Fig 1.

Effects of stress and psychological processes on the tumor microenvironment. The stress response results in activation of the autonomic nervous system and the hypothalamic-pituitary-adrenal axis. Factors released from these pathways can have direct effects on the tumor microenvironment, resulting in a favorable environment for tumor growth and progression. These dynamics can also adversely affect patient quality of life. CRH, corticotropin-releasing hormone; ACTH, adrenocorticotrophic hormone; NK, natural killer; T-regs, regulatory T cells; TAM, tumor-associated macrophages; MMP, matrix metalloprotinease; VEGF, vascular endothelial growth factor; IL, interleukin; STAT3, signal transducer and activator of transcription factor-3; QOL, quality of life.