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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.

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.

Treatment of cancer typically involves surgery to remove tumors and nearby lymph nodes to which the cancer may have spread, combined with radiation therapy and/or chemotherapy. The latter two target cells in the body that are rapidly dividing. This includes the cancer cells but also certain healthy ones, which is the reason for the severe side effects of these treatments.