As we transition towards an era of Computational Medicine, our mathematical models of cancer dynamics must be revised. As such, recent evidence supports the perspective that cancermicroenvironment interactions consist of turbulent flows and strange attractor dynamics. Cancer pattern formation, invasion-growth dynamics, protein folding kinetics, stem cell fate bifurcations and metastatic invasion are discussed within the context of hydrodynamical turbulence. Cancer is presented as a three-dimensional Navier-Stokes equations global regularity, smoothness and existence problem.
POSTULATE:Cancer stem cells are strange attractors on the Waddington energy landscape governed by turbulence dynamics.
EMERGENCECancers are complex systems. The Hanahan-Weinberg 'hallmarks' are an inadequate representation of these dynamical systems. Complex systems are systems in which the interactions of its elements and parts cannot be deduced due to interdependence. Some general characteristics of complex systems include nonlinearity, emergence, computational irreducibility, unpredictability, nonequilibrium statistical mechanics and intractability. In simple terms, the concerted whole cannot be defined by the sum of its interacting parts. For example, the flow of exosomes between cancer cells are emergent characteristics of tumor ecosystems. It is impossible to understand exosomes without complex systems approaches. Exosomes are heterogeneous nano-scaled packets of information forming complex long-range communication networks. Along with ctDNA (circulating tumor DNA), exosomes are emerging targets for early tumor detection from liquid biopsies of patients (1, 2). Human embryonic stem cells-derived exosomes have shown capability of reprogramming malignant cancer phenotypes to benign-like fates, indicating exosomes are potent phenotype reprogramming machineries (3). However, the identity of cancer stem cells remains ambiguous. It is debated whether cancer stem cells conform a small subset of the tumor hierarchy or whether all cancer cells are potentially stem cells (i.e., have the potency of phenotypic plasticity and unlimited replication). In attempt to reconcile such problems, precision oncology is transitioning towards the use of artificial intelligence and machine learning algorithms in guiding clinical decision-making (4). Machine intelligence is emerging as a powerful tool in deciphering cancer ecosystems.Each tumor exhibits spatio-temporal heterogeneity and emergent properties that are unpredictable. For example, certain malignant melanomas spontaneously regress, a property not recognized as a hallmark (5). Another example, PEDF (pigment epithelium-derived factor) upregulated by extracellular vesicle bodies-mediated EGFRvIII promotes the self-renewal and propagation of GSCs (glioma stem cells) (6, 7). However, PEDF is an anti-angiogenic factor and GSCs require vascular interactions for development. Such complex feedback loops are emergent properties of complex systems. Certain tumors exhibit vasculogenic mimicry, the spontaneous form...