[Stochastic phenomena and the tumoral process].

In the reductionist perspective, genetic modifications are considered to initiate cancer. Their appearance is a stochastic phenomenon, but there are some biases linked to DNA sequence or exposure to mutagenic agents for instance. Cancer genome sequencing has shown a high inter- and intra-tumoral heterogeneity, sometimes questioning the genetic origin of cancer. Other stochastic processes are also studied in cancer, especially epigenetic modifications. They have a major role in diversifying phenotypes among cancer cells in the progression steps, but might also provide an alternative to genetic theories of cancer initiation. Nevertheless, the reductionist framework remains dominant here. Finally, stochastic cell-to-cell variations in gene expression constitute a third class of stochastic phenomena that can be considered as causal factors in cancer. Highlighting the role of high gene expression variability due to disruption of cellular interactions and communications allows avoiding reductionism by considering the interplay between genetic and tissue levels at every step of the disease. No organization level is privileged in this alternative theory.