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For most of the cancers, it cannot be told which event was the initial cause. However, with molecular biology, it is possible to characterize the mutations within a tumor, and to a certain extent predict its behavior. For example, about half of the tumors are deficient in the tumor suppressor gene p53, also known as "the guardian of the genome". This is associated with poor prospects for the patient, since those tumor cells are unlikely to go into apoptosis (programmed cell death) after they are damaged by therapy. There are more mutations that make a tumor more malignant. Telomerase mutations enable a tumor cell to divide indefinitely. Other mutations enable the tumor to grow new blood vessels to feed it, or to detach from the surrounding tissue, spreading to other parts of the body.

Cancers are capable of spreading through the body by two mechanisms: local invasion and distant metastasis. Invasion refers to the direct migration and penetration by cancer cells into neighboring tissues. Metastasis refers to the ability of cancer cells to penetrate into lymphatic and blood vessels, circulate through the bloodstream, and then invade normal tissues elsewhere in the body. Cancer is most deadly when it metastasizes.

In cellular model systems, cells are exposed to carcinogenic influences (chemicals, radiation). In these systems, the first signs of a cell developing into a tumor cell are:

Immortality. The usual number of cell divisions for a mammalian cell is 50-60 (cell senescence), then it ceases to divide. Tumor cells keep dividing forever.
Altered morphology.
Building of cellular clusters (Foci).
Loss of contact inhibition.
Low or no need for growth factors.

Items 2-4 (above) can sometimes be traced to mutations in genes that result in a disruption of cell adhesion. Some cell adhesion proteins are oncogenes.

CancerDirect
Patient consultation service offering treatment advice, online second opinions and oncologist referral for individual disease.
COX-2 Inhibitors: Cancer
Information about these treatment agents which is based on an educational grant from the Pharmacia company.
Ladies Home Journal: Cancer
Links to articles about skin and breast tumors.
Cancer Survivors Project
A community resource for long term survivors. Includes access to the ACOR email discussion group.
Cancer Page
Information and community resources including chat rooms, message boards, physician directory and clinical trials.

American cancer institute