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Fig. 1 | Genome Biology

Fig. 1

From: When (distant) relatives stay too long: implications for cancer medicine

Fig. 1

A timeline of neoplastic progression, therapy, and recurrence. We illustrate a hypothetical example of clonal expansion of neoplastic cells over time (x-axis). A cell lineage accumulates somatic mutations (and other genetic and epigenetic alterations), one of which initiates carcinogenesis (red star). These somatic mutations are shared across all neoplastic cells. During neoplastic progression, two separate lineages accumulate driver damaging mutations (green and purple circles) that lead to transformation events. A damaging mutation is defined as a nonsynonymous mutation that is predicted to have a functional effect. We define a transformation (black star) as the last mutational hit to make the clone malignant. During therapy most of the lineages are eliminated. However, a rare subclone at diagnosis with a resistance mutation (orange star) survives therapy and may continue to expand until reaching a detectable population size (recurrence). This hypothetical scenario reflects the 41.6 % of cases in which Morrissy and colleagues [9] did not find common damaging mutations between diagnosis and recurrence samples

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