Fig. 2.

Natural history of cancer. Left: Breast cancer cell (National Cancer Institute [83])

Middle: Stereoscan image showing neovascularisation around an in situ carcinoma (angiogenesis). Photo provided by Professor M A Konerding. Right: PET scan showing cancer disseminated throughout the body (dark patches). Image originally published in JNM [84] and reproduced with permission: Even-Sapir E, Metser U, Mishani E, Gennady Lievshitz G, Lerman H, Leibovitch I. The detection of bone metastases in patients with high-risk prostate cancer: 99mTc-MDP planar bone scintigraphy, single- and multi-field-of-view SPECT, 18F–fluoride PET, and 18F–fluoride PET/CT. J Nucl Med. 2006;47:287–97. © by the Society of Nuclear Medicine and Molecular Imaging, Inc. Most of this evolutionary process is clinically silent or covert