Spontaneous immune responses to sporadic tumors: tumor-promoting, tumor-protective or both?

Cancer cells cannot develop into invasive cancers without interactions with cells and soluble mediators present in the tumor microenvironment. Accumulating evidence indicates that the immune system is a critical determinant of malignant outgrowth; however, the tumor-modulating effects of spontaneous immune responses towards nascent malignancies are rather paradoxical. Both cancer-protective and cancer-promoting features of the immune system have been described. This review will discuss the role of the dynamic inflammatory tumor microenvironment during cancer development and progression, and will focus on the intriguing question: "Do malignancies develop in spite of-or because of-spontaneous immune responses?" Special emphasis will be put on recent progress in our understanding of the immune system's double-edged sword function during de novo carcinogenesis.