A mutation in the APC tumor-suppressor gene in a single epithelial cell causes the cell to divide, although surrounding cells do not, forming a mass of localized benign tumor cells called a polyp. Subsequent mutations leading to expression of a constitutively active Ras protein and loss of two tumor-suppressor genes, DCC and p53, generates a malignant cell carrying all four mutations; this cell continues to divide and the progeny invade the basal lamina that surrounds the tissue. Some tumor cells spread into blood vessels that will distribute them to other sites in the body. Additional mutations cause exit of the tumor cells from the blood vessels and growth at distant sites; a patient with such a tumor is said to have cancer. [Adapted from B. Vogelstein and K. Kinzler, 1993, Trends Genet. 9:101.]