From one fertilised egg cell we grow by cell division to over 30 trillion cells, and on the way extensive cellular differentiation and tissue remodelling occurs according to a tightly regulated sequence of changes in gene expression, together with the programmed death and replacement of billions of cells every day. Inevitably mutational processes impact on all stages, carrying an accumulating risk of autonomous cellular growth as we age. The emergence of a tumour then presents many challenges in diagnostics, prognostics and therapy. Newer therapies using monoclonal antibodies and kinase inhibitors now offer some extension of survival, while sophisticated analyses of mutational signatures* are yielding more understanding of the processes driving cancers and promise more focused and personalised therapy.

*Further reading: http://cancer.sanger.ac.uk/cosmic/signatures