Cancer is an extremely complex and heterogeneous disease that exhibits a high level of robustness against a range of therapeutic efforts. Robustness enables a system to maintain functionality in the face of various external and internal perturbations. Robustness is not an accidental property, but follows certain principles. It allows tumours to promote growth and survival in several ways. For example, heterogeneity among tumour cells provides a high level of redundancy, and hence increased chances of survival and growth; these benefits are further enhanced by feedback controls at the cellular level. Viewing cancer as a robust system may provide insight for the development of new drugs and therapies.

In general, carcinomas are heterogeneous and intrinsically redundant populations of cells, generated by transformations including diverse mutations in individual genes, mitotic recombinations, and the loss or gain of entire chromosomes (aneuploidy). This heterogeneous redundancy makes a tumour robust, because survival of any of these proliferating tumour cells allows the cancer to recur. Unfortunately, many anti-tumour drugs are mutagens, and so the diversity of mutations may be increased among surviving cells. In order to control this robustness, an effective therapy needs to reduce or at least avoid increasing this diversity.

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