Opinion - Inflammation and necrosis promote tumour growth

In children, cancer probably arises from a combination of inherited genetic mutations and genetic alterations that are acquired during the rapid cellular expansion that occurs during embryogenesis, and it is rarely associated with immune cell infiltrates. Conversely, in adults, cancer is frequently preceded by a long period of subclinical inflammatory disease and micronecrosis that provides a setting in which the epigenetic regulation of genes, cell death, cell proliferation and mutagenesis occurs. Here, we provocatively suggest that adult cancer results from rounds of disordered and unscheduled necrotic cell death, subsequent epithelial proliferation and the resulting suppressed immunity, rather than from a process that is dictated solely by cell growth. This paradigm shift regarding the development of cancer and this 'sixth sense' of the immune system indicates new strategies for cancer prevention and therapy.