[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [General pathology](https://durgical.com/en/general-pathology/) › [Neoplasia](https://durgical.com/en/general-pathology/#a-neoplasia) › The hallmarks of cancer

[General pathology](https://durgical.com/en/general-pathology/) · [Neoplasia](https://durgical.com/en/general-pathology/#a-neoplasia)

# The hallmarks of cancer

- Topic

Every cancer, whatever its organ, acquires the same set of abilities: to grow without orders, ignore brakes, avoid death, live forever and spread.

Updated 2026-11-01

## Key points

- Growth signals: oncogenes (RAS, HER2, BCR-ABL).
- Insensitivity to inhibition: loss of tumour suppressors (RB, TP53, APC).
- Evasion of apoptosis: BCL2 overexpression, TP53 loss.
- Limitless replication: telomerase reactivation.
- Angiogenesis (VEGF), invasion and metastasis (E-cadherin loss), Warburg metabolism, immune evasion (PD-L1).
- Enablers: genomic instability (defective DNA repair) and chronic inflammation.

## What it is

The hallmarks of cancer are the capabilities a normal cell must acquire to become a malignant tumour. Different genes are mutated in different cancers, but they converge on the same functions: self-sufficient growth signals, insensitivity to growth inhibitors, evasion of cell death, limitless replication, angiogenesis, invasion and metastasis, reprogrammed metabolism and immune evasion. Genomic instability and tumour-promoting inflammation are the enabling conditions that let these traits accumulate.

## Key facts

- Cancer is a clonal disease: a tumour descends from one transformed cell and gains further mutations over time (tumour progression and heterogeneity).
- Driver mutations confer a growth advantage; passenger mutations ride along without effect.
- The tumour microenvironment (fibroblasts, immune cells, vessels) is part of the disease, not a bystander.

## The hallmarks, their key molecules and a classic example

| Hallmark | Key molecules | Classic example |
| --- | --- | --- |
| [Self-sufficient growth signals](https://durgical.com/en/conditions/chronic-myeloid-leukaemia/) | RAS, growth factor receptors, BCR-ABL | BCR-ABL in chronic myeloid leukaemia |
| [Insensitivity to growth inhibitors](https://durgical.com/en/conditions/colorectal-cancer/) | RB, TP53, APC, CDK inhibitors | Loss of APC in colorectal adenomas |
| [Evasion of cell death](https://durgical.com/en/conditions/non-hodgkin-lymphoma/) | BCL2, TP53 | BCL2 in follicular lymphoma |
| Limitless replication | Telomerase (TERT) | Telomerase reactivated in most carcinomas |
| [Sustained angiogenesis](https://durgical.com/en/conditions/renal-cell-carcinoma/) | VEGF, HIF | VHL loss in clear cell renal carcinoma |
| [Invasion and metastasis](https://durgical.com/en/conditions/breast-cancer/) | E-cadherin, metalloproteinases | Lobular breast carcinoma with E-cadherin loss |
| Reprogrammed metabolism | Aerobic glycolysis (Warburg) | Glucose-avid tumours light up on PET |
| [Evasion of the immune system](https://durgical.com/en/conditions/melanoma/) | PD-L1, loss of MHC class I | Melanoma and lung cancer that respond to checkpoint blockade |
| [Enabler: genomic instability](https://durgical.com/en/conditions/lynch-syndrome/) | Mismatch repair, BRCA, NER | Lynch syndrome |

## Clinical notes

- Many modern therapies target one hallmark each: kinase inhibitors (growth signals), anti-VEGF antibodies (angiogenesis), BCL2 inhibitors (apoptosis) and checkpoint inhibitors (immune evasion).
- Biomarker testing of the tumour decides which of these targeted therapies can work.

## Memory aid

A cancer cell is a teenager who does not need permission (growth signals), ignores curfew (inhibitors), refuses to die, never ages, builds its own roads (vessels), leaves home (metastasis), eats sugar all day (Warburg) and hides from the police (immune evasion).

## Test yourself

Think of the answer, then tap the question to see it.

## Which hallmark does telomerase reactivation provide?

Limitless replicative potential (immortality), by preventing telomere shortening and crisis.

## What are the two enabling characteristics of cancer?

Genomic instability (defective DNA repair) and tumour-promoting inflammation.

## What is the Warburg effect?

Cancer cells favour glycolysis to lactate even with oxygen present, which supplies building blocks for growth; it is why tumours take up glucose on PET.

## Which hallmark does a PD-1 inhibitor counter?

Evasion of immune destruction: it removes a brake on cytotoxic T cells.

[Add to my cards (4)](https://durgical.app/estudiar/?add=/en/general-pathology/the-hallmarks-of-cancer/)

## Related

- [Oncogenes: RAS, MYC, HER2, BCR-ABL and the table to know](https://durgical.com/en/general-pathology/oncogenes-ras-myc-her2-bcr-abl-and-the-table-to-know/)
- [Tumour suppressor genes: RB, TP53, APC, BRCA and the two-hit hypothesis](https://durgical.com/en/general-pathology/tumour-suppressor-genes-rb-tp53-apc-brca-and-the-two-hit-hypothesis/)
- [The cell cycle in cancer: cyclins, CDKs and checkpoints](https://durgical.com/en/general-pathology/the-cell-cycle-in-cancer-cyclins-cdks-and-checkpoints/)
- [Evading cell death and replicating without limit: BCL2 and telomerase](https://durgical.com/en/general-pathology/evading-cell-death-and-replicating-without-limit-bcl2-and-telomerase/)
- [Tumour angiogenesis](https://durgical.com/en/general-pathology/tumour-angiogenesis/)
- [Invasion and metastasis: the metastatic cascade, step by step](https://durgical.com/en/general-pathology/invasion-and-metastasis-the-metastatic-cascade-step-by-step/)
- [How tumours evade the immune system](https://durgical.com/en/general-pathology/how-tumours-evade-the-immune-system/)
- [Genomic instability: mismatch repair, BRCA and xeroderma pigmentosum](https://durgical.com/en/general-pathology/genomic-instability-mismatch-repair-brca-and-xeroderma-pigmentosum/)
- [Multistep carcinogenesis: the adenoma–carcinoma sequence](https://durgical.com/en/general-pathology/multistep-carcinogenesis-the-adenoma-carcinoma-sequence/)

## Related conditions

- [Colorectal cancer](https://durgical.com/en/conditions/colorectal-cancer/)
- [Lung cancer](https://durgical.com/en/conditions/lung-cancer/)
- [Breast cancer](https://durgical.com/en/conditions/breast-cancer/)
- [Chronic myeloid leukaemia](https://durgical.com/en/conditions/chronic-myeloid-leukaemia/)
- [Melanoma](https://durgical.com/en/conditions/melanoma/)
- [Renal cell carcinoma](https://durgical.com/en/conditions/renal-cell-carcinoma/)
- [Non-Hodgkin lymphoma](https://durgical.com/en/conditions/non-hodgkin-lymphoma/)
- [Lynch syndrome (hereditary non-polyposis colorectal cancer)](https://durgical.com/en/conditions/lynch-syndrome/)

## Elsewhere in DurgiPedia

- [Warburg effect (aerobic glycolysis in cancer)](https://durgical.com/en/biochemistry/topics/warburg-effect/)
- [Tumor immunology and checkpoint inhibitors](https://durgical.com/en/immunology/tumor-immunology-and-checkpoint-inhibitors/)
- [Oncogenes and tumour suppressor genes](https://durgical.com/en/biochemistry/topics/oncogenes-and-tumour-suppressor-genes/)
- [Telomerase](https://durgical.com/en/biochemistry/enzymes/telomerase/)
- [DNA repair](https://durgical.com/en/biochemistry/topics/dna-repair/)
- [Cell injury, apoptosis and necrosis](https://durgical.com/en/histology/cell-injury-apoptosis-and-necrosis/)

[← All of general pathology](https://durgical.com/en/general-pathology/)

Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given.

Sources: [What Is Cancer?](https://www.cancer.gov/about-cancer/understanding/what-is-cancer) (National Cancer Institute (NCI), 2026); [The Genetics of Cancer](https://www.cancer.gov/about-cancer/causes-prevention/genetics) (National Cancer Institute (NCI), 2026); [Targeted Therapy to Treat Cancer](https://www.cancer.gov/about-cancer/treatment/types/targeted-therapies) (National Cancer Institute (NCI), 2026).

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Source: https://durgical.com/en/general-pathology/the-hallmarks-of-cancer/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/general-pathology/the-hallmarks-of-cancer/