Cancer Biology and Evolution Program, Department of Integrated Mathematical Oncology, Moffitt Cancer Center, Tampa, Florida.
The Cancer Ecology Center, The Brady Urological Institute, Johns Hopkins School of Medicine, Baltimore, Maryland.
Mol Cancer Res. 2023 Nov 1;21(11):1142-1147. doi: 10.1158/1541-7786.MCR-23-0411.
Most definitions of cancer broadly conform to the current NCI definition: "Cancer is a disease in which some of the body's cells grow uncontrollably and spread to other parts of the body." These definitions tend to describe what cancer "looks like" or "does" but do not describe what cancer "is" or "has become." While reflecting past insights, current definitions have not kept pace with the understanding that the cancer cell is itself transformed and evolving. We propose a revised definition of cancer: Cancer is a disease of uncontrolled proliferation by transformed cells subject to evolution by natural selection. We believe this definition captures the essence of the majority of previous and current definitions. To the simplest definition of cancer as a disease of uncontrolled proliferation of cells, our definition adds in the adjective "transformed" to capture the many tumorigenic processes that cancer cells adopt to metastasize. To the concept of uncontrolled proliferation of transformed cells, our proposed definition then adds "subject to evolution by natural selection." The subject to evolution by natural selection modernizes the definition to include the genetic and epigenetic changes that accumulate within a population of cancer cells that lead to the lethal phenotype. Cancer is a disease of uncontrolled proliferation by transformed cells subject to evolution by natural selection.
大多数癌症的定义都广泛符合美国国立卫生研究院（NCI）目前的定义：“癌症是一种疾病，其中一些身体细胞会失控生长并扩散到身体的其他部位。”这些定义往往描述了癌症“是什么样子”或“做了什么”，但没有描述癌症“是什么”或“已经变成了什么”。虽然反映了过去的见解，但目前的定义并没有跟上认识的步伐，即癌细胞本身已经发生了转化和演变。我们提出了癌症的一个修正定义：癌症是一种由经过自然选择进化的转化细胞引起的不受控制的增殖性疾病。我们相信这个定义抓住了大多数以前和现在的定义的本质。除了癌症最简单的定义，即细胞不受控制的增殖性疾病，我们的定义还增加了形容词“转化”，以捕捉癌细胞为转移而采用的许多肿瘤发生过程。对于转化细胞不受控制的增殖的概念，我们提出的定义然后添加了“受自然选择进化的支配”。通过自然选择进化的支配这一概念使定义现代化，包括在导致致死表型的癌细胞群体中积累的遗传和表观遗传变化。癌症是一种由经过自然选择进化的转化细胞引起的不受控制的增殖性疾病。
