Multistep tumorigenesis and the microenvironment.
Early-stage cancers have long been considered to be less aggressive than late-stage cancers because it is assumed that they have accumulated fewer of the mutations that are required for full metastatic potential. For breast cancer, recent gene expression profiling data have challenged this paradigm by identifying early-stage cancers with similar gene expression profiles to fully metastatic cancers. In this review, multistep carcinogenesis is reconsidered in light of these new data. The concept that the tumor stroma plays a key role in determining whether a metastatic tumor cell will remain dormant or become invasive is discussed. Recent studies demonstrating the feasibility of targeting tumor stroma for cancer prevention and treatment are presented.
Department of Medicine, Division of Medical Oncology and Colorado Cancer Center, University of Colorado Health Science Center, Denver, Colorado, USA. pepper.schedin@uchsc.edu
Pepper
P
Schedin
Anthony
A
Elias
D000818:Animals; D001943:Breast Neoplasms / Q000235:genetics* / Q000556:secondary*; D020869:Gene Expression Profiling; D015972:Gene Expression Regulation, Neoplastic / Q000235:genetics; D052138:Genes, Neoplasm / Q000235:genetics; D006801:Humans; D009362:Neoplasm Metastasis / Q000235:genetics