肿瘤与其对应的正常组织相比表现出显著的代谢改变。这些代谢改变可以支持合成性生长，在恶劣环境下生存并调节促进恶性进展的基因表达方案。这些代谢变化是否在恶性转化期间被选择，或者它们自身就是肿瘤启动的驱动因素仍不清楚。然而令人感到困惑的是，在肿瘤启动的许多关键环节 - 控制细胞命运、生存和增殖 - 都可以通过代谢调节进行调节。在本文中，我们回顾了证据，证明代谢途径在支持肿瘤发展的最早阶段的过程中扮演了关键角色。我们讨论了细胞内因素，如起源细胞或转化致癌基因，以及细胞外因素，如局部养分供应，如何促进或抑制肿瘤启动。更深入地了解代谢途径如何控制肿瘤启动将提高我们设计代谢干预以限制肿瘤发生率的能力。© 2022. Springer Nature Limited.

Tumours exhibit notable metabolic alterations compared with their corresponding normal tissue counterparts. These metabolic alterations can support anabolic growth, enable survival in hostile environments and regulate gene expression programmes that promote malignant progression. Whether these metabolic changes are selected for during malignant transformation or can themselves be drivers of tumour initiation is unclear. However, intriguingly, many of the major bottlenecks for tumour initiation - control of cell fate, survival and proliferation - are all amenable to metabolic regulation. In this article, we review evidence demonstrating a critical role for metabolic pathways in processes that support the earliest stages of tumour development. We discuss how cell-intrinsic factors, such as the cell of origin or transforming oncogene, and cell-extrinsic factors, such as local nutrient availability, promote or restrain tumour initiation. Deeper insight into how metabolic pathways control tumour initiation will improve our ability to design metabolic interventions to limit tumour incidence.© 2022. Springer Nature Limited.