How fast cancer grows varies hugely from one type to another: some cancers, such as Burkitt lymphoma, acute leukaemia and small cell lung cancer, grow very fast, and some tumours double in volume within a few days, whereas breast, prostate and bowel cancers more often grow over months or years [1, 7, 8, 9]. Most tumours have been in the body for several years by the time they are big enough to be found [1]. That is why the few weeks needed for tests and treatment planning are part of getting the right treatment; but extra delays, even of one month, are linked to a slightly higher risk [12].
Key points
- Cancer usually starts from a single cell, and it often takes several years before it is big enough to be found [1].
- Fast-growing cancers: Burkitt lymphoma, acute leukaemia, small cell lung cancer, testicular cancer and many childhood cancers [1, 7, 8, 9].
- Often slow-growing cancers: many breast, bowel and prostate cancers, and very small thyroid cancers [1, 5, 6].
- The higher a tumour's grade, the more likely it is to grow and spread quickly [10].
- Tests before treatment are necessary; but each month of avoidable delay in starting treatment is linked to a slightly higher risk [12].
How fast does cancer grow? What does "doubling time" mean?
Most tumours start from a single cell that divides again and again; they keep growing at a fairly steady rate for a long time [1]. Doctors measure the speed of growth by the "doubling time": the time it takes for the volume of a tumour to double [1]. In some cancers this is a few days, and in others a few months or years [1].
When the volume of a tumour doubles, its width grows by only about a quarter; that is why a small tumour can go unseen or unfelt for a long time. The speed of growth depends on the type of cancer and its grade: the more abnormal the cells look under the microscope (the higher the grade), the faster the cancer is likely to grow and spread [10]. Read more: What is cancer grade? and What is cancer and how does it start?
On how cancer spreads: What is metastasis?, cancer that has spread to the liver and cancer that has spread to the bones
How fast does cancer spread? Fast- and slow-growing cancers
| Cancer | Usual growth speed | Explanation |
|---|---|---|
| Burkitt lymphoma | Very fast | The fastest-growing human tumour known; with intensive chemotherapy, treatment results in children are excellent [8] |
| Acute leukaemia (such as acute myeloid leukaemia) | Fast (weeks) | Symptoms often appear 4 to 6 weeks before diagnosis, and without treatment it gets worse quickly [9] |
| Small cell lung cancer | Fast | Can spread early to other parts of the body [7] |
| Testicular cancer and many childhood cancers | Fast | The tumour volume may double within a few days [1] |
| Breast cancer | Usually months | Tumour volume usually doubles about every 6 months; triple-negative and HER2-positive types are faster [2] |
| Bowel cancer | Usually slow (years) | Mostly develops from a polyp over a number of years [1, 4] |
| Prostate cancer confined to the prostate | Often very slow | Most men, even without immediate treatment, had not died of this cancer 15 years later [6] |
| Very small papillary thyroid cancer (1 cm or smaller) | Often very slow or not growing | Over 10 years of monitoring, most did not grow [5] |
| Pancreatic cancer | Years before it is found, but then progressive | Its genetic changes begin ten years or more before it spreads [3] |
The figures and patterns come from studies of groups of patients and do not apply to every tumour.
How fast does breast cancer grow?
In a review of studies from the past 80 years, the volume of breast tumours usually doubled about every 6 months, and this speed has not changed over those years [2]. But not all breast tumours are the same [2]:
- Faster: triple-negative breast cancer (about every three and a half months), HER2-positive breast cancer (about every 5 months), and grade 3 tumours or tumours with a high Ki-67 (a marker that shows how fast cells are dividing)
- Slower: hormone receptor positive breast cancer (about every 8 months); more recent studies have also found tumours that barely grew at all
If you have found a lump in your breast, do not wait to see whether it grows; have it checked soon: I found a lump in my breast. What should I do? and At what age should I start mammograms?
How fast does colon cancer grow?
Many bowel cancers grow slowly [1], and most of them start from a polyp; polyps can turn into cancer over a number of years [4]. In a large German study based on the colonoscopies of more than 800,000 people, researchers estimated that even large or high-risk polyps (advanced adenomas) in 55-year-olds turn into cancer within 10 years in only about 1 in 4 people [4].
This gap of several years is an important opportunity: polyps can be removed during a colonoscopy before they become cancer. Read more: What are bowel polyps and are they dangerous?, At what age should screening colonoscopy start? and What does blood in the stool mean?
How fast does prostate cancer spread?
Many prostate cancers grow slowly [1]. In a large study in England of men with prostate cancer confined to the prostate, almost all of those who had regular monitoring instead of immediate treatment had not died of this cancer 15 years later [6]. However, in the group who were only monitored, the cancer progressed or spread more often than in the groups who had surgery or radiotherapy [6]; that is why the choice between monitoring and treatment should be weighed with your doctor based on the grade and features of the tumour. Read more: Can prostate cancer be cured? and Does a high PSA mean prostate cancer?
How fast does pancreatic cancer spread?
Pancreatic cancer is often found when it has already spread [3]. But a genetic study showed that it takes a long time to form: at least 10 years from the first genetic change to the first cancer cell, and then at least 5 more years before the cells gain the ability to spread [3]. The researchers see this long period as an opportunity to find the disease earlier [3]. Know the warning signs: What are the symptoms of pancreatic cancer?
How long can you have cancer without knowing?
Most tumours have a long silent period, and by the time they are found with today's methods, they have been in the body for several years [1]. This time differs for each cancer: in slow cancers such as prostate and bowel cancer it can be years [1, 4], whereas in acute leukaemia symptoms usually start only a few weeks before diagnosis [9].
Some cancers may even never cause a problem. In Japan, more than 1,200 people with very small papillary thyroid cancers (1 cm or smaller) were monitored with ultrasound instead of having immediate surgery; after 10 years, more than 9 in 10 had tumours that had not grown, and no one died of this cancer [5]. Read more: Thyroid nodules and TIRADS
For some cancers there are screening tests that are done before any symptoms appear: Which screening tests do I need? and What are the signs of cancer?
Is a 2 cm tumour big? What tumour size means
Tumour size is only one of the things that determine a cancer's stage; whether the cancer has reached the lymph nodes or distant parts of the body matters too, and what a given size means differs for each cancer [11]. For example, in breast cancer [11]:
- A tumour of up to 2 cm is in the smallest size group; if the lymph nodes are not involved and the cancer has not spread, it is stage 1.
- A tumour of more than 2 cm and up to 5 cm is in the second group, and one larger than 5 cm in the third.
Size alone does not show how fast a tumour is growing; its type and grade matter too [10]. Read more: What are the stages of cancer? and breast cancer staging calculator
Is it safe to wait a few weeks for tests? When is treatment urgent?
Before treatment, a biopsy, scans and sometimes genetic tests of the tumour are usually needed to choose the right treatment; this usually takes a few weeks. In slow-growing cancers, the tumour usually does not change much during this time [1, 2]. But in a study that combined data from more than a million patients, each 4-week delay in starting surgery, chemotherapy or radiotherapy was linked to a slightly higher risk of death [12]. So:
- Keep track of your tests and appointments and do not put them off.
- In fast-growing cancers, such as acute leukaemia, Burkitt lymphoma and small cell lung cancer, and in high-grade tumours, treatment usually needs to start sooner [8, 9, 10].
Read more: Complete, on-time treatment without breaks and How long do biopsy results take?
When should I call my doctor?
Do not wait to see whether a symptom gets bigger; see a doctor soon in these situations:
- Fever, severe tiredness, paleness, easy bruising or bleeding, or one infection after another that have come on over a few weeks; acute leukaemia can get worse quickly [9].
- A new lump or symptom that does not go away or keeps getting worse, such as a lump in the breast or neck, blood in the stool or unexplained weight loss: warning signs of cancer
- If you have been diagnosed with cancer, do not put off your treatment appointments [12].
Frequently asked questions
How much does cancer grow in a month?
How many years does it take for cancer to develop?
Why does cancer progress very quickly in some people?
Because the speed of growth depends on the type of cancer, its grade and the genetic features of the tumour; for example, in breast cancer, triple-negative and HER2-positive types usually grow faster [2, 10]. Fast growth does not always mean a worse outcome: some fast-growing cancers, such as Burkitt lymphoma in children, respond very well to treatment [8].
Can stress or eating sugar make cancer grow faster?
We have looked at these questions separately, based on the studies: Does stress cause cancer? and Does sugar make cancer grow?
Can a biopsy make cancer spread faster?
We have looked at this concern separately: Does a biopsy make cancer spread?
Tumour growth kinetics and treatment delay (for doctors)
For physicians
Tumour volume doubling time (TVDT). Testicular carcinomas, paediatric tumours and some mesenchymal tumours have TVDTs counted in days; breast, prostate and colon cancers are often slow-growing, with TVDTs of months or years. Most tumours start from a single cell, have a long subclinical period and are several years old when detectable with current methods [1]. In a systematic review of 16 studies, breast cancer DT was stable over 80 years at an average of 180 days; in the Ryu series, DT was 103±43 days for triple-negative, 162±60 for HER2-positive and 241±166 for ER-positive tumours (P<0.0001), and in the Förnvik series 296 days for grade 1, 352 for grade 2 and 105 for grade 3 [2].
Colorectal. In the German screening colonoscopy registry (840,149 people), the annual transition rate from advanced adenoma to cancer rose from 2.6% at 55 to 59 years to 5.6% (women) and 5.1% (men) at 80 years and older; the 10-year cumulative risk rose from 25.4% (women) and 25.2% (men) at 55 years to 42.9% and 39.7% at 80 years [4]. Pancreas. Based on genome sequencing of metastases, there was at least a decade between the initiating mutation and the birth of the non-metastatic founder clone, and at least 5 more years until the acquisition of metastatic ability; patients died an average of 2 years thereafter [3].
Indolent tumours. Low-risk PTMC under active surveillance (1235 patients): size enlargement ≥3 mm 8.0%, novel lymph node metastasis 3.8% and progression to clinical disease 6.8% at 10 years; no distant metastases or deaths from cancer; progression more frequent in younger patients [5]. ProtecT (1643 men, median follow-up 15 years): prostate cancer death 3.1% with active monitoring, 2.2% with prostatectomy and 2.9% with radiotherapy (P=0.53); metastases 9.4%, 4.7% and 5.0% [6].
Treatment delay (Hanna et al.). Meta-analysis of 34 studies (1,272,681 patients, 17 indications in bladder, breast, colon, rectal, lung, cervical and head and neck cancers): HR for death per 4-week delay 1.06 to 1.08 for surgery (colectomy 1.06; 95% CI 1.01 to 1.12; breast surgery 1.08; 1.03 to 1.13), 1.01 to 1.28 for systemic treatment, and 1.09 (1.05 to 1.14) for radical radiotherapy for head and neck cancer [12].
Scientific evidence
Scientific evidence
2 itemsFifteen-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Prostate Cancer
Patient Age Is Significantly Related to the Progression of Papillary Microcarcinoma of the Thyroid Under Observation
Related cancer types
Related questions
References
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Numbers in the text, such as [1], refer to these sources. Sources with a “Study card” button are summarised in the site’s evidence library.
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