“…Impaired clearance of debris fuels a pro-tumorigenic feedback loop between inflammation, DNA damage and carcinogenesis which can be aggravated by the tumor cell debris generated by cytotoxic cancer therapy including chemotherapy and radiation ( Chang et al, 2019 ; Gartung et al, 2019 ; Huang et al, 2011 ; Sulciner et al, 2018 ). Cross-talk between the cellular responses to DNA damage, RNA processing, and the extracellular vesicles mediate metastasis ( Meng, Yang, & Camp, 2019 ). Thus, differentiating between genotoxic and non-genotoxic mechanisms emphasizing the critical role of the tumor microenvironment including cancer stem cells (or tumor initiating cells), circulating tumor cells, inflammation and angiogenesis are critical for tumor initiation, tumor promotion, tumor dormancy escape and tumor progression ( Alitalo et al, 2013 ; Balkwill, Charles, & Mantovani, 2005 ; Fujiki, Sueoka, & Suganuma, 2013 ; Hanahan & Coussens, 2012 ; Hanahan & Folkman, 1996 ; Hanahan and Weinberg, 2000 , Hanahan and Weinberg, 2011 ; Trosko, 2001 ).…”