Understanding the Path to Cancer Development Cancer is not a single disease but a collection of related diseases, in which some of the body’s cells divide uncontrollably and spread to other parts of the body. During the course of cancer development, abnormal or damaged cells acquire so-called “hallmarks” or characteristics that distinguish cancer cells from normal cells. Some of the hallmarks of cancer cells include their ability to: multiply limitlessly by ignoring signals that tell cells to stop dividing or to die; sustain rapid growth by relying on unique nutrients that are different from those used by normal cells; accumulate multiple changes in their genetic material; leave the tissue of origin and spread to other tissues; evade the immune system responsible for eliminating abnormal or damaged cells; and recruit blood vessels, thus increasing nutrients and oxygen supply to tumors (see Figure 3, p. 25) (62). There are several ways to characterize cancers, and the methodology used depends on the type and purpose of the research and/or reporting (see Sidebar 5, p. 26). In most research and clinical settings, multiple classification methods are used simultaneously to identify and describe the type of cancer that a person has. Cancer Development: Generating Knowledge Much of the current knowledge of how cancer develops comes from basic research. Sometimes called “pure” or “fundamental” science, basic research helps researchers understand living systems and life processes. This knowledge is essential to develop better ways to predict, prevent, detect, diagnose, and treat disease. Knowledge gained from basic research provides the foundation for new advances in clinical care and refines existing practices. Recognizing the critical role of basic research in improving the overall health for all individuals, NIH has spent more than 50 percent of its budget on basic research every year over the past two decades (64). Basic research is a fundamental component of medical research (see Figure 4, p. 27). Scientists working across the spectrum of medical research seek to address biological and/or clinical significance of a new discovery through experiments in a wide range of models that mimic healthy and diseased conditions. IN THIS SECTION, YOU WILL LEARN: ⚫ Cancer is a collection of diseases that are characterized by unchecked cell multiplication. ⚫ Basic research is an essential driver of our understanding of the biology of cancer. ⚫ Both acquired and inherited genetic mutations can contribute to cancer initiation and progression. ⚫ Cancer development is influenced by modifications inside the cell as well as changes in the environment that surrounds a tumor. ⚫ Technological advances are revolutionizing the identification of alterations in DNA, RNA, protein and cells that drive cancer. ⚫ The knowledge gleaned from an integrated approach to understanding cancer development is fueling progress in the field of precision medicine. Research funding from NIH has contributed to the development of 354 out of 356 new drugs approved by the U.S. Food and Drug Administration from 2010 to 2019 (57). AACR Cancer Progress Report 2023 Understanding the Path to Cancer Development 24
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