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Years before a tumour, whole patches of normal-looking tissue are already colonised by mutant clones (a smoker's airway, sun-exposed skin, Barrett's oesophagus). The cancer is the one clone that got further; the field explains second cancers and local recurrence.
Pick a product above a diagram to see the nodes it hits and the escape routes below the block. Hover or tap any node or arrow for what it is; every node opens its target, glossary entry or the pathway page. Violet boxes are druggable targets.
A lawn where many patches have already turned to weeds. Any single tumour is one patch that took over; mowing it leaves the rest of the lawn ready to sprout again.
In plain words, then the glossary entries the stage rests on. Chapter 2, How a cell becomes cancer: Cancer is evolution inside a body.
Years before a tumour, whole patches of normal-looking tissue are already colonised by mutant clones (a smoker's airway, sun-exposed skin, Barrett's oesophagus). The cancer is the one clone that got further; the field explains second cancers and local recurrence.
Field cancerisation. Cancer often arises from a whole region of tissue that already carries mutations, not from one rogue cell. Sun-exposed skin, smokers' airways, and Barrett's oesophagus are patchworks of mutant clones competing long before a tumour appears.
The proteins and genes at this stage, with their role and how many products act on each. Listed players come from the atlas; drawn players sit as nodes in the diagrams above.
TP53 is the 'guardian of the genome', broken in half of all cancers. Fixing it directly has so far defeated every attempt, so drugs exploit what its loss makes cancers depend on.
Products grouped by the node they hit, most advanced first, with the cancers an approved product is linked to. Pick one above the diagram to see it light up.
Records tied to this stage that describe resistance, evasion or tolerance. Resistance: how tumours escape each drug class lists the routes class by class.
PSA screening finds harmless prostate cancers that would never cause trouble. Selecting men by PSA plus a polygenic risk score, then MRI before any biopsy and targeted biopsy only for PI-RADS 4 to 5 lesions, finds the dangerous cancers and skips the rest; GOTEBORG-2 showed MRI-targeted biopsy halves overdiagnosis.
H. pylori eradication often fails because of antibiotic resistance. A stool DNA test showing which antibiotics will work would raise cure rates and protect antibiotics.
In a minority of men, prostate cancer escapes hormone drugs by becoming a different kind of cell that no longer needs the androgen receptor. By the time a biopsy shows it, the treatment options are almost gone. The genetic changes that allow the switch are detectable years earlier, and nobody is looking for them.
To prove a leftover-cancer test works you need blood taken years before relapse. Collecting and freezing yearly samples now makes every future test testable.
Some cancers escape treatment by changing into a different kind of cell that the drug no longer affects. Tumour RNA in blood could show this shift months before a biopsy would.
Prevention drug trials run separately in each precancer and are slow. One master protocol with shared infrastructure across Barrett's oesophagus, oral leukoplakia, lung nodules and pancreatic cysts, using regression as an intermediate endpoint and adding or dropping arms adaptively, would test several drugs at once.
What is not known at this stage: the atlas's own questions, the bottlenecks it bears on, and the ideas in the corpus that try to answer them.
Set a legal limit: anyone referred with suspected cancer should be told within 28 days whether they have it. Publish how every hospital performs each month.
A pill on a string collects cells from the food pipe and finds Barrett's oesophagus, a precursor of cancer. Offering it in pharmacies to people on long-term heartburn drugs would find it early.
Sunbeds cause melanoma, especially when used young. Australia and Brazil have banned them. Other countries should follow and measure the effect.
Nasopharyngeal cancer is common in southern China and is caused by a virus. A blood test for viral DNA finds it early, and a large study showed better survival. Scale it up.
Most people do not know alcohol causes seven cancers. Ireland is putting cancer warnings on bottles; other countries should follow and measure the effect on drinking.
The HPV vaccine prevents most cervical cancer, but false safety claims have cut uptake in several countries. Rebuild confidence locally and deliver the vaccine in schools.
Hepatitis C is now curable in weeks. Testing and treating where it is concentrated, and keeping those with scarring in surveillance afterwards, would cut liver cancer.
About one in eight cancers is caused by an infection we can vaccinate against, cure or eradicate. A concerted global programme could make those cancers rare within a generation.
Scotland and Wales put a floor under the price of alcohol. Deaths from liver disease have already fallen. Cancer takes longer to show, so someone has to keep measuring for a decade.
Lung screening is a teachable moment. Giving cessation medicine and support by default at every scan, unless the person opts out, roughly doubles quit rates.
115 more ideas are linked to this stage's pathways, targets and terms; see the rankings →
Papers in the corpus tied to this stage's pathways, targets and terms, newest first.
src/data/mechanics-atlas.ts). Players, medicines, escape routes, tests, ideas and papers are resolved from the knowledge graph at build time through the stage's pathways, targets and terms, so every item here has its own page and sources. Where a section is missing, the corpus has no record tied to the stage yet. Nothing here is medical advice; see about and methodology. Stage 2.5 of 56.