Cancer stem cells exist as a minor portion of the overall population of cells comprising a tumor. They maintain the ability to produce both distinct daughter cells and rejuvenate the cancer stem cell repertoire through self-renewal. They are of therapeutic importance not only because they seed the growth of the primary cancer, but also because they can be chemo-resistant and can seed metastasis.
Angiogenesis is the formation of new blood vessels. The proliferation, migration and differentiation of the endothelial cells lining the vasculature are normally under tight molecular control. However, malignant cells can evolve to produce their own angiogenesis signaling molecules. New tumor-associated blood vessels supply oxygen and nutrients, enabling cancer progression. Angiogenic factors also can prime distant tissues for metastatic cell invasion and survival.
In tissues, communication between proximal cells, as well as between cells and the extracellular matrix, provides essential signals for cellular growth and survival. When non-transformed cells lose cell-cell and cell–matrix contact, they can succumb to programmed cell death. This form of death that occurs in anchorage-dependent cells when they detach is termed “anoikis”. Resistance to anoikis is one characteristic of tumor cells that contributes to metastasis.
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