Review Article

Precancerous niche (PCN), a product of fibrosis with remodeling by incessant chronic inflammation

¹ Theodor-Billroth-Academy®, Germany, USA
² INCORE, International Consortium of Research Excellence of the Theodor-Billroth-Academy®, Germany, USA
³ Department of Surgery, Carl-Thiem-Klinikum, Cottbus, Germany
⁴ Risk-Based Decisions Inc., Sacramento, CA, USA

^* Corresponding author: b-bruecher@gmx.de

Received: 22 March 2018
Accepted: 19 December 2018

Abstract

Fibroblasts are actively involved in the creation of the stroma and the extracellular matrix which are important for cell adhesion, cell–cell communication, and tissue metabolism. The role of fibrosis in carcinogenesis can be examined by analogy to tissues of various cancers. The orchestration of letters in the interplay of manifold components with signaling and crosstalk is incompletely understood but available evidence suggests a hitherto underappreciated role for fibrosis in carcinogenesis. Complex signaling and crosstalk by pathogenic stimuli evoke persistent subclinical inflammation, which in turn, results in a cascade of different cell types, ubiquitous proteins and their corresponding enzymes, cytokine releases, and multiple signaling pathways promoting the onset of fibrosis. There is considerable evidence that the body's attempt to resolve such a modified extracellular environment leads to further disruption of homeostasis and the genesis of the precancerous niche as part of the six-step process that describes carcinogenesis. The precancerous niche is formed and can be understood to develop as a result of (1) pathogenic stimulus, (2) chronic inflammation, and (3) fibrosis with alterations of the extracellular matrix, stromal rigidity, and mechano-transduction. This is why carcinogenesis is not just a process of aberrant cell growth with damaged genetic material but the role of the PCN in its entirety reveals how carcinogenesis can occur without invoking the need for somatic mutations.