Integrative Oncology: What Conventional Cancer Care Doesn't Address

By Dr. Lena Suhaila

You've read your pathology report. You've researched your diagnosis with the kind of attention most people reserve for a stranger's lawsuit. You learned the staging, the markers, the molecular profile of whatever this is. You showed up to your oncology appointments with questions, and the answers you got were about the tumor.

What you didn't get answers about is everything else.

Why this body. Why now. What was happening in your life in the years before this. What your insulin has been doing. What your gut has been doing. What your nervous system has been carrying. What the inflammation that's been quietly running in the background for a decade has been priming. What the microbiome that no one mapped is going to do to your response to treatment.

Those questions matter. Modern cancer biology says they matter. Your oncology team isn't structured to ask them, but the science has been clear about why they should be asked for years now.

This is what integrative oncology is. Not a parallel system. Not an alternative. A clinical approach that takes the cancer biology mainstream research has already validated and brings it to bear on the actual person sitting in the chair. The biology is published. The translation into care is what's missing.

The Science Has Already Moved

In 2022, Douglas Hanahan published an update to the canonical "Hallmarks of Cancer" framework, the same framework taught in every medical school and used by every cancer researcher in the world (Hanahan, 2022). That update formally added phenotypic plasticity, nonmutational epigenetic reprogramming, polymorphic microbiomes, and senescent cells to the recognized hallmarks and enabling characteristics of cancer.

The 2022 paper isn't on the periphery of cancer research. It's at the center. Cancer Discovery, where it was published, is one of the highest-impact journals in oncology. The framework it updates is the most-cited concept in cancer biology.

What that update means clinically should be reshaping the conversation. If the microbiome is now formally an enabling characteristic of cancer, microbiome assessment and intervention belong in cancer care. If nonmutational epigenetic reprogramming is part of how cancer cells become cancer cells, the lifestyle and metabolic inputs that shape epigenetic expression belong in cancer care. If the tumor microenvironment, with its inflammatory and neuroendocrine signaling, is part of how cancer behaves, addressing systemic inflammation and chronic stress physiology belongs in cancer care.

These aren't soft recommendations. They're the implications of the most current cancer biology. The reason they're not in your oncology visit is structural, not scientific.

The Metabolic Terrain

Cancer cells use fuel differently than normal cells. This has been understood at the level of mainstream cancer research for over a decade. Pavlova and Thompson's review in Cell Metabolism described the emerging hallmarks of cancer metabolism, with cancer cells reprogramming their use of glucose, glutamine, and other substrates in ways that depend on a permissive metabolic environment in the host (Pavlova & Thompson, 2016).

Insulin and IGF-1 are central to that environment. Pollak's review in Nature Reviews Cancerlaid out the relationship clearly. Chronically elevated insulin and IGF-1 signaling activates the very pathways, including PI3K/Akt/mTOR, that cancer cells exploit for proliferation and survival (Pollak, 2012). The PET scan your oncology team uses to find your tumor works because cancer cells take up glucose at dramatically higher rates than surrounding tissue. The imaging modality is built on the fact that tumors eat sugar differently. And yet many patients are still told sugar doesn't matter.

When I work with a patient, I'm asking about fasting insulin, A1C, continuous glucose data, and the metabolic markers that don't appear on a standard oncology workup. Not because the numbers are interesting. Because they describe the metabolic terrain that supports or disrupts the biology your treatment is trying to outsmart. That terrain doesn't reset because you started chemotherapy. It carries on doing what it's been doing, in the background, while everyone's attention is on the tumor.

The Microbiome That Wasn't Mapped

The gut microbiome shapes immune surveillance, drug metabolism, systemic inflammation, and as we're now learning, response to chemotherapy and immunotherapy. Helmink and colleagues' review in Nature Medicine synthesized a decade of research showing that microbial composition influences how patients respond to specific cancer therapies, including checkpoint inhibitors (Helmink et al., 2019). Certain microbiome profiles respond better. Disrupted gut microbiomes, often from years of antibiotics, ultraprocessed food, or untreated dysbiosis, may respond worse.

Has anyone on your oncology team mapped your microbiome? Has anyone asked about the antibiotics you took for two years for chronic sinus infections, the proton pump inhibitor you've been on since 2014, or the bowel patterns you've had for the last decade? These questions are directly relevant to how your body is currently set up to respond to treatment. They aren't in the standard oncology intake.

Chronic Inflammation as Cancer Biology

Greten and Grivennikov's review in Immunity described how inflammation acts as both an enabling characteristic and an active driver of cancer biology, with tumor-promoting inflammation altering cell signaling, supporting angiogenesis, suppressing antitumor immune responses, and creating the kind of microenvironment in which cancer cells thrive (Greten & Grivennikov, 2019).

Where does that chronic inflammation come from? A small portion of it is genetic. Most of it isn't. It comes from gut permeability, ultraprocessed food intake, poor sleep, persistent low-grade infections, environmental toxin exposure, untreated metabolic dysfunction, and chronic psychological stress. None of these are addressed in a chemotherapy infusion suite. All of them are part of the biology you're being treated for.

The Nervous System Is Part of the Tumor Microenvironment

This is the piece I want you to sit with, because it's where the science most clearly outpaces clinical practice.

Cole, Sood, and colleagues published a landmark review in Nature Reviews Cancer describing how sympathetic nervous system activity, specifically the catecholamines released during chronic stress, directly modulate the tumor microenvironment (Cole et al., 2015). Adrenergic signaling has been shown to influence angiogenesis, immune cell trafficking, inflammation, and the behavior of certain tumor cell types. The work has been replicated across ovarian, breast, prostate, pancreatic, and other cancers.

The chronic stress you've been carrying, the unprocessed grief, the trauma your body has been compensating for, the sympathetic activation you live in because your life hasn't allowed you to rest, is biologically interacting with the tumor microenvironment through measurable signaling pathways that affect how tumors grow, vascularize, and evade immune surveillance.

The work I do with patients isn't stress management in the casual sense. It's nervous system regulation, informed by somatic work like polyvagal theory, Internal Family Systems, and Compassionate Inquiry. The parts of a person that have been holding pain for decades, often pain the body has been compensating for in ways that show up as chronic inflammation, dysregulated cortisol, gut dysbiosis, and the sympathetic dominance we now know affects tumor biology, the compensation has a cost. The work, when it's done well, lowers that cost.

What Working With Me Actually Looks Like

A first visit is 75 minutes. I review your pathology, your conventional treatment plan, your labs, your history, and the questions no one else has had time to ask. We discuss what you were carrying in the years before the diagnosis. What had no exit. What you weren't allowed to feel. Where you felt safe, and how often.

Then we look at your terrain. I order the labs your oncology team didn't. The metabolic markers. The inflammation panels. The gut function workup. The nutrient and methylation data. The genomic individualization through tools like the Nutrition Genome report, which lets us see how your specific body methylates, detoxifies, handles oxidative stress, and responds to specific nutrients. Your protocol isn't generic. It's built from your biology.

We work with metabolic biology, the microbiome, inflammation, the nervous system, and the terrain underneath the diagnosis. Not as a replacement for what your oncology team is doing. As the work the oncology team isn't structured to do. The treatment plan from your medical oncologist stays in place. What we're changing is the condition of the body the protocol is acting on, so the protocol works better and so you come out of it more whole than you went in.

This isn't a kit. It isn't a list of supplements you can buy on a website. It's individualized clinical care, grounded in your specific pathology, your specific biology, your specific life, by a clinician who has the training and the time to do this work.

The Difference Between Surviving and Thriving

Most people walk into a cancer diagnosis hoping to survive it. Many do. Modern oncology is extraordinarily good at treating tumors, and the targeted therapies developed in the last fifteen years have meaningfully changed survival in cancers that used to be uniformly fatal.

What conventional oncology doesn't address, and isn't structured to address, is the body from which the tumor came. The terrain that allowed the cancer to take hold. The biology that, if nothing changes about it, will continue producing whatever conditions made the cancer possible in the first place.

Surviving treatment is one outcome. Thriving in your body, before treatment, during it, and especially after, is a different outcome. The work I do is calibrated for the second one.

If You're Ready

If you're navigating an active diagnosis, in treatment, post-treatment, or living with the questions that come after, and you've been sensing there's more to this than what your oncology team is structured to give you, you've been right.

This is the gap I live in. The metabolic work. The microbiome work. The nervous system work. The genomic individualization. The questions no one else has had time to ask. These are the things that make the difference between surviving and thriving.

If you're ready to bring that kind of attention to your own care, I'd welcome the conversation.

References

1. Cole, S. W., Nagaraja, A. S., Lutgendorf, S. K., Green, P. A., & Sood, A. K. (2015). Sympathetic nervous system regulation of the tumour microenvironment. Nature Reviews Cancer, 15(9), 563–572. https://doi.org/10.1038/nrc3978

2. Greten, F. R., & Grivennikov, S. I. (2019). Inflammation and cancer: Triggers, mechanisms, and consequences. Immunity, 51(1), 27–41. https://doi.org/10.1016/j.immuni.2019.06.025

3. Hanahan, D. (2022). Hallmarks of cancer: New dimensions. Cancer Discovery, 12(1), 31–46. https://doi.org/10.1158/2159-8290.CD-21-1059

4. Helmink, B. A., Khan, M. A. W., Hermann, A., Gopalakrishnan, V., & Wargo, J. A. (2019). The microbiome, cancer, and cancer therapy. Nature Medicine, 25(3), 377–388. https://doi.org/10.1038/s41591-019-0377-7

5. Pavlova, N. N., & Thompson, C. B. (2016). The emerging hallmarks of cancer metabolism. Cell Metabolism, 23(1), 27–47. https://doi.org/10.1016/j.cmet.2015.12.006

6. Pollak, M. (2012). The insulin and insulin-like growth factor receptor family in neoplasia: An update. Nature Reviews Cancer, 12(3), 159–169. https://doi.org/10.1038/nrc3215