This is such a valuable reframing, because in oncology we often get trapped in binary thinking (either “conventional” or “integrative,” either “cured” or “back to normal,” either “everything is evidence-based” or “it’s all woo). Your post makes space for the more clinically honest truth: cancer care is layers, and the layers have different goals (tumor control, treatment tolerance, symptom burden, recovery physiology, long-term resilience). 
As a physician-scientist, I especially appreciate the discipline you keep coming back to: don’t lose the plot. Standard-of-care remains the backbone, and the “adjunct” conversation is strongest when it’s framed as: What is the intended mechanism? What’s the human data quality? What are the risks/interactions? What will we monitor, and what would make us stop? 
And I love the tone of empowerment without magical thinking: the goal isn’t to turn survivorship into a full-time job, it’s to help patients reclaim agency, including sleep, nutrition, strength, nervous-system recovery, and appropriately rigorous surveillance, so “watchful waiting” doesn’t become “fearful waiting.”
Thank you and thanks to the original poster too. I love the way you communicated your perspective. Threads like this are rare and make me feel hopeful. If I think someone's intentions are good and they are offering something with benefit, I always want to keep comments civil. If the poster considers them I'm grateful. I appreciate any feedback that helps me engage my brain cells. My posts certainly reveal that they are fallable and misfire at times!
Thank you so much for sharing this. Lifestyle intervention can sometimes be undervalued due to the slow longterm benefits rather then the immediate benefits of medical interventions. I really liked how you have gently connected the two using silence.
Even though you backtrack at the end, we haven't been thinking about cancer wrong, we may have been thinking about it too narrowly. Tissue is a collection of cells. Cancer starts with a mutation that can be induced by lots of things. Once we have a mutated cell, whether it survives to become a tumor is dependent on a number of facts including the nature of the mutated cell and the ability of our immune system to detect it. So yes, it can land in tissue that is more or less beneficial to its growth. The same cells don't randomly flip back and forth between being cancerous and noncancerous. Presenting what you say as a refutation of the mutated cell growing into a tumor is odd
Thank you for reading and your comment! You are right, "too narrowly" is actually more precise than "wrong." The Huang et al. paper isn't dismissing the SMT so much as pointing out that its own tools have produced paradoxes it can't resolve i.e. many cancers have no identifiable driver mutations, while many normal tissues harbor oncogenic mutations without ever forming tumors.
On your point that the same cells don't flip between cancerous and non-cancerous: the paper actually describes a direct experimental test of this. When hepatocarcinoma cells are injected in bulk into the liver, a tumor develops. When the same cells, same quantity, are injected into the spleen where they distribute individually and integrate with normal hepatic cells, no tumor forms. The cells are normalized by contact with the surrounding tissue! That's not random flipping. That's the tissue environment actively overriding what those cells "were."
In my mind, I am thinking about it like this: mutations may lower the barrier to a cancer attractor state, but the tissue field determines whether that barrier gets crossed. The tissue isn't just a passive host, it's part of the mechanism. And that's exactly where integrative oncology has something meaningful to contribute.
Thanks for that, now we're aligned. I have no problem that you cited about one environment allowing the introduced cancer cells to grow where another presents an environment that isn't favorable to them. If we can give cancer cells fewer " welcoming homes" that's a good thing. Letting them die via "homelessness" in effect :)
This is such a valuable reframing, because in oncology we often get trapped in binary thinking (either “conventional” or “integrative,” either “cured” or “back to normal,” either “everything is evidence-based” or “it’s all woo). Your post makes space for the more clinically honest truth: cancer care is layers, and the layers have different goals (tumor control, treatment tolerance, symptom burden, recovery physiology, long-term resilience). 
As a physician-scientist, I especially appreciate the discipline you keep coming back to: don’t lose the plot. Standard-of-care remains the backbone, and the “adjunct” conversation is strongest when it’s framed as: What is the intended mechanism? What’s the human data quality? What are the risks/interactions? What will we monitor, and what would make us stop? 
And I love the tone of empowerment without magical thinking: the goal isn’t to turn survivorship into a full-time job, it’s to help patients reclaim agency, including sleep, nutrition, strength, nervous-system recovery, and appropriately rigorous surveillance, so “watchful waiting” doesn’t become “fearful waiting.”
Thank you and thanks to the original poster too. I love the way you communicated your perspective. Threads like this are rare and make me feel hopeful. If I think someone's intentions are good and they are offering something with benefit, I always want to keep comments civil. If the poster considers them I'm grateful. I appreciate any feedback that helps me engage my brain cells. My posts certainly reveal that they are fallable and misfire at times!
It sounds like the tissue around a cancer is like the soil in a garden ... if the environmental doesn't support it's growth, it can't grow.
This is brilliant. Thank you!
Thank you so much for sharing this. Lifestyle intervention can sometimes be undervalued due to the slow longterm benefits rather then the immediate benefits of medical interventions. I really liked how you have gently connected the two using silence.
Even though you backtrack at the end, we haven't been thinking about cancer wrong, we may have been thinking about it too narrowly. Tissue is a collection of cells. Cancer starts with a mutation that can be induced by lots of things. Once we have a mutated cell, whether it survives to become a tumor is dependent on a number of facts including the nature of the mutated cell and the ability of our immune system to detect it. So yes, it can land in tissue that is more or less beneficial to its growth. The same cells don't randomly flip back and forth between being cancerous and noncancerous. Presenting what you say as a refutation of the mutated cell growing into a tumor is odd
Thank you for reading and your comment! You are right, "too narrowly" is actually more precise than "wrong." The Huang et al. paper isn't dismissing the SMT so much as pointing out that its own tools have produced paradoxes it can't resolve i.e. many cancers have no identifiable driver mutations, while many normal tissues harbor oncogenic mutations without ever forming tumors.
On your point that the same cells don't flip between cancerous and non-cancerous: the paper actually describes a direct experimental test of this. When hepatocarcinoma cells are injected in bulk into the liver, a tumor develops. When the same cells, same quantity, are injected into the spleen where they distribute individually and integrate with normal hepatic cells, no tumor forms. The cells are normalized by contact with the surrounding tissue! That's not random flipping. That's the tissue environment actively overriding what those cells "were."
In my mind, I am thinking about it like this: mutations may lower the barrier to a cancer attractor state, but the tissue field determines whether that barrier gets crossed. The tissue isn't just a passive host, it's part of the mechanism. And that's exactly where integrative oncology has something meaningful to contribute.
Thanks for that, now we're aligned. I have no problem that you cited about one environment allowing the introduced cancer cells to grow where another presents an environment that isn't favorable to them. If we can give cancer cells fewer " welcoming homes" that's a good thing. Letting them die via "homelessness" in effect :)
Unrelated— I am in San Diego, your home base, this weekend for a medical conference. Much, much nicer than Seattle in February!