Invasion and metastasis.

Malignant tumours cause sickness and death largely because they invade and metastasize. Such spread is made possible by many cellular properties, including the ability of neoplastic cells to move and to release degradative enzymes. These properties enable tumour cells to break free of the primary tumour, penetrate blood or lymphatic vessels and, after being transported to distant sites, pass out of the vessels to establish new tumours. Not all cells in a tumour, however, are able to metastasize, so the process tends to select for greater malignancy in the secondary tumour. The heterogeneity of tumours probably accounts for the difficulty of providing effective treatment, in that the various subpopulations of cells arising from each tumour vary in their responses to chemotherapeutic agents. We do not yet understand the process sufficiently to treat cancer patients by interfering selectively with the metastatic mechanisms.