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A cell that degenerates into a tumor cell does usually not acquire all these properties at once, but its daughter cells are selected to build them. This process is called cellular evolution. A first step in the development of a tumor cell is usually a small change in the DNA, often a point mutation, which leads, among other things, to a genetic instability of the cell. The instability increases to a point where the cell loses whole chromosomes, or has double ones. Also, the DNA methylation pattern of the cell changes, activating and deactivating genes more or less at random. Cells that divide at a high rate, such as stem cells, show a higher risk of becoming tumor cells than those which divide less or not at all, for example neurons. If the initial tumor cell (or group of tumor cells) is not removed by the immune system, it will develop into cancer.

Cancer is, ultimately, a disease of genes. Typically, a series of several mutations is required before a cell becomes a cancer cell. We distinguish between oncogenes, which promote cancer when "switched on" by a mutation, and tumor suppressor genes, which prevent cancer unless "switched off" by a mutation. These mutations can have various causes: radiation or chemicals called carcinogens; some inherited predisposition is not uncommon; some viruses that can cause cancer have also been described. Usually, they carry in their genome some oncogene or tumor suppressor inactivating gene. In about 15% of all cancers, viruses seem to play a role; Bacteria, like Helicobacter pylori, also induce carcinogenesis by a process of chronic inflammation. Finally, damage by free radicals, which are a natural by-product of oxygen metabolism, can cause mutations in the DNA.

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.