癌症并非是一种固有的现象，而是一种进化性疾病。从癌症发生的开始，癌细胞不断适应和演化，以满足它们不断增长的增殖需求。这导致了多种不同表型、细胞组成的癌细胞亚型的形成，因此显示出不同程度的肿瘤形态特征和功能。这种现象被称为癌症可塑性，在这种情况下，癌细胞存在于具有不同表型的大量细胞状态中。随着现代技术的出现，具备增强分辨率和深度的技术，例如单细胞RNA测序和先进计算工具，单细胞分辨率的无偏见癌症分析正在引领了解癌细胞在空间和时间上的重组。在本综述中，介绍了导致癌症可塑性产生的过程和机制，包括内在的遗传因素（如表观遗传学变化、由于癌细胞内DNA、RNA或蛋白质含量变化而引起的差异表达），以及外在环境因素（如组织灌注、细胞外环境）的详细情况，并讨论了它们对关键的癌症可塑性标志（如上皮-间质转化和癌细胞干性）的影响。由于治疗逃避和药物抗性，由癌症可塑性引起的肿瘤异质性具有重大的治疗意义。因此，了解控制细胞可塑性的所有细胞和分子机制至关重要。必须认真研究这一过程如何规避治疗及以治疗癌症可塑性为靶点的治疗方法。Copyright © 2023 Elsevier Ltd. All rights reserved.

Cancer is not a hard-wired phenomenon but an evolutionary disease. From the onset of carcinogenesis, cancer cells continuously adapt and evolve to satiate their ever-growing proliferation demands. This results in the formation of multiple subtypes of cancer cells with different phenotypes, cellular compositions, and consequently displaying varying degrees of tumorigenic identity and function. This phenomenon is referred to as cancer plasticity, during which the cancer cells exist in a plethora of cellular states having distinct phenotypes. With the advent of modern technologies equipped with enhanced resolution and depth, for example, single-cell RNA-sequencing and advanced computational tools, unbiased cancer profiling at a single-cell resolution are leading the way in understanding cancer cell rewiring both spatially and temporally. In this review, the processes and mechanisms that give rise to cancer plasticity include both intrinsic genetic factors such as epigenetic changes, differential expression due to changes in DNA, RNA, or protein content within the cancer cell, as well as extrinsic environmental factors such as tissue perfusion, extracellular milieu are detailed and their influence on key cancer plasticity hallmarks such as epithelial-mesenchymal transition (EMT) and cancer cell stemness (CSCs) are discussed. Due to therapy evasion and drug resistance, tumor heterogeneity caused by cancer plasticity has major therapeutic ramifications. Hence, it is crucial to comprehend all the cellular and molecular mechanisms that control cellular plasticity. How this process evades therapy, and the therapeutic avenue of targeting cancer plasticity must be diligently investigated.Copyright © 2023 Elsevier Ltd. All rights reserved.