Hallmarks of Cancer


When I was at the NBCC Project Lead course, I was fascinated to learn about the “Six Hallmarks of Cancer”:

Before you are rendered speechless wondering WTF these scientific words mean, know that I’m going to explain it — so that you understand it.

The reason that it’s important for me to share this information is because today in an oncologist’s office with my girlfriend (going over her diagnosis and treatment), the doctor was throwing out many of these words to his dazed and stunned patient. Ugh. That irks me to no end. As if hearing that you have f’ing cancer isn’t hard enough…then you hear that you are going to have to have chemo…then you hear words like angiogenesis and proliferative (describing your f’ing cancer) that make absolutely no sense and sound quite scary as they roll off of an oncologist’s tongue.

A wee bit of background: The “Six Hallmarks of Cancer” stems from peer-reviewed article published in the journal Cell in January 2000 by US cancer researchers Douglas Hanahan and Robert Weinberg. Hanahan and Weinberg believe that the complexity of cancer can be reduced to six underlying principles. The paper suggests that all cancers share common traits (“hallmarks”) that contribute to the conversion of normal cells to f’ing cancer (malignant or tumor) cells.

These hallmarks are:

  1. Sustaining proliferative signaling. Normal cells require external growth signals (a/k/a growth factors) to grow and divide…kind of like a cross light. Normal cells grow with the “walk” sign. Cancer cells do not need the “walk” sign in order to  multiply. In other words, they grow and divide all on their own which goes against the natural order of cell growth.
  2. Evading growth suppressors. Growth of normal cells is tightly controlled by growth suppressors or inhibitors. Cancer cells resist these signals that might otherwise stop their growth….which means, yes, they grow unchecked and uncontrollably, producing more and more cancer cells.
  3. Activating (tissue) invasion and metastasis. Cancer cells invade local tissue and spread to distant sites (metastasis). “Pioneer cells” are a perfect name for the cells that come from the primary tumor and invade adjacent tissues, and then possibly travel to distant sites. Most of the deaths from human cancers (90%) are due to cancer cells spreading and establishing colonies in other parts of the body.
  4. Enabling replicative immortality. In other words, cancer cells can multiply forever with limitless reproductive potential. Normal cells have a lifespan. Normal cells can only double a certain number of times. F’ing cancer cells on the other hand procreate indefinitely.
  5. Inducing angiogenesis. To grow beyond a certain size, tumors need a system to bring in nutrients and take out wastes. The cancer cells that make up a tumor attract blood vessels to grow into the tumor mass (a/k/a angiogenesis). The blood vessels then nourish the tumor just like any organ in the body. It’s a very clever system that this f’ing cancer has!
  6. Resisting cell death. This means that cancer cells resist their own programmed cell death (apoptosis). So, if something goes awry as a cell is growing and dividing, first the cell tries to fix the damage itself. If the problem can’t be fixed, then it commits cell suicide or programmed cell death. Cancers can result from cells that do not die when they should. In other words, they bypass this mechanism.

If you don’t understand what I’ve explained, please tell me so that I can break it down further. This does NOT need to be complicated (Silver Lining).

And the other thing…please, please, please ask questions. Ask your doctor(s) to slow down when delivering news about a diagnosis or treatment…or anything else for that matter. If you don’t understand something, say so.

It’s so important that if you or a loved one have f’ing cancer that you have a basic understanding of WTF is happening. Knowledge is a wonderful tool to have in your toolbox as you begin (or continue) on this long, pothole filled road of cancer treatment.


Leave a comment


  1. says

    Thanks for explaining the six principles of the "The Hallmarks of Cancer" . It makes those six points a bit more understandable. When I had my first appointment with my oncologist, who would map out my course of treatment, it was the week before Christmas. He said I would start with four rounds of chemo treatment, followed by radiation treatments. I hardly heard much of what he said as I was quite upset about the diagnosis of FBC and all of the prescribed treatment that was being thrown at me. Lastly my doctor handed me a pamphlet to read on breast cancer treatment. I was so angry about losing my once good health, that I felt like throwing the pamphlet back in his face, or at the very least on the floor, and slamming out the door. But somehow I held it together and left without making a scene. Maybe "throwing a temper tantrum" would have given me a sense of power in that moment, but it would only have been temporary. relief.

    • says

      ABsolutely, Carolee. I think it's so important to that we as patients are informed. And by the way, I'm a BIG fan of throwing temper tantrums…and having big messy meltdowns. They are actually very cleansing! Thank you for your comment, as always!

  2. E.B. says

    Thank you so very, very much. Your (much-needed) explanation is perfect and perfectly understandable. And absolutely, ASK QUESTIONS. Hollye, my dear, I sound like a broken record, but you and your blog are two Major Silver Linings in many, many lives. You help us get through the bumps and pot-hole filled road of Life and help us see there is a light at the end of the tunnel and smooth sailing up ahead … really mixing it up here, aren't I? Signing off with one of my favorite Tasha Tudor quotes, "Take joy!"