The 10 hallmarks of cancer (Figure 4.1)
It is likely that all multicellular organisms are affected, or have the potential to be affected, by cancer. Paleopathologists have demonstrated cancerous lesions in the long bones of dinosaurs long before the advent of Homo sapiens. The Edwin Smith papyrus includes a glyph clearly outlining a cancer of the breast, proving the Ancient Egyptians knew of the existence of cancer in humans.
There have been considerable advances in the knowledge and understanding of cancer since these early records. The formation and growth of cancer is a multistep process, during which sequentially occurring gene mutations result in the formation of a cancerous cell. For cells to be able to initiate carcinogenesis successfully, they need to acquire a set of key cellular characteristics. A number of these key features, collectively referred to as the hallmarks of cancer, are required for cancer cells to survive, proliferate and disseminate successfully, and these are discussed in the next four chapters.
1. Genome instability and mutation
Genomic instability is undoubtedly the most important factor for the development of the cancer cell. Random genetic mutations occur continuously throughout all cells of the body but these changes are rarely associated with significant phenotypic alterations. Occasionally, mutations confer a selective advantage to single cells, allowing overgrowth and dominance of these cells in local tissue environments. Multistep carcinogenesis occurs as a result of successive clonal expansions of premalignant cells, with each expansion being triggered by the acquisition of a random enabling genetic mutation.
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