER/PR status. Alcohol consumption and breast cancer
risk among women from five ethnic groups with light to moderate intakes: The Multiethnic
Cohort Study IJC 2013
• All levels of evidence showed a risk relationship between alcohol
consumption and the risk of breast cancer, even at low levels of
consumption. Due to this strong relationship, and to the amount of
alcohol consumed globally, the incidence of and mortality from
alcohol‐attributable breast cancer is large. Alcohol Use and Breast Cancer: A
Critical Review Alcoholism Clinical and Experimental Research 2016

44. Medication
• Multiple
• Some not fully delineated

45. • Nutrition

47. Meat and Cancer Risk
• Lancet Oncology 2015/WHO
• 22 Scientists from 10 countries reviewed 800 studies and concluded
• “Consumption of processed meat is “carcinogenic to humans” (Group 1)
• The Working Group classified consumption of red meat as “probably
carcinogenic to humans” (Group 2A)
• Consumption of red meat was also positively associated with pancreatic and
with prostate cancer.
“Meat processing, such as curing and smoking, can result in formation of
carcinogenic chemicals, including N‐nitroso‐compounds (NOC) and
polycyclic aromatic hydrocarbons (PAH). Cooking improves the digestibility
and palatability of meat, but can also produce known or suspected
carcinogens, including heterocyclic aromatic amines (HAA) and PAH. High‐
temperature cooking by pan‐ frying, grilling, or barbecuing generally
produces the highest amounts of these chemicals.”
“Meat processing, such as curing and smoking, can result in formation of
carcinogenic chemicals, including N‐nitroso‐compounds (NOC) and
polycyclic aromatic hydrocarbons (PAH). Cooking improves the digestibility
and palatability of meat, but can also produce known or suspected
carcinogens, including heterocyclic aromatic amines (HAA) and PAH. High‐
temperature cooking by pan‐ frying, grilling, or barbecuing generally
produces the highest amounts of these chemicals.”

48. Dairy and Cancer Risk
• Among men without metastases when diagnosed, higher intake of dairy foods after
prostate cancer diagnosis may be associated with increased prostate cancer‐specific and
all‐cause mortality. Dairy intake after prostate cancer diagnosis in relation to disease‐specific
and total mortality IJC, 2015
• In 26 years, 6810 incident PCa cases were identified from 47299 men. There was no
association between nut consumption and being diagnosed with PCa or PCa‐specific
mortality. However, patients who consumed nuts five or more times per week after
diagnosis had a significant 34% lower rate of overall mortality than those who consumed
nuts less than once per month (HR=0.66, 95% CI: 0.52–0.83, P‐trend=0.0005). Nut
consumption and prostate cancer risk and mortality BJC 2016
Insulin Like Growth Factor One ( IGF‐1 )
Calcium
Insulin Like Growth Factor One ( IGF‐1 )
Calcium

49. Plants and Cancer
• We also observed that a higher intake of yellow/orange vegetables, cruciferous vegetable, fruits and
vegetables rich in vitamin C, fruits and vegetables rich in α‐carotene, fruits and vegetables rich in β‐
carotene, and fruits and vegetables rich in lutein was each associated with a lower breast cancer risk.
Fruit and vegetable intake and risk of breast cancer: Pooled analysis of the Nurses’ Health Study and the
Nurses’ Health Study II, Cancer Research 2017
• Higher fruit intake was associated with a small reduction in prostate cancer risk. EPIC Study 2017
• This meta‐analysis indicated a protective effect of consumption of vegetables and fruits on RCC risk.
Consumption of fruits and vegetables and risk of renal cell carcinoma: a meta‐analysis of observational
studies Oncotarget 2017
• The direct and indirect evidence taken together suggests that vegetarian diets are a useful strategy for
reducing risk of cancer. Reduced cancer risk in vegetarians: an analysis of recent reports Cancer
Management and Research 2011
• Vegan diets showed statistically significant protection for overall cancer incidence (HR=0.84; 95%CI:
0.72, 0.99) in both genders combined and for female‐specific cancers (HR=0.66; 95%CI: 0.47, 0.92).
Lacto‐ovo‐vegetarians appeared to be associated with decreased risk of cancers of the gastrointestinal
system (HR=0.75; 95%CI: 0.60, 0.92). VEGETARIAN DIETS AND THE INCIDENCE OF CANCER IN A LOW‐RISK
POPULATION AACR 2012

50. Prostate CA and Diet
• Dean Ornish et al Journal of Urology 2005
– Men with low‐mod level of biopsy proven PCA
– 1 year on Ornish program or regular
– PSA  4% and  6% in controls
– Serum inhibited Prostate CA cell growth by 70% in
diet group and only by 9% in controls

51. Diet Changes Gene Expression
• Ornish et al PNAS 2008
– 31 men with biopsy proven PrCA
– 3 months of Ornish program
– Repeat biopsy
– 48 up‐regulated and 453 down‐regulated genes
– These genes shown to relate to cancer growth and
development

52. Nutrition
• Increase Fiber
– Accelerate Gut transit
– Improve Gut Health, Alter Gut Flora (toxin production)
– Bind Excess Hormones
• Increase Micronutrients
– Absorb Inflammation
– Alter Oncogenesis
• Increase Spices
• Alter Initiation and block proliferation
• Increase Allium
• As above
“Spices have been widely used as food flavorings and folk medicines for thousands of years.
Numerous studies have documented the antioxidant, anti‐inflammatory and immunomodulatory
effects of spices, which might be related to prevention and treatment of several cancers, including
lung, liver, breast, stomach, colorectum, cervix, and prostate cancers. Several spices are potential
sources for prevention and treatment of cancers, such as Curcuma longa (tumeric), Nigella
sativa (black cumin), Zingiber officinale(ginger), Allium sativum (garlic), Crocus
sativus (saffron), Piper nigrum (black pepper) and Capsicum annum (chili pepper), which contained
several important bioactive compounds, such as curcumin, thymoquinone, piperine and capsaicin.
The main mechanisms of action include inducing apoptosis, inhibiting
proliferation, migration and invasion of tumors, and sensitizing
tumors to radiotherapy and chemotherapy.
Spices for Prevention and Treatment of Cancers
Nutrients 2016
“Spices have been widely used as food flavorings and folk medicines for thousands of years.
Numerous studies have documented the antioxidant, anti‐inflammatory and immunomodulatory
effects of spices, which might be related to prevention and treatment of several cancers, including
lung, liver, breast, stomach, colorectum, cervix, and prostate cancers. Several spices are potential
sources for prevention and treatment of cancers, such as Curcuma longa (tumeric), Nigella
sativa (black cumin), Zingiber officinale(ginger), Allium sativum (garlic), Crocus
sativus (saffron), Piper nigrum (black pepper) and Capsicum annum (chili pepper), which contained
several important bioactive compounds, such as curcumin, thymoquinone, piperine and capsaicin.
The main mechanisms of action include inducing apoptosis, inhibiting
proliferation, migration and invasion of tumors, and sensitizing
tumors to radiotherapy and chemotherapy.
Spices for Prevention and Treatment of Cancers
Nutrients 2016

53. What we know
• Those who consume the highest amounts of
– Vegetables, fruits, beans, lentils etc  risk
• 7th
day Adventists/Less‐Industrialized nations
– Meat, dairy, fiber‐poor foods  risk
• SAD
• Migration studies demonstrate ’d risk
– Asian men develop same risk for PrCA as white
men after 2‐3 generations of migration to the US

56. Benefits of Plant-Based Foods
• ’d blood androgen concentrations
• ’d blood levels of IGF-1, Insulin
• ’d exposure to carcinogens released in the heating of meats
• ’d levels of ant-oxidant substances
• ’d fiber consumption
• Positively altered Gut microbiome to reduce carcinogen production

57. • Exercise

58. Exercise
• A protective effect of physical activity on site-specific cancer risk with a dose-
response association between physical activity and colon and pre- and
postmenopausal breast cancer supported by identified biological mechanisms
has been observed. Physical activity and cancer risk: dose-response and
cancer, all sites and site-specific. Medicine and Science in Sports and Exericse
2001
• There is considerable evidence that physical activity is associated with reduced risk of
colon cancer in both males and females. A meta-analysis of the association of physical
activity with reduced risk of colorectal cancer Colorectal Disease 2005
-Reduce Systemic Inflammation
-Improve Blood Flow to tissues: Oxygen/Nutrition
-Improve Mitochondrial Function/Energy production
- Enhance Immune Function
-Reduce Cellular Senescence
-Reduce Systemic Inflammation
-Improve Blood Flow to tissues: Oxygen/Nutrition
-Improve Mitochondrial Function/Energy production
- Enhance Immune Function
-Reduce Cellular Senescence

59. • Evidence suggests that one-third of the more than
500,000 cancer deaths that occur in the United States
each year can be attributed to diet and physical activity
habits, including overweight and obesity, while another
third is caused by exposure to tobacco products. Although
genetic inheritance influences the risk of cancer, and
cancer arises from genetic mutations in cells, most of the
variation in cancer risk across populations and among
individuals is due to factors that are not inherited. American
Cancer Society Guidelines on Nutrition and Physical Activity for Cancer Prevention:
Reducing the Risk of Cancer With Healthy Food Choices and Physical Activity CA
2009

60. The Big Picture

61. CancerCancer
Sedentary
Lifestyles
Sedentary
Lifestyles
GeneticsGenetics
Aging
Population
Aging
Population
Chronic
Stress
Chronic
Stress
Dietary
Habits
Dietary
Habits
ToxinsToxins

62. CancerCancer
Sedentary
Lifestyles
Sedentary
Lifestyles
GeneticsGenetics
Aging
Population
Aging
Population
Chronic
Stress
Chronic
Stress
Dietary
Habits
Dietary
Habits
ToxinsToxins

63. CancerCancer
Sedentary
Lifestyles
Sedentary
Lifestyles
GeneticsGenetics
Aging
Population
Aging
Population
Chronic
Stress
Chronic
Stress
Dietary
Habits
Dietary
Habits
ToxinsToxins

64. What can we do?
HealthHealth
ExerciseExercise
SleepSleep
Clean
Water
Clean
Water
Emotional
Poise
Emotional
Poise
Clean
Food
Clean
Food
ToxinsToxins

65. Conclusions
• Cancer is a significant cause of death and
disability in America today
• Cancer is directly related to inappropriate cell
division and development

66. Conclusions
• Cancer initiation, proliferation, metastasis and
both recurrence and survival are influenced by
the personal choices we make every day

67. Tips
• Stress: Develop coping strategies, remove toxic people
and toxic situations from your life
• Sleep: Prioritize this period of recovery, 6-9 hrs/night
• Nutrition: Increase richly colored ideally organic fruits
and vegetables, beans, lentils, mushrooms, onions and
spices
• Exercise: Strive for 150 minutes per week of “moderate”
intensity exercise
• Toxins: Reduce or eliminate “toxins” as much as possible
• Obesity: Achieve a BMI of 18-24

68. Cancer Prevention Plan
• 1: Evaluate YOUR Risk
– Family History, Personal History, Toxic Exposures
– Assess your Health: Sleep, Stress, Nutrition,
Exercise
• 2: Select a Team
– Family/Friends
– Doctors, Nutritionists, LAC etc
– Trainer, LMT, Psychologist, etc

69. Cancer Prevention Plan
• 3: Write out a Plan
– Sleep
– Stress Management
– Exercise
– Nutrition
– Sunlight
• 4: Re-evaluate/Modify/Be Flexible

70. You CAN improve your health and alter your
cancer risk!

71. This is such a great thing, it should spread like wildfire. It offers
great hope for people, and a wide variety of conditions
respond well ……………….But it requires discipline. It is not
something to be bought or to be sold as a quick fix. Those
who are not disciplined are accustomed to their addictions,
and it is very difficult for them to get away from that.………..I
tell people to value health and the pleasure of being well.
Cherish the wonderful knowledge and enjoyment that you
gain from living in a healthy way. That is the reward of it all!
Dr. William EsserDC, ND

72. Thank You!
Stephan Esser MD, USPTA
Follow me on Instagram or Facebook
@EsserHealth