2/25/2011
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Cancer, Massage,
and the Myth of Metastasis
A Webinar with Tracy Walton, MS, LMT
Why Skilled Massage Won’t Spread Cancer
Part 1 of the Massage in Cancer Care Webinar Series
Background
• Author
• Educator
• Researcher
• Massage Therapist
• Specialist in
massage therapy
and cancer care
Tracy Walton
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The History of Massage and Cancer
An absolute contraindication to massage
Cancer Massage
This contraindication persisted for decades.
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What was this
contraindication
based on?
• The belief that massage ↑ circulation
• The belief that ↑ circulation would ↑ cancer
spread (metastasis)
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Important Terms
• Metastasis = cancer spread
• Movement of cancer cells from primary site to
secondary site (another organ or tissue)
• Establishment of lesions at secondary site
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Important Terms
• Certain cancers named by primary site, with
metastasis to the secondary site
– Breast cancer with mets to the bone
(not “bone cancer”)
– e.g., lung cancer with mets to the liver
(not “liver cancer”)
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Important Terms
• When cancer spreads to another organ/tissue
= Distant spread
= Advanced disease
= Metastatic disease
• Regional spread = cancer cells in nearby lymph
nodes, organs, tissues
• Cancer staging is more complex
See www.cancer.gov for more info8
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More about Metastasis
• Often cancer is “clinically silent” until
metastasis has occurred
• Often not diagnosed until after it has spread
• Most common sites of metastasis:
Liver Lungs Bone Brain
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How Does Cancer Spread?
• Focus on solid tumor spread
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How Does Cancer Spread?
• Focus on solid tumor spread
• Many steps in cancer spread
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How Does Cancer Spread?
• Focus on solid tumor spread
• Many steps in cancer spread
• Focus on 3 steps most relevant to massage
Cell shedding Cell floating Cell planting
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Step 1 of Cancer Spread: Cell Shedding
Cells shed
From tumor
into
blood
(hematogenous spread)
or lymphatic vessel
(lymphogenous spread)
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Step 2 of Cancer Spread: Cell “Floating”
Cancer cells
carried
through
lymphatic
system
and
bloodstream
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Step 3 of Cancer Spread: Cell “Planting”
Cancer cells implant in the tissues
Under the right conditions,
cells reproduce/colonize
Then the disease is considered
advanced
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Three Steps of Metastasis
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The Role of Massage?
• Examine each step
of cancer spread
• First, cell shedding
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Cell shedding a function of:
• Character of tumor cells
• The environment around them
Millions of cells shed from solid
tumors…
…only a small fraction of those
are able to spread
Tumor Cell Shedding
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Massage Role in Cell Shedding?
For massage to mechanically speed up shedding,
it would have to satisfy 3 conditions:
1. Sufficient pressure
2. Pressure applied directly at the site
of the primary tumor
3. Primary tumor within reach
of hands or movements
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Massage and Cell Shedding:
The Reality
• Most primary tumors are too deep
to reach with the hands
Examples: pancreas, lung,
brain, liver, ovary
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Massage and Cell Shedding:
The Reality
• Most primary tumors are too deep
to reach with the hands
Examples: pancreas, lung, brain, liver, ovary
• Some are more accessible
Examples: skin, skeletal muscle, bone, colon
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Avoid Disturbing a Tumor
• No pressure over an active tumor site
(if it is directly accessible to the hands)
• Care with joint movements that could disturb an active tumor site
• If the location of tumor is unclear, limit pressure everywhere to the lightest touch (“applying lotion”)
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Questions for the Client
• Is the cancer
active?
• Where is it in your
body?
• Is it isolated to one
area, or more than
one?
• Any bone
involvement?
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Questions for the Client
• Any recent or
scheduled
diagnostic tests?
• Purpose of the
test?
• Findings, if any?
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Can massage speed up
cancer cell “floating” toward the
destination tissue?
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Can Massage Speed Up Cancer
Cell Movement …
…by ↑
Blood and
Lymph
Circulation?
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Two Questions
1. Does massage increase blood or lymph
circulation?
2. If it does increase
blood/lymph flow,
will that promote
cancer spread?
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Does Massage Increase Blood and
Lymph Flow?
• Most of us were taught that it does
• Massage literature states that it does
But…
• Little research supports this claim
• Much research is outdated, small, poorly
designed
• The evidence is not convincing
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Assume massage does ↑ blood
and lymph flow
Could it promote
cancer spread that way?
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Cancer Cell Movement
through Circulation
• Question: Under normal conditions,
how fast does a tumor cell move through
circulation?
• Answer: as fast as the blood or lymph
carries it!
How fast is that?
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How Fast do Blood and Lymph Flow?
1-2 min
1-24 hr
Blood takes
about 1-2 min
to complete a
circuit
Lymph takes
1-24 hr
to travel
from
capillary or
node to
bloodstream
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How Much Faster Can Blood Move
when Massage is Applied?
• Hard to improve on 1-2 minute circuit time
• Even if massage did speed it up, it would just
send blood more quickly in circles
• Metastasis not dependent on blood flow rate
• Metastasis is complete only when cancer cells
leave the circulation, plant, and form new
lesions in new tissues
• The Exercise Argument
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If increased blood circulation did ↑ cancer spread, other circulatory activities would also ↑ risk
Cancer care does not prohibit exercise
Patients typically encouraged to exercise
If exercise is considered safe, then massage should be safe
The Exercise Argument
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How Much Faster Can Lymph Move
when Massage is Applied?
• Normal lymph flow rate (from
capillary/node to duct): 1-24 hrs
• Again, exercise facilitates lymph flow
• Patients typically encouraged to
exercise
If exercise is considered safe, then
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Can Massage Speed Up Cancer Cell “Floating?”
Answer:
If massage
increases
circulation,
it would only
send cells
“around in
circles” more
quickly.
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Cell “Planting” (Implantation)
• Cancer cells move from blood vessels to tissues
• Reproduce/colonize
• A function of tissue affinity between cancer cell and surrounding tissue
• Implantation is not thought to be a mechanical
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Can Massage Speed up Implantation?
•Implantation a function of
tissue affinity
•Mechanical force not
considered a factor in
implantation
•Implantation unlikely to be
affected by massage
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Summary
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Summary
Avoid
disturbing a
tumor site
No direct
pressure;
no joint
movement
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SummaryNo medical concern about cancer spread
through increased circulation
Avoid
disturbing a
tumor site
No direct
pressure;
no joint
movement
Mechanical force not thought to
↑ implantation
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Where Does This Leave Us?
Client with
Cancer Massage
vs.
NOW
then
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“Massage therapy
is not
contraindicated in
cancer patients.
Massaging a tumor is,
but there is a great
deal more to a
person than the
tumor.”
--Bernie Siegel, MD
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“Borrowing the Medical Concern”
in Massage Therapy
• In medicine, there is concern about disturbing
a tumor site
• In massage, we should also be concerned
about disturbing a tumor site, and be careful
not to disturb it
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“Borrowing the Medical Concern”
in Massage Therapy
• In medicine, providers are not concerned
about ↑ cancer spread through ↑ circulation
• In massage, we should not be concerned
about ↑ cancer spread through ↑ circulation
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“Borrowing the Medical Concern”
in Massage Therapy
• There is no concern in medicine that
movement or pressure affects implantation.
• In massage, we should not be concerned
about massage movement or pressure
affecting implantation.
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“Borrowing the Medical Concern”
in Massage Therapy
• If concern did exist in medicine/nursing,
massage would not be at major cancer centers
• Massage use is ↑ in these facilities
• Massage typically provided by MTs with
specialized training/knowledge
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How Do We Respond when Asked,
“Will Massage Spread Cancer?”
• Skilled massage will not spread cancer
• Concern based on an old myth
• The Exercise Argument
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How Do We Respond when Asked,
“Will Massage Spread Cancer?”
• Massage is offered at cancer care centers and
clinics around the world
• Avoid claiming that research shows massage
will not spread cancer.
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Other Safety Precautions
• Massage adapted to
– Active cancer
– Current treatment
– Lingering/long-term effects of treatment
• Society for Oncology Massage
(www.s4om.org)
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The Scope of This Webinar Series
“Massage in Cancer Care”
• Share information
• Introduction to key issues and massage
adjustments
• Appreciation of the complexity of cancer,
treatment, and effects on the body
• Overview of literature resources
• Introduction to other resources—the Society
for Oncology Massage and recognized training
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Essential Resources for Practicing Safely with People
with Cancer and Cancer Histories
Walton, T. Medical
Conditions and Massage
Therapy: A Decision Tree
Approach. Philadelphia:
LWW, 2011. Description and
link at www.tracywalton.com.
Collinge, W. “Touch, Caring
& Cancer: Simple
Instruction for Family and
Friends” View trailers at
www.tracywalton.com;
complete description at
www.partnersinhealing.netLearn more at
www.tracywalton.com
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Essential Resources for Practicing Safely with People with
Cancer and Cancer Histories
“Cancer and Massage,” a regular column at Massage Today.
At www.massagetoday.com
Walton , T. Cancer &
massage therapy:
contraindications and
cancer treatment. Free
download, link at
www.tracywalton.com
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Essential Resources for Practicing Safely with People with
Cancer and Cancer Histories
MacDonald, G. Medicine
Hands: Massage Therapy
for People with Cancer.
Available at
www.medicinehands.com.
MacDonald, G. Massage
for the Hospital Patient and
Medical Frail Client.
Available at
www.medicinehands.com.
Curties, D. Massage
Therapy & Cancer.
Available at
www.curties-overzet.com
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The Society for Oncology Massage
www.s4om.org.
Contact Information
Tracy Walton at www.tracywalton.com
Reach us at [email protected]
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Massage in Cancer Care
1. Cancer, Massage, and the Myth of Metastasis:
Why Skilled Massage Won’t Spread Cancer
2. Cancer, Massage, and Symptom Relief:
What does Research Tell Us about the Benefits of Massage?
3. Cancer, Massage, and Safety Essentials:
How is Oncology Massage Unique?
4. Cancer, Massage, and Unstable Tissues:
Hidden Contraindications
5. Cancer, Massage, and the Vital Organ Principle
More Hidden Contraindications
6. Cancer, Massage, and Detoxification
Does Massage Have a Role, or Not?
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Unraveling the Mystery of Low Back Pain
Unraveling the Mystery of Shoulder Pain
Unraveling the Mystery of Cervical Pain
Unraveling the Mystery of Knee Pain
Other Webinars
Available on Demand
All Webinars Available
at www.benbenjamin.com
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References
• Bacac M, Stamenkovic I. Metastatic cancer cell. Annu Rev Pathol. 2008;3:221-47. Review
• Curties D. Could massage promote cancer metastasis? Journal of Soft Tissue Manipulation April/May 1994:3-6. Reprinted in Massage Therapy Journal Fall 2000;39(3):83-88.
• Curties D. Massage therapy and cancer. Moncton, New Brunswick: Curties-Overzet Publications, Inc. 1999.
• Le Bitoux MA, Stamenkovic I. Tumor-host interactions: the role of inflammation. Histochem Cell Biol. 2008 Dec;130(6):1079-90. Epub 2008 Oct 25. Review.
• Lorusso G, Rüegg C . The tumor microenvironment and its contribution to tumor evolution toward metastasis.
• Histochem Cell Biol. 2008 Dec;130(6):1091-103. Epub 2008 Nov 6
• MacDonald G. How Cancer spreads. Massage Therapy Journal Winter 2001;39(4):74-78.
• MacDonald G. Massage for the hospital patient and medically frail client. Philadelphia: Lippincott Williams & Wilkins 2005.
• MacDonald G. Medicine hands: massage therapy for people with cancer (2nd ed). Forres, Scotland: Findhorn Press 2007.
• Maximilian Bockhorn, Rakesh K Jain, and Lance L Munn. Active versus passive mechanisms in metastasis: do cancer cells crawl into vessels, or are they pushed? Lancet Oncol. 2007 May; 8(5): 444–448. at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2712886/. Accessed Dec 2010.
• Oncobiology ™: Cancer Biology and Cancer Management. Available at: http://www.oncobiology.com/Apoptosis.htm. Accessed Dec 2010.
• Siegel B. Clarifications (letter to the editor). Massage Therapy Journal 1996;35(2):12.
• Walton T. Cancer and massage: contraindications and cancer treatment. Massage Therapy Journal Fall 2006;45(3):119-135.
• Walton T. Cancer and massage: essential contraindications. Massage Therapy Journal Summer 2006;45(2):119-135.
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Photo/Illustration Credits
• Susan Mapel
• Stephen Fischer
• Alexirius
• Elizabeth Armstrong, Informmotion
• Shutterstock
• Bernie Siegel, MD
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