The latter includes phenotypic diversity such as cell surface markers, epigenetic abnormality, growth rate, apoptosis and other hallmarks of cancer that. Several clinical findings can be explained by tumor evolution during progression and metastasis. Multifocal primary prostate cancer exhibits high degree of. However, the significance of tumor heterogeneity on disease course and clinical outcome in bladder cancer is of more recent interest to researchers and clinicians. Jun 23, 2009 the results of our recent studies investigating breast cancer cells with stem cell characteristics and the genetic diversity of cellular populations within tumors imply multiple layers of heterogeneity and a combination of different molecular mechanisms underlying breast tumor heterogeneity. Intratumor heterogeneity may foster the selection of a resistant subclone, sometimes dete. Possible signs and symptoms include a lump, abnormal bleeding, prolonged cough, unexplained weight loss, and a change in bowel movements. Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body. Investigation into intratumoral heterogeneity ith of the epigenome is in a formative stage.
Breast cancer is a heterogeneous group of neoplasms originating from the epithelial cells lining the milk ducts. In any case, cellular heterogeneity existing prior to treatment could lead to resistance, in that intrinsic differences between different tumor cell fractions may influence drug responsiveness and promote selective growth, for example, of cancer. There are two models used to explain the heterogeneity of tumour cells. Such cancer cell diversityrepresented by the red stars, blue circles, and green triangles in this illustrationis called tumor heterogeneity.
The clinical and molecular heterogeneity of various cancer types is well documented. This metabolic flexibility is different from normal cellular metabolic processes and leads to heterogeneity in cancer metabolism within the same cancer type or even within the same tumor. Translational implications of tumor heterogeneity clinical cancer. These are the cancer stem cell model and the clonal evolution model. Cancer results from an accumulation of mutations and epigenetic modifications in somatic cells. Tumoral heterogeneity of breast cancer request pdf. In addition to metastatic deposits, routine serial monitoring of breast cancer heterogeneity during disease progression or in response to treatment in ctcs, dtcs, andor ctdna shows great promise for overcoming sampling bias when only a limited number of biopsies are available from the primary tumor.
Intratumour heterogeneity is likely to have implications for cancer therapeutics and biomarker discovery, particularly in the era of targeted treatment, and evidence for a relationship between intratumoural heterogeneity. In this model, luminal tumors arise from transformation of more committed progenitors and. To get a handle on cancers heterogeneity, some researchers are using computational modeling and simulation. Today, clinical evaluation of tumor heterogeneity is an emergent issue to improve clinical oncology. Colon cancer is the third most common cancer worldwide. In addition to genetics, epigenetic mechanisms are crucial players in tumorigenesis.
Tumor heterogeneity has been one of the most important factors leading to the failure of conventional cancer therapies due to the accumulation of genetically distinct tumor cell subpopulations during the tumor development process. Breast tumor heterogeneity has been noted in histology and clinical outcome for a long time, and these differences have served as the basis for disease classification. Nuclear pleomorphism is another example of intratumour heterogeneity, which is accounted for in breast cancer grading. Intertumor heterogeneity exceeds the boundaries of specific tumors. I could homogenous a sample of the tumor, separate it into 3 parts and test against a panel of drugs. Heterogeneity of liver cancer and personalized therapy. However one frames this concept, most cancer biologists accept that, at any given time in a cancer, there are populations of cells with cancer cell renewal and tumor initiating properties. Find out more about the types of tumor and the outlook for people with each type.
Feb 19, 20 intratumour heterogeneity is likely to have implications for cancer therapeutics and biomarker discovery, particularly in the era of targeted treatment, and evidence for a relationship between intratumoural heterogeneity and clinical outcome is emerging. Cancer cell differentiation heterogeneity and aggressive behavior in solid tumors. As a result of this heterogeneity, the bulk tumour might include. Tumour heterogeneity describes the observation that different tumour cells can show distinct morphological and phenotypic profiles, including cellular morphology, gene expression, metabolism, motility, proliferation, and metastatic potential. Scientists are using improved sequencing technologies. Jul 18, 2017 the advent of rapid and inexpensive sequencing technology allows scientists to decipher heterogeneity within primary tumours, between primary and metastatic sites, and between metastases. May 20, 2014 in recent years it has become clear that cancer cells within a single tumor can display striking morphological, genetic and behavioral variability. Most women with breast cancer will have some type of surgery to remove the tumor. Tumor heterogeneity has been suggested based on clinical and pathological findings. Tumour heterogeneity and resistance to cancer therapies.
Intratumour heterogeneity is likely to have implications for cancer therapeutics and biomarker discovery, particularly in the era of targeted treatment, and evidence for a relationship between. Handwritten copies of his writing were very popular and were distributed to various countries around the world18, 19. These contrast with benign tumors, which do not spread. Intratumour heterogeneity is likely to have implications for cancer therapeutics and. As demonstrated in other tumor types, this diversity may contribute to the development of drug resistance. In the era of precision oncology whereby molecular profiling of tumors is incorporated into clinical care, both intra and intertumoral molecular and genetic heterogeneity have been described. Breast cancer intratumor heterogeneity researchgate. The heterogeneity of cancer metabolism anne le springer. Ecology and evolution of cancer is a timely work outlining ideas that not only represent a substantial and original contribution to the fields of evolution, ecology, and cancer, but also. Cell heterogeneity and phenotypic plasticity in metastasis.
Recent cancer genome studies have led to the identification of scores of cancer genes, in glioblastoma1, ovarian2, colorectal3, lung4, head and neck5, multiple myeloma6, chronic. In this first large genomic heterogeneity study of primary prostate cancer, we observe that different tumor foci within the same patient are genetically distinct, only rarely sharing any somatic gene mutations, including those in cancer driver genes. About frontiers institutional membership books news frontiers. Tumor functional heterogeneity has been recognized for decades, and technological. It is also readily apparent to those clinicians treating cancer that there is marked variation in tumour behaviour between patients with the same tumour type. Cancer cell differentiation heterogeneity and aggressive. Malignant cells can continue to evolve during cancer development and progression, often leading to the generation of genetically and or phenotypically distinct clones within the same tumor. Charting the evolutionary history of individual tumours has revealed drivers of tumour heterogeneity and highlighted its impact on therapeutic outcomes. The models are not mutually exclusive, and it is believed that they both contribute to heterogeneity in varying amounts across different tumour types. Together, these findings suggest that both the cancer stem cell and clonal evolution could contribute to breast cancer heterogeneity, in which, the cancer stem cell is more likely to contribute to lobular cancer heterogeneity, while the clonal evolution is more likely to contribute to ductal cancer heterogeneity. Elusive dream describes some answers of achieving the so far elusive dream of treating cancers like other chronic diseases with therapies that focus using improved drug delivery systems designed to better align with the unique biological and physiological properties of cancer. Image tumor heterogeneity breast cancer information and. Mutational heterogeneity in cancer and the search for new. Promise, potential and practice offers guidance on how to conduct pdx modeling and trials, including how to know when these models are appropriate for use, and how the data should be interpreted through the selection of immunodeficient strains.
The role of tumour heterogeneity and clonal cooperativity in. Intratumoral heterogeneity and clonal evolution in liver. The evolutionary history of lethal metastatic prostate cancer. Such intratumor heterogeneity ith poses significant clinical challenges, including formulation of optimal biopsy strategy, characterization of molecular. Due to the diversity of genetic mutations during tumor. Department of cancer biology, the university of texas md anderson. Together with inherited genetic variations predisposing to the disease, these alterations contribute to the conversion of normal human cells into malignant ones during the multistep process of tumorigenesis. Cancer can spread from its original site by local spread, lymphatic spread to regional lymph nodes or by hematogenous spread via the blood to distant sites, known as metastasis. Glioblastoma is a devastating form of brain cancer. Most colorectal cancer occurrences are sporadic, not related to genetic predisposition or family history. This phenomenon occurs both between tumours and within tumours. Once patients are placed in prognostic categories, this information can contribute to the selection of an optimal approach. Kottapurath kunjumoideen md first published online on august 04, 2005 at 3 written extensively on various topics. Review breast cancer intra tumor heterogeneity luciano g martelotto, charlotte ky ng, salvatore piscuoglio, britta weigelt and jorge s reisfilho abstract in recent years it has become clear.
Nanornp overcomes tumor heterogeneity in cancer treatment. Aug 21, 2019 a tumor is an abnormal mass of tissue that may be benign, premalignant, or cancerous. Cancer or malignant neoplasia is not any single disease but a name for a group of more than 200 related diseases all characterized by uncontrolled cellular proliferation, invasion and metastasis. In this book, we delve into the complexity and diversity of cancer metabolism, and highlight how understanding the heterogeneity of cancer. In addition to metastatic deposits, routine serial monitoring of breast cancer heterogeneity during disease progression or in response to treatment in ctcs, dtcs, and or ctdna shows great promise for overcoming sampling bias when only a limited number of biopsies are available from the primary tumor or metastases. Together, they impact patient treatment and outcomes.
The heterogeneous composition of ctc clusters encompassing parenchymal cancer cells together with immune cells, cancerassociated fibroblasts, tumor stroma, and platelets, seems to reflect the heterogeneity of the primary tumors. The clinical and molecular heterogeneity of various cancer types is well. In a recent study of cll, landau and colleagues used wholeexome sequencing and cna to identify clonal and subclonal driver. At memorial sloan kettering and at other research centers around the world, the push is on to characterize the molecular variations between tumors known as intertumor heterogeneity and offer individualized treatments to more patients. When cancer spreads through the blood, it may spread through the body but is more likely to travel to certain areas depending on the cancer type. This heterogeneity affects how genomicsbased management of prostate cancer can be implemented. Hepatocellular carcinoma hcc arises most frequently in the setting of chronic liver inflammation and fibrosis, and takes a variety of course in individual patients to process to tumor. Cancer is one of the leading causes of morbidity and mortality worldwide, with. Promise, potential and practice offers guidance on how to conduct pdx modeling and trials, including how to know when these models are appropriate. To identify aspects of tumor heterogeneity that may illuminate drivers of tumor invasion, we created a glioblastoma tumor cell atlas with singlecell transcriptomics of cancer. Together with inherited genetic variations predisposing to the disease, these alterations contribute to the conversion of normal human cells into malignant ones during the multistep process of tumorigenesis figure 1. Identifying rule books of cancer evolution might have important implications for.
Burgeoning genetic, epigenetic and phenomenological data support the existence of intra tumor genetic heterogeneity in breast cancers. Depending on the type of breast cancer and how advanced it is, you might need other. Mice with only one allele of the tumor suppressor p53 mutated are not as cancer prone as when both alleles are mutated. Because what kills one kind of cell might pass over another, we need treatments in combination or in sequence, working in different ways, that together may eliminate all of the cancer. Sep 29, 2016 tumor heterogeneity has been suggested based on clinical and pathological findings.
Tumor evolution, heterogeneity, and therapy for our patients with. Integrative cancer cience and fferapeutics integr cancer ci fferap, 2017 doi. The mechanisms behind intratumoral heterogeneity are not yet fully understood, and potential theories include the clonal evolution or cancer. Evidence that highly metastatic clones from tumor cell populations had a higher rate of genetic mutability than nonmetastatic clones from the same tumor provided an early link between metastasis and genetic instability fidler, 2003. However, developments in highthroughput singlecell rna sequencing scrnaseq may now. During the course of disease, cancers generally become more heterogeneous. He has written more than 100 notes on tumors and cancers alone. Pdf developments in genomic techniques have provided insight into the remarkable genetic complexity of malignant tumours. The patterns of tumor evolution inferred from epigenetic ith and genetic ith are remarkably. I worked in a research lab that was trying to do drug sensitivity testing on patients tumors. Recent cancer genome studies have led to the identification of scores of cancer.
Ecology and evolution of cancer is a timely work outlining ideas that not only represent a substantial and original contribution to the fields of evolution, ecology, and cancer, but also goes beyond by connecting the interfaces of these disciplines. Heterogeneity and targeting of pancreatic cancer stem. Breast cancer intratumor heterogeneity breast cancer. With the increased recognition of cellular heterogeneity in pdac and identification of tumor cells with enhanced tumorigenic potential and selfrenewal, questions have emerged. This book was conceived from a simple question as to why cancer. In the era of precision oncology whereby molecular profiling of tumors is.
Tumor heterogeneity and resistance to targeted therapies. Intratumoral heterogeneity is among the greatest challenges in precision cancer therapy. Prostate cancer staging is the process by which physicians categorize the risk of cancer having spread beyond the prostate, or equivalently, the probability of being cured with local therapies such as surgery or radiation. Cancer develops progressively as mutations accumulate.
Liver cancer is an extraordinarily heterogeneous malignant disease among the tumors that have so far been identified. They aim to illuminate how the variety of cell types in a tumor influences cancer progression, and to predict the most effective course of treatment for a given tumor. Heterogeneity can reveal a tumor s life history a tumor s mutational catalog represents a historical record of alterations that have accumulated during its life history. This intra tumor heterogeneity is further enhanced by clonal variation and microenvironmental influences on cancer.
The ability of cancer cells to adapt to pharmacological pressures can be described in terms of tumor evolution, and stems from the intrinsic diversity, or heterogeneity of cancer 2. A study of tumor heterogeneity in a case with breast cancer. Tumor heterogeneity has been recognized in many cancer types for decades. Intratumor heterogeneity from a cancer stem cell perspective. In this book, we delve into the complexity and diversity of cancer metabolism, and highlight how understanding the heterogeneity of cancer metabolism is. The heterogeneity observed within tumors and the myriad of genome. Overview on clinical relevance of intratumor heterogeneity. Biological and therapeutic impact of intratumor heterogeneity in. How intratumor heterogeneity influences cancer treatment and outcome june 2016 american society of clinical oncology educational book 36. A tumor is a heterogeneous population of cells, containing transformed cancer cells, supportive cells and tumor infiltrating cells. Experimental evidence in mice with either the ras or the myc protooncogenes mutated. Patient derived tumor xenograft models 1st edition. Singlecell transcriptomic analysis of tumor heterogeneity.
Inherent to the above concept of cancer cell heterogeneity as it contributes to tumor initiation and progression, is the cancer stem cell hypothesis. Heterogeneity is evident between cancers from different patients inter tumor heterogeneity and within a single tumor intra tumor heterogeneity. Because of their reversibility, epigenetic modifications likely allow dynamic switching from a silent state to growth and invasiveness, respectively, and could thus also contribute to intra tumor heterogeneity or differences between primary tumors and their metastases. We herein report a case of metastatic breast cancer indicated tumor heterogeneity by clinical findings and a genomic analysis. Outer radial glialike cancer stem cells contribute to. Though molecular definition of subgroups of breast cancer patients and their tumors has increased the understanding of primary cancer subtypes, the heterogeneity that affects key cancer pathways and mutations continues to pose a challenge in the development of targeted medicine. Scientists, engineers, and inventors contributions have impacted and in most cases improved society and the human condition. Intratumor heterogeneity predicts metastasis of triple. Intratumoral heterogeneity of the epigenome sciencedirect. As a result of this heterogeneity, the bulk tumour might include a diverse collection of. Two of the most widely evoked concepts to explain the origin of.154 780 731 193 1557 1484 356 1603 804 1189 609 348 394 1285 1291 1246 1612 1405 694 1551 781 802 508 784 1480 178 1319 172 185 667