Chapter 18 – Obstacles to the Darwinian Framework of Somatic Cancer Evolution

Cancers are the results of somatic clonal evolution and hence should follow Darwinian principles. Even though this postulate is generally accepted within the cancer research community, considerations of evolutionary framework are largely missing from the way we study, prevent and treat cancers. To a large extent, this situation can be attributed to the predominance of the assumption that clonal evolution is the result of acquisition of “driver” mutations that unlock malignant phenotypes. This assumption renders consideration of context-specific selection forces unnecessary and focuses all of the attention on proximal causation mechanisms. Second, somatic evolution has several unique features that complicate application of insights gained from studies of evolution in natural populations. These unique features need to be considered and incorporated into a larger conceptual framework of somatic evolution to fully unlock explanatory and predicted power of Darwinian framework.