A new study has revealed that lung cancers can lie dormant for over 20 years before suddenly turning into an aggressive form of the disease.
According to the study by cancer research UK on seven patients - including smokers, ex-smokers and never smokers, the first genetic mistakes that cause the cancer, can exist undetected for many years until new, additional, faults trigger rapid growth of the disease.
Study author Professor Charles Swanton, at Cancer Research UK's London Research Institute and the UCL Cancer Institute, said that survival from lung cancer remains devastatingly low with many new targeted treatments making a limited impact on the disease and by understanding how it develops they have opened up the disease's evolutionary rule book in the hope that they can start to predict its next steps.
The study also highlighted the role of smoking in the development of lung cancer. Many of the early genetic faults are caused by smoking. But as the disease evolved these became less important with the majority of faults now caused by a new process generating mutations within the tumour controlled by a protein called APOBEC.
The wide variety of faults found within lung cancers explains why targeted treatments have had limited success. Attacking a particular genetic mistake identified by a biopsy in lung cancer will only be effective against those parts of the tumour with that fault, leaving other areas to thrive and take over.
The study was published in Science.