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Organs are built like walled towns. Lining cells sit on a dense protein sheet, the basement membrane, and hold hands through junctions. A growth that stays above the sheet is 'in situ' and almost always curable; the disease becomes cancer proper when it cuts through.
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 shop floor with a locked glass floor beneath it. Staff (epithelial cells) can be unruly upstairs and it is still contained; the emergency begins when someone cuts through the glass into the building services below, where the plumbing (blood and lymph vessels) runs.
A building inspector (Hippo) who checks that the block is full and stops new floors. Cancers fire the inspector, and the architect (YAP/TAZ) keeps adding storeys.
In plain words, then the glossary entries the stage rests on. Chapter 1, The body's defences: Cancer is not the default.
Organs are built like walled towns. Lining cells sit on a dense protein sheet, the basement membrane, and hold hands through junctions. A growth that stays above the sheet is 'in situ' and almost always curable; the disease becomes cancer proper when it cuts through.
Basement membrane & tissue barriers. Every organ keeps its lining cells behind a thin, dense sheet of protein called the basement membrane. A tumour that has not crossed it is 'in situ' and essentially curable; crossing it is the moment cancer becomes invasive.
Hippo-YAP/TAZ. The pathway that tells organs when to stop growing. Cancers disable it so YAP and TAZ stay in the nucleus driving growth; in mesothelioma, NF2 loss does exactly that, and the first drugs against the YAP-TEAD switch are in trials.
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.
No target record is listed at this stage or drawn in its diagrams; the pathways above carry the mechanism.
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.
Biomarkers, tests and assays in the corpus that read this stage in a patient.
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.
A swallowed sponge on a string can sample the oesophagus in a GP's office. Screen people with chronic reflux to catch adenocarcinoma at a curable stage.
You cannot manage what you do not measure quickly. Publishing stage at diagnosis by cancer and region every quarter, not years later, would show whether detection efforts are working.
Whole regions of tissue carry cancer mutations long before a tumour exists. Detecting and treating the field, not the tumour, could prevent cancers rather than cure them.
AI for screening should be judged on whether it finds dangerous cancers earlier and misses fewer, not just on whether it agrees with radiologists on old images.
Guidelines send everyone whose chance-found gallbladder cancer has just reached the muscle layer back for liver and lymph node surgery, yet the largest international series found 95 in 100 alive without the disease at five years whether or not they had it. A prospective study could spare thousands of operations, or confirm they are needed.
Screening finds cancers that would never have caused harm alongside dangerous ones. Pair every screening test with a test that says which is which, so people with harmless findings can safely watch and wait.
Instead of separate screening programmes for a few cancers, assess every adult's overall cancer risk and offer blood tests, imaging and preventive treatment tuned to that risk, all inside one system that learns.
Multi-cancer early detection blood tests take a decade to prove they save lives. Regulators could accept a fall in late-stage cancers as the first answer, validated against pooled data from completed screening trials, provided approval is conditional on continued mortality follow-up.
Whether finding cancer earlier saves lives depends on the cancer. Public models, one per cancer, would let trials and payers predict the mortality benefit from a stage shift honestly.
Health systems earn from treating cancer, not preventing it. Paying them for lower cancer incidence and earlier stage in their population would flip the incentive.
1 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 1.1 of 56.