Does cancer grow fast
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Understanding the Growth Rate of Cancer: Insights from Recent Research
Tumor Dormancy and Rapid Growth Transition
Dormant Tumors and Angiogenesis
Research has shown that certain tumors can remain dormant for extended periods before switching to a fast-growing, angiogenic phenotype. This transition is marked by significant genetic reprogramming and changes in angiogenesis-related pathways. For instance, dormant tumors exhibit down-regulation of angiogenesis inhibitors like thrombospondin and decreased sensitivity to angiostatin, leading to rapid growth once these tumors become angiogenic. This switch is also associated with the regulation of pathways involving endothelial cell-specific molecules and growth factor receptors.
MicroRNAs and Tumor Growth
MicroRNAs (miRs) play a crucial role in the transition from dormancy to rapid growth. A consensus set of 19 miRs has been identified as governing this switch in various tumor types, including breast carcinoma and glioblastoma. Loss of dormancy-associated miRs correlates with the transition to fast growth, and reconstitution of specific miRs can revert fast-growing tumors to a dormant state.
Growth Rates and Metastasis
Rapid Growth and Metastasis
Contrary to the long-held belief that rapidly growing tumors are more likely to metastasize, recent studies suggest that rapid growth and metastasis are outcomes of complex molecular events rather than a direct correlation. Evidence from breast, cervical, and colorectal cancers indicates that rapidly growing tumors are not necessarily more prone to metastasize compared to slower-growing ones. This challenges the traditional view and suggests that treatment strategies should be reconsidered.
Tumor Volume Doubling Time (TVDT)
The growth rates of tumors vary significantly across different types. For example, testicular carcinomas and some pediatric tumors have very short TVDTs, counted in days, while breast, prostate, and colon cancers often have much longer TVDTs, spanning months or years. Despite these differences, most tumors start from a single cell and grow at constant rates for long periods, often metastasizing before the primary tumor is detected.
Clinical Implications of Fast-Growing Tumors
Prognosis and Treatment
The growth rate of primary tumors, such as breast cancer, has significant prognostic implications. Fast-growing tumors with extensive lymph node involvement (N+ > 3) have a worse prognosis compared to slow-growing tumors. This highlights the importance of considering growth rates in clinical decision-making and treatment planning.
Non-Small Cell Lung Cancer (NSCLC)
In NSCLC, fast progression (FP) has been observed in a subset of patients treated with both atezolizumab and docetaxel. FP is characterized by a significant increase in tumor size within a short period or early death due to disease progression. Factors such as poor performance status and multiple metastatic sites are associated with higher FP rates.
Molecular Characteristics of Fast-Growing Tumors
Melanomas
Fast-growing melanomas (FGMM) exhibit specific molecular characteristics, including a higher number of deleterious mutations and associations with factors like ulceration and FGFR2 mutations. These tumors have a lower relapse-free survival rate, indicating their aggressive nature.
Colorectal Cancer
A distinct type of fast-growing colorectal cancer has been identified, characterized by a flat appearance and deep invasion into the submucosa even in early stages. This type differs significantly from the traditional adenoma-cancer sequence and requires more rigorous detection methods.
Conclusion
The growth rate of cancer varies widely across different types and stages, influenced by genetic, molecular, and environmental factors. While some tumors can switch from dormancy to rapid growth through angiogenesis and genetic reprogramming, others exhibit fast growth due to specific molecular mutations. Understanding these mechanisms is crucial for developing targeted treatment strategies and improving prognostic assessments.
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