![]() We review the data describing punctuated evolution in cancer, and reason that punctuated phenotype evolution is consistent with both gradual and punctuated genome evolution. We argue that selection in cancer can only be properly studied once we have some understanding of what the absence of selection looks like. In this review, we describe how a cancer's genome can be analysed to reveal the temporal history of mutation and selection, and discuss why both selective and neutral evolution feature prominently in carcinogenesis. Fortuitously however, the cancer genome, by virtue of ongoing mutations that uniquely mark clonal lineages within the tumour, provides a rich, yet surreptitious, record of cancer development. Consequently, our knowledge of how cancers grow largely derives from inferences made from a single point in time – the endpoint in the cancer's evolution, when it is removed from the body and studied in the laboratory. ![]() The temporal dynamics of cancer evolution remain elusive, because it is impractical to longitudinally observe cancers unperturbed by treatment.
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