Neglected factors in cancer treatment: cellular interactions and dynamic microenvironment in solid tumors

Solid tumors are "organoids" consisting of highly heterogeneous populations of malignant, stromal and inflammatory cells and dynamic extracellular matrix. In particular, distinct cellular microenvironments are observed. The survival strategies of malignant cells might therefore be highly differentiated, causing the high genotypic and phenotypic instability characteristic of malignant cells in vivo. A constant interplay between the tumor compartments and the host immune and hemostatic systems determines the behavior of the tumor. A description of typical microenvironments and of cellular and matrix interactions is provided. Based on these, it is here postulated that: (a) any cancer treatment, by influencing differently the various tumor compartments, will alter previously established equilibria; (b) the behavior (growth, invasiveness, metastatic potential, resistance to further treatment) of a malignancy after treatment might be altered with respect to what is assumed in terms of effect of the treatment on the malignant cells alone.