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These data are also in agreement with several studies showing that PA system components are involved in tumour evolution [ 22, 23] including tumoural transitions EMT and mesenchymal to amoeboid transition (MAT)) [ 57- 61].
The timing of mutational events during tumour evolution presents diagnostic, prognostic and therapeutic opportunities.
Owing to cancers' complexity and heterogeneity the rules of tumour evolution, such as the role of selection, remain incompletely understood.
Particularly, there is a lack of gender-based studies with regard to brain tumour evolution and response to treatment.
Here we investigated spatial and temporal tumour evolution and tumour heterogeneity in order to evaluate the potential use of targeted treatment of metastatic bladder cancer.
As such epigenetic changes in the regions of genomic gain may have an additional selective advantage during tumour evolution.
This observation suggests the possibility that during tumour evolution, hypomethylation and gain of certain genomic regions may act cooperatively to increase the gene expression/gene dosage levels.
While there is some understanding of how such genetic and epigenetic changes may influence the gene expression, and thereby tumour evolution, it is less clear how these mechanisms influence each other, and how cumulative changes could co-evolve and influence gene expression during tumourigenesis.
Tumour evolution is most likely an important factor.
One can therefore hypothesize that foetal cells in breast cancer tumours may influence tumour evolution.
During tumour evolution, cells acquire other mutations and may become founder cells of succeeding carcinogenic states.
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