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IMF-040-01-0001-en	Why is malignancy not defined simply by rapid growth?	Cancer is clonal evolution within tissue, and tumours vary in differentiation, invasion, metastasis, treatment sensitivity and host interaction, so growth rate alone does not capture malignant behaviour.	Integrated Medical Foundations; chapter 40, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: e71131deaaf2e2d6385713b6092f76d5c637fc376fb7f035c51c1602752f1e5f; editorial review pending	imf lang::en chapter::040 module::040-01 review::pending
IMF-040-01-0002-en	What distinguishes how proto-oncogenes and tumour-suppressor genes contribute to cancer?	Proto-oncogenes promote growth or survival and become drivers through activating mutation, amplification or fusion; tumour suppressors restrain proliferation, and both copies often need functional loss at the cellular level.	Integrated Medical Foundations; chapter 40, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: e71131deaaf2e2d6385713b6092f76d5c637fc376fb7f035c51c1602752f1e5f; editorial review pending	imf lang::en chapter::040 module::040-01 review::pending
IMF-040-01-0003-en	Why can a mutation found in a tumour not be assumed to drive it?	Passenger changes accumulate without providing major advantage, and even a driver essential in one clone can be bypassed by another clone.	Integrated Medical Foundations; chapter 40, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: e71131deaaf2e2d6385713b6092f76d5c637fc376fb7f035c51c1602752f1e5f; editorial review pending	imf lang::en chapter::040 module::040-01 review::pending
IMF-040-01-0004-en	How does treatment itself shape the tumour population that later relapses?	Tumours contain subclones with different vulnerabilities; treatment removes sensitive cells and selects resistant populations, while new mutations and non-genetic plasticity continue evolution.	Integrated Medical Foundations; chapter 40, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: e71131deaaf2e2d6385713b6092f76d5c637fc376fb7f035c51c1602752f1e5f; editorial review pending	imf lang::en chapter::040 module::040-01 review::pending
IMF-040-01-0005-en	Tumour-only sequencing suggests a possible inherited variant. Why does this matter beyond the tumour, and what follows?	A germline defect exists throughout the body and affects relatives, surveillance and therapy, so the finding requires counselling and confirmatory testing.	Integrated Medical Foundations; chapter 40, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: e71131deaaf2e2d6385713b6092f76d5c637fc376fb7f035c51c1602752f1e5f; editorial review pending	imf lang::en chapter::040 module::040-01 review::pending
IMF-040-01-0006-en	Why is no single hallmark of malignancy sufficient to make a cell cancerous?	No hallmark is unique to cancer; malignancy emerges from the combination and persistence of the traits, which genomic instability and tumour-promoting inflammation enable.	Integrated Medical Foundations; chapter 40, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: e71131deaaf2e2d6385713b6092f76d5c637fc376fb7f035c51c1602752f1e5f; editorial review pending	imf lang::en chapter::040 module::040-01 review::pending
IMF-040-01-0007-en	Through which mechanisms do oncogenic infections promote cancer, and how does this make some cancers preventable?	They act through microbial proteins, inflammation, immune suppression or regeneration, so vaccination and antimicrobial treatment can remove the cause and prevent cancer.	Integrated Medical Foundations; chapter 40, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: e71131deaaf2e2d6385713b6092f76d5c637fc376fb7f035c51c1602752f1e5f; editorial review pending	imf lang::en chapter::040 module::040-01 review::pending
IMF-040-01-0008-en	Why should cancer prevention messages avoid blaming the individual?	Risk is probabilistic: exposure does not guarantee cancer, and messages should account for social, commercial and environmental determinants rather than personal fault.	Integrated Medical Foundations; chapter 40, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: e71131deaaf2e2d6385713b6092f76d5c637fc376fb7f035c51c1602752f1e5f; editorial review pending	imf lang::en chapter::040 module::040-01 review::pending
IMF-040-01-0009-en	How does hypoxia in a tumour promote progression and treatment failure?	Hypoxia stabilises transcriptional programmes that support angiogenesis, glycolysis, invasion and treatment resistance.	Integrated Medical Foundations; chapter 40, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: e71131deaaf2e2d6385713b6092f76d5c637fc376fb7f035c51c1602752f1e5f; editorial review pending	imf lang::en chapter::040 module::040-01 review::pending
IMF-040-01-0010-en	Why do tumour vessels supply resources yet leave perfusion uneven?	New tumour vessels are structurally abnormal, leaky, heterogeneous and poorly organised, so they deliver resources while perfusing the tumour unevenly.	Integrated Medical Foundations; chapter 40, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: e71131deaaf2e2d6385713b6092f76d5c637fc376fb7f035c51c1602752f1e5f; editorial review pending	imf lang::en chapter::040 module::040-01 review::pending
IMF-040-01-0011-en	How can a tumour continue to grow despite anti-angiogenic therapy?	It can recruit alternative vascular pathways or invade along existing vessels, bypassing the inhibited angiogenesis.	Integrated Medical Foundations; chapter 40, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: e71131deaaf2e2d6385713b6092f76d5c637fc376fb7f035c51c1602752f1e5f; editorial review pending	imf lang::en chapter::040 module::040-01 review::pending
IMF-040-01-0012-en	Why is metastasis not a single irreversible switch such as epithelial-mesenchymal change?	Epithelial-mesenchymal programmes increase movement and plasticity, but cells must still enter vessels, survive shear and immunity, arrest, exit and adapt to a foreign niche.	Integrated Medical Foundations; chapter 40, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: e71131deaaf2e2d6385713b6092f76d5c637fc376fb7f035c51c1602752f1e5f; editorial review pending	imf lang::en chapter::040 module::040-01 review::pending
IMF-040-01-0013-en	Why can distant metastases appear years after the primary tumour is treated?	Most disseminated cells fail, but some remain dormant for years before outgrowth once blood flow, adhesion, chemokines and niche allow.	Integrated Medical Foundations; chapter 40, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: e71131deaaf2e2d6385713b6092f76d5c637fc376fb7f035c51c1602752f1e5f; editorial review pending	imf lang::en chapter::040 module::040-01 review::pending
IMF-040-01-0014-en	What does lymph-node involvement imply about how distant metastases arose?	It reflects spread and prognosis, but it does not mean every distant metastasis passed sequentially through each node.	Integrated Medical Foundations; chapter 40, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: e71131deaaf2e2d6385713b6092f76d5c637fc376fb7f035c51c1602752f1e5f; editorial review pending	imf lang::en chapter::040 module::040-01 review::pending
IMF-040-01-0015-en	Why does portal drainage favour liver metastasis while systemic venous drainage favours lung?	Circulating tumour cells arrest in the distant capillaries their drainage reaches, and metastasis depends partly on blood flow, alongside adhesion, chemokines and niche compatibility.	Integrated Medical Foundations; chapter 40, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: e71131deaaf2e2d6385713b6092f76d5c637fc376fb7f035c51c1602752f1e5f; editorial review pending	imf lang::en chapter::040 module::040-01 review::pending
IMF-040-01-0016-en	Why can checkpoint inhibitors cause inflammation in almost any organ, and what does management require?	They release inhibitory brakes on T cells, and the activated immunity can inflame skin, bowel, liver, lung, endocrine organs, heart, kidney or nerves; early recognition and graded immunosuppression are crucial.	Integrated Medical Foundations; chapter 40, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: e71131deaaf2e2d6385713b6092f76d5c637fc376fb7f035c51c1602752f1e5f; editorial review pending	imf lang::en chapter::040 module::040-01 review::pending
IMF-040-01-0017-en	Why is a benign tumour not necessarily harmless?	Although it remains local, it can still secrete hormones, bleed, obstruct or compress neighbouring structures.	Integrated Medical Foundations; chapter 40, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: e71131deaaf2e2d6385713b6092f76d5c637fc376fb7f035c51c1602752f1e5f; editorial review pending	imf lang::en chapter::040 module::040-01 review::pending
IMF-040-01-0018-en	What distinguishes carcinoma in situ from invasive carcinoma?	Carcinoma in situ has malignant cytology but has not invaded through the basement membrane, whereas carcinomas breach basement membrane and invade stroma.	Integrated Medical Foundations; chapter 40, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: e71131deaaf2e2d6385713b6092f76d5c637fc376fb7f035c51c1602752f1e5f; editorial review pending	imf lang::en chapter::040 module::040-01 review::pending
IMF-040-01-0019-en	How do grade and stage differ in what they describe?	Grade describes differentiation, mitoses and architecture, approximating biological aggressiveness; stage describes anatomical extent through primary tumour, regional nodes and metastasis.	Integrated Medical Foundations; chapter 40, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: e71131deaaf2e2d6385713b6092f76d5c637fc376fb7f035c51c1602752f1e5f; editorial review pending	imf lang::en chapter::040 module::040-01 review::pending
IMF-040-01-0020-en	Why can a tumour marker rarely diagnose cancer on its own?	Benign disease can raise tumour markers and some cancers do not secrete them, so the marker gives both false positives and false negatives.	Integrated Medical Foundations; chapter 40, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: e71131deaaf2e2d6385713b6092f76d5c637fc376fb7f035c51c1602752f1e5f; editorial review pending	imf lang::en chapter::040 module::040-01 review::pending
IMF-040-01-0021-en	What distinguishes the purposes of neoadjuvant and adjuvant treatment?	Neoadjuvant treatment precedes surgery to shrink the tumour or test its biology; adjuvant treatment follows surgery to eradicate microscopic disease.	Integrated Medical Foundations; chapter 40, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: e71131deaaf2e2d6385713b6092f76d5c637fc376fb7f035c51c1602752f1e5f; editorial review pending	imf lang::en chapter::040 module::040-01 review::pending
IMF-040-01-0022-en	Why is radiation delivered in fractions rather than a single dose?	Fractionation allows normal tissue to repair between doses while the tumour is repeatedly injured.	Integrated Medical Foundations; chapter 40, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: e71131deaaf2e2d6385713b6092f76d5c637fc376fb7f035c51c1602752f1e5f; editorial review pending	imf lang::en chapter::040 module::040-01 review::pending
IMF-040-01-0023-en	Why does a targeted agent eventually fail, and how can the cause be found?	Tumours resist through target mutation, amplification, bypass signalling, lineage change, altered drug transport or protective niches; repeat tissue or circulating DNA testing can reveal the mechanism and guide next therapy.	Integrated Medical Foundations; chapter 40, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: e71131deaaf2e2d6385713b6092f76d5c637fc376fb7f035c51c1602752f1e5f; editorial review pending	imf lang::en chapter::040 module::040-01 review::pending
IMF-040-01-0024-en	What distinguishes screening from diagnostic testing, and when is screening justified?	Screening tests asymptomatic people and is justified only when benefit exceeds false positives, overdiagnosis, harm and cost; diagnostic testing investigates symptoms.	Integrated Medical Foundations; chapter 40, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: e71131deaaf2e2d6385713b6092f76d5c637fc376fb7f035c51c1602752f1e5f; editorial review pending	imf lang::en chapter::040 module::040-01 review::pending