6 May 2018: Preinvasive cancer

I recently published a Letter to the Editor, entitled Focusing on Preinvasive Neoplasia, that may be of interest. Neoplasia is the abnormal growth of tissue due to uncontrolled division by one or more cells. It includes cancer as well as benign tumors. Preinvasive neoplasia means growths that have not yet demonstrated the ability to infiltrate adjacent tissue, a property relatively specific for cancer.

To understand cancer, it is helpful to think about how life arose. According to Kauffman, life is the emergent collective property of a modestly complex mix of biomolecules (DNA, RNA, proteins and others), confined to a closed space, which catalyze each other’s formation (The Origins of Order 1993). Networks of biomolecules with this property are relatively resistant to change from internal or external stressors (The Laws of Complexity 2017). In addition, natural selection has added additional control features that make deviations less likely. As a result, a cell cannot quickly change from normal to malignant. I previously proposed that most cancers are caused, typically over decades, by nine chronic stressors (chronic inflammation, carcinogen exposure, reproductive hormones, Western diet, aging, radiation, immune system dysfunction, germ line changes and random chronic stress / bad luck), acting together and in the appropriate context (How Cancer Arises Based on Complexity Theory 2017).

Cancer arises through stepwise progression. Although intuitively it might seem that the microscopic appearance would be slightly different at each step, this may not be true. For example, glioblastoma and Hodgkin lymphoma have no known intermediate or premalignant states based on microscopic examination. However, the Letter to the Editor suggested that intermediate states may be identified based on analysis of molecular patterns. They are also predicted by complexity theory, which discusses the requirement for stable intermediate states for cancer to develop.