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In tumor types that do not follow the cancer stem cell model, all cell types may accumulate alterations that have the potential to persist in the population, and therefore all tumor cells are included in the model describing tumors of this latter type.
Tumor genomes accumulate alterations during oncogenesis.
A gene highly tolerant to mutations will accumulate alterations in its nucleotide sequence on the course of its history.
Evidence is growing that disseminated cancer cells continue to accumulate alterations outside the primary tumor (Schmidt-Kittler et al, 2003; Weckermann et al, 2009; Klein, 2013) and that the number of genetic alterations in single CTCs is associated with shortened survival (Fischer et al, 2013).
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Hepatocarcinogenesis is considered a slow process in which diverse genomic alterations accumulate, altering the phenotype of hepatocytes and hence leading to multiple monoclonal and dysplastic hepatocyte populations (Thorgeirsson and Grisham, 2002).
Most human sporadic colon cancers develop gradually as accumulating alterations in gene expression transform normal colonic epithelium to adenocarcinoma.
Hence a novel mathematical framework is necessary to investigate the extent of heterogeneity of an asexually evolving population accumulating alterations with large fitness effects over time.
The detrimental effect of accumulating alterations was also confirmed by the logistic model, showing that, on average, an unitary increase in the number of alteration(s), would mean a decrease in the odds of response by 96% (odds ratio = 0.04; p<0.040.04.
This may exert effects by accumulating alterations in driver genes and promoting cancer cell growth and proliferation.
Classical models of carcinogenesis, such as the Fearon Vogelstein diagram (Fearon and Vogelstein, 1990), consist of accumulating alterations in oncogenes, protooncogenes, tumour suppressor genes, and senescence pathways that increase growth-promoting signals and decrease growth inhibitors.
Noticeably, human tumour cell lines in culture accumulate genetic alterations during serial passaging that dramatically alter their biological behaviour [ 40].
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