HPLC-ED Links Stress Hormones to Oral Cancer

Cancer patients often show heightened activity in their body's stress-response system. When this system misfires, it can throw off the balance of stress hormones like norepinephrine (NE) and epinephrine (EPI), and this imbalance has been linked to tumors growing more aggressively, as well as worse outcomes both physically and emotionally. Despite this, not much research has looked specifically at how these hormones behave in oral cancer patients or what factors might influence their levels. To fill this gap, researchers studied 168 patients with oral squamous cell carcinoma (OSCC), looking at how their norepinephrine and epinephrine levels related to a range of factors, including demographics, cancer characteristics, lifestyle habits, and psychological well-being. They compared hormone levels in these cancer patients to those in patients with a precancerous condition called oral leukoplakia, as well as healthy individuals. Hormone levels were measured using high-performance liquid chromatography with electrochemical detection (HPLC-ED), and patients' moods and emotional symptoms were assessed using the Brunel Mood Scale (BRUMS). A paper based on this research was published in the journal Psychoneuroendocrinology.

How is Stress Connected to Cancer, and How Do Stress Hormones Relate to Cancer Patients' Mood and Mental Health?

Stress is a complicated process that involves both psychological and environmental factors, triggering a chain of reactions throughout the central and peripheral nervous systems.²Psychological stress can raise levels of stress hormones in the body, and this may play a role in how tumors form, grow, and spread.³Cancer patients deal with stress consistently, whether it's coming to terms with their diagnosis or facing the uncertainty of what treatment and their future might look like.⁴Because cancer patients carry such a heavy stress load, many of them end up dealing with emotional struggles like anxiety, depression, and other mood-related issues.^5,6Mood can have a negative effect on cancer patients' health habits and how well they stick to their treatment.^6,7A study looking at breast cancer patients reported that they experienced noticeably more mood disturbances overall compared to women who didn't have the disease. In addition, blood levels of norepinephrine and epinephrine have been linked to anxiety symptoms in head and neck cancer patients, suggesting that psychological struggles may be connected to how much of these stress hormones the body releases in people with cancer.⁹

How Do Stress Hormone Levels in Oral Cancer Patients Compare to Other Groups, and What Factors Are Linked to These Hormone Levels?

The researchers found that patients with oral squamous cell carcinoma (OSCC) had notably higher levels of the stress hormone norepinephrine in their blood compared to both patients with a precancerous mouth condition called oral leukoplakia and healthy volunteers. OSCC patients also tended to have higher levels of another stress hormone, epinephrine, but once other factors were accounted for, this difference was not statistically meaningful, and it seemed to be tied more to whether patients used tobacco.¹

When the researchers dug deeper, they found that certain moods, specifically feeling "angry" and feeling "alert," were linked to higher norepinephrine levels in OSCC patients. However, no specific factor stood out as being connected to epinephrine levels in these patients.¹

“The results reveal,” write the authors of the paper,¹ “that patients with oral cancer display increased systemic concentrations of stress-related catecholamines, and that higher levels of norepinephrine are associated with the emotional symptoms of anger and alertness.”

Read More on Similar Topics
Using CE-MS and LC-MS to Profile Mouth-Rinse Metabolites for Rapid Workplace Stress Assessment

References

1. Bastos, D. B.; Sarafim-Costa, B. A. M.; Santos-Sousa, A. L. et al. Higher Plasma Catecholamine Concentrations in Oral Cancer Patients and Association with Clinical and Psychological Characteristics. Psychoneuroendocrinol. 2026, 191,107947. DOI: 10.1016/j.psyneuen.2026.107947
2. Godoy, L. D.; Rossignoli, M. T.; Delfino-Pereira, P. et al. A Comprehensive Overview on Stress Neurobiology: Basic Concepts and Clinical Implications. Front Behav Neurosci. 2018, 12, 127. DOI: 10.3389/fnbeh.2018.00127
3. Wu, Y.; Zhou, L.; Zhang, X. et al. Psychological Distress and Eustress in Cancer and Cancer Treatment: Advances and Perspectives. Sci Adv. 2022, 8 (47), eabq7982. DOI: 10.1126/sciadv.abq7982
4. Negash, B. T.; Alelign, Y. Stress and Coping Strategies of Cancer Among Adult Cancer Patients in Hawassa University Comprehensive Specialized Hospital Cancer Centre in 2024: Patient, Family and Health Professional Perspective. BMC Cancer 2025, 25 (1), 621. DOI: 10.1186/s12885-025-14023-0
5. Koizumi, K.; Tayama, J.; Ishioka, T. et al. Anxiety, Fatigue, and Attentional Bias Toward Threat in Patients with Hematopoietic Tumors. PLoS One 2018, 13 (2), e0192056. DOI: 10.1371/journal.pone.0192056
6. Walker, Z. J.; Xue, S.; Jones, M. P. et al. Depression, Anxiety, and Other Mental Disorders in Patients With Cancer in Low- and Lower-Middle-Income Countries: A Systematic Review and Meta-Analysis. JCO Glob Oncol. 2021, 1233-1250. DOI: 10.1200/GO.21.00056
7. Acquaye, A. A.; Lin, L.; Vera-Bolanos, E. et al. Hope and Mood Changes Throughout the Primary Brain Tumor Illness Trajectory. Neuro Oncol. 2016, 18 (1), 119-125. DOI: 10.1093/neuonc/nov101
8. Carlson, L. E.; Campbell, T. S.; Garland, S. N. et al. Grossman P. Associations Among Salivary Cortisol, Melatonin, Catecholamines, Sleep Quality and Stress in Women with Breast Cancer and Healthy Controls. J Behav Med. 2007, 30 (1), 45-58. DOI: 10.1007/s10865-006-9082-3
9. Bastos, D. B.; Sarafim-Silva, B. A. M.; Sundefeld, M. L. M. M. et al. Circulating Catecholamines Are Associated with Biobehavioral Factors and Anxiety Symptoms in Head and Neck Cancer Patients. PLoS One 2018, 13 (8), e0202515. DOI: 10.1371/journal.pone.0202515