cancer cells evolve, Giving them an increasingly competitive advantage
The mutations that lead to cancer do not cripple the mutant cells. On the contrary, they give these cells a competitive advantage over their neighbors. It is this advantage enjoyed by the mutant cells that leads to disaster for the organism as a whole. As an initial population of mutant cells grows, it slowly evolves: new chance mutations occur, some of which are favored by natural selection because they enhance cell proliferation and cell survival. This process of random mutation followed by selection culminates in the genesis of cancer cells that run riot within the population
of cells that form the body, upsetting its regular structure (Figure 20–47).
Non-mutagenic environmental or lifestyle factors such as obesity may favor the development of cancer by altering the selection pressures that operate in tissues. A glut of circulating nutrients, or abnormal increases in hormones, mitogens, or growth factors, for example, may help cells with dangerous mutations survive, grow, and proliferate. Eventually, cells emerge that have all the abnormalities required for full-blown cancer.
To be successful, a cancer cell must acquire a whole range of abnormal properties—a collection of subversive behaviors. A proliferating precursor cell in the epithelial lining of the gut, for example, must undergo changes that permit it to carry on dividing when it would normally stop (see Figure 20–36). That cell and its progeny must also be able to avoid cell death, displace their normal neighbors, and attract a blood supply to nourish continued tumor growth. For the tumor cells to then become invasive, they must be able to detach from the epithelial sheet and digest their way through the basal lamina into the underlying connective tissue. To spread to other organs and form metastases, they must be able to get in, and then out, of blood or lymph vessels and settle, survive, and proliferate in new sites (see Figure 20–45).
Different cancers require different combinations of properties. Nevertheless, we can draw up a general list of characteristics that distinguish cancer cells from normal cells.
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