Cancer

Tumors & Metastasis unlock

Level 7 unlock

Cancer unlocks for your whole save the first time any virus reaches skill-tree level 7. It's introduced with its own notice at the start of an organ in your next run, and that organ is guaranteed a tumor.

• In-game intro: most organs now grow a tumor that gets bigger, spreads to other rooms over time and sends assassins after you
• The Oncolytic Payload trait, the Oncolytic Strain and Carcinogen Exposure modifiers, the Strong p53 and BRCA host traits and the Metastatic Cancer condition only show up once cancer is unlocked
• Tumors appear in Infect Game Mode and Pandemic Game Mode
• No tumors in Endless Game Mode: they never grow, spread or send assassins there
• The first time you meet each cancer or assassin, a briefing card marked CANCER explains it

Tumor Room

Event room

The room where an organ's cancer grows. Its doors never lock, so you can always walk away mid-fight and come back later.

• After unlock, each organ has a 70% chance to grow one tumor room
• A tumor room is guaranteed after a metastasis, and with some modifiers, host conditions and city policies
• Shown in pink on the minimap
• Bigger than a normal room, and it swells 12% with every growth stage (up to 70% bigger)

Growth timer

Timer

While a tumor lives, a countdown at the bottom left shows when it will next grow or spread. Each tick it does one or the other, taking turns, growth first.

• Tick interval: 60s Nasal Passage, 57s Lungs, 54s Bloodstream, 51s Lymph Node, 48s Gut, 45s Liver, 42s Bone Marrow, 40s Brain
• Reads TUMOR GROWS IN m:ss or TUMOR SPREADS IN m:ss, plus stage x/y and spread x/y
• Turns red in the last 10 seconds
• Pauses while you fight inside an uncleared tumor room (TUMOR · fighting it)
• Stops once every tumor on the floor is dead, or it has used all its growth and spreads (TUMOR · fully grown)

Growth stages

Stages

Every growth tick makes the cancer a stage bigger: tougher, more crowded with satellite cells, and faster to attack.

• Maximum stage: Nasal Passage 3, Lungs 4, Bloodstream 5, Lymph Node 6, Gut 7, Liver 8, Bone Marrow 9, Brain 10
• Each stage: +30% health for the core and its starting cells
• Each stage: more satellites (nodules, blasts, clones, polyps, lobes or glial nodes)
• Each stage: attack timers 18% shorter (down to 30% of normal) and shots 12% faster

Spreading (local invasion)

Spread

Instead of growing, a tick can spread the cancer: it takes over an unexplored fight room or grows a whole new tumor room onto the map.

• Maximum spreads: Nasal Passage 1, Lungs 2, Bloodstream 3, Lymph Node and deeper 4
• Invading: an unvisited fight room becomes a tumor room, and its immune cells stay, all attacking at once around the tumor
• New room: the tissue buds a brand-new tumor room next to an existing room (never beside the boss)
• Each spread is another tumor you must destroy to fully clear the cancer
• Announced as THE TUMOR SPREAD

Leaving mid-fight

Persistence

Walk out of a tumor fight and your progress is kept: satellite cells you destroyed stay dead and the core keeps its damage.

• Destroyed nodules, leukemic blasts, lymphoma clones, polyps and glial nodes stay dead when you return
• The core comes back with the health it had when you left
• Liver lobes always grow back
• Growth while you're away still adds new satellite cells
• Pools, lesions and tendrils disappear when you leave

How tumor cells behave

Rules

Cancer cells play by their own rules: they never become elites, never lose track of you and never adapt to your build.

• Tumor cells never roll elite tiers or affixes
• Once alerted they never lose sight of you
• Killing tumor cells does not raise Detection
• They never turn into adapted Cytokine Storm cells
• CRISPR: tumor cores and the leukemic stem cell take 4x your damage per touch (up to twice a second) instead of being cut apart; other tumor cells are cut apart instantly

Nasopharyngeal Carcinoma

Organ 1 · Nasal Passage

A lumpy core ringed by satellite nodules that shield it and bud clone cells. Destroy the nodules, then the core.

• Hint: Destroy the nodules shielding the tumor, then the tumor itself
• 4 nodules at stage 1, +2 per stage (8 at stage 3)
• While any nodule lives, the core takes only 12% damage and looks faded
• Each nodule buds a fast clone cell every 4.5-6s (up to 10 alive, +3 per stage)

Lung Adenocarcinoma

Organ 2 · Lungs

A growing core that keeps healing and launches metastasis seeds. Any seed you don't shoot down takes root as a new nodule.

• Hint: Kill the growing tumor. Shoot down metastases before they take root
• 1 nodule at stage 1, +1 per stage
• The core regrows 0.6% of its health per second, plus that much again for every living nodule
• About every 3.6s it launches 2 metastasis seeds and fires a smaller volley

Leukemia

Organ 3 · Bloodstream

A crowd of white blast cells that keep dividing. One gold leukemic stem cell hides among them: kill it and the whole leukemia collapses.

• Hint: Cancer cells keep dividing. Find and kill the glowing stem cell
• 7 blasts at stage 1, +3 per stage
• Blasts divide every 6-9s, up to 26 at once
• The health bar counts the cells left (LEUKEMIA · N CELLS)

Lymphoma

Organ 4 · Lymph Node

A germinal centre in a crowd of identical lymphocytes. Most are harmless, but lymphoma clones hide among them, and the core is only soft while it swells to split.

• Hint: Clones hide among harmless lymphocytes. Hit the germinal centre while it swells
• 3 clones and 6 harmless lymphocytes at stage 1, +1 of each per stage (up to 8 clones and 10 lymphocytes)
• The germinal centre takes 40% damage, but 160% while swelling
• It swells about every 8.5s for 1.4s (SWELLING · HIT IT NOW), then splits into a ring of 16 shots and 2 more cells

Colon Carcinoma

Organ 5 · Gut

A shell game: the core hides down in one of several crypts, surfaces in another to fire, then dives again. Polyps on the walls drip caustic pools.

• Hint: The tumor hides in its crypts. Watch where it surfaces, and dodge the polyps' pools
• 4 crypts in a ring (5 from stage 3)
• It can't be hurt while down in a crypt
• When it dives, a ripple runs under the floor to its next crypt, plus a decoy ripple to another

Hepatocellular Carcinoma

Organ 6 · Liver

A liver tumor fed by satellite lobes through pulsing vessels. Kill every lobe before the first regrows and the core turns cirrhotic.

• Hint: It regenerates from its lobes. Kill every lobe before they regrow, then strike
• 3 lobes at stage 1, +1 per stage (up to 7); the bar reads FED BY N LOBES
• While any lobe lives, the core heals 2% of its health per second and takes half damage
• A destroyed lobe regrows after 9s

Multiple Myeloma

Organ 7 · Bone Marrow

A malignant plasma cell drifting in slow circles, firing spirals of Y-shaped antibodies that lock on to you and punching bone lesions into the floor.

• Hint: Dodge the antibody spirals when they lock on, and keep off the bone lesions
• The core drifts in a slow circle around the room
• Every 3.4s it takes turns between an M-protein spiral and bone lesions
• Starts with 1 myeloma clone (+1 per two stages) and buds another every 7s, up to 5 (+1 per two stages, max 8)
• Up to 9 stages and 4 spreads

Glioblastoma

Organ 8 · Brain

A brain tumor rooted among glial nodes. Tendrils creep across the floor at you, and the core hops between nodes. Cut the nodes down to strand it.

• Hint: Tendrils creep toward you and the core hops between nodes. Cut the nodes down
• 4 glial nodes at stage 1, +1 per two stages (up to 7); the bar counts NODES
• Tendrils creep out every 3.6s from the nearest node (2 nodes from stage 3), and from the core while it's rooted
• About every 7s the core moves to a new spot by a node and comes up firing pulse rings

Metastasis

Next organ

Leaving an organ with a living tumor carries the cancer into the next organ at the stage it reached.

• The leave prompt warns you: A tumor is still alive here: it will metastasize to the next organ at its current stage
• The next organ is guaranteed a tumor room at that stage
• It can still grow as many stages as that organ's own tumor could, on top of the ones it brought
• A METASTASIS banner announces it: stage X of Y, still growing

Radiation Therapy

50% after metastasis

Half the time after a metastasis, the host fights back with radiation: the tumor shrinks a stage, but it scorches you too.

• Comes a few seconds after the METASTASIS banner
• The tumor drops one stage (never below stage 1)
• You lose 20% of your max health (never lethal)
• Radiation sickness for 30s: you deal 20% less damage and move 10% slower

Assassin squads

After metastasis

A heartbeat warning, then a squad of nearly invisible cells that stalk you, mark a line and pounce.

• Only after a metastasis, while any tumor in the organ is alive
• First squad about 35s after you arrive; then every 30s, 3s sooner per growth stage (never under 14s)
• Never in a boss room or while you're fighting in a tumor room
• Warning: THEY'RE COMING, and a red heartbeat pulses three times at the screen edges

Squamous Stalker

Nasal Passage

A dart of layered keratin scales: the Nasal Passage cancer's assassin. It stalks nearly invisible, marks a line and pounces.

• The standard assassin: cloak, marked line, pounce
• Its bite marks you to take more damage

Lepidic Glider

Lungs

A lacy cell gliding on thin membrane wings. Its pounce glides further than the others, down a longer marked line.

• Marked line about 25% longer than other assassins'
• Its pounce lasts longer, so backing away doesn't save you: step sideways

Circulating Blast

Bloodstream

A blast cell bristling with needle-like Auer rods. The fastest assassin of all.

• Moves faster than any other assassin
• Its bite marks you to take more damage

Owl-Eye Mimic

Lymph Node

Instead of cloaking it looks like an ordinary lymphocyte, until it gets close and shows its owl-eyed twin nuclei and pounces.

• Never cloaked; it wears a harmless blue lymphocyte's face at range
• Shows its true face up close or when it strikes

Signet-Ring Burrower

Gut

A cell whose nucleus is squashed to the rim by mucus. Almost completely invisible at range, though a little slower than the others.

• Far harder to see at range than any other assassin
• The slowest assassin; watch for its marked line

Hepatoid Regenerator

Liver

A hexagonal cell threaded with green bile. Leave it alone for a moment and it heals itself.

• Starts healing 1.5s after you stop hitting it, at 5% of its health per second
• Once you start hitting it, don't stop

Lytic Stalker

Bone Marrow

A jagged bone shard. Where its pounce lands it punches a small bone lesion that hurts to stand in.

• Every pounce leaves a lesion for 3s
• Dodge the pounce, then step off the hole

Glial Infiltrator

Brain

A narrow cell trailing long, wavy processes. After its pounce it re-aims and pounces a second time, straight away.

• The second pounce comes after a short 0.3s wind-up down a new marked line
• Save your dash for the second pounce

Tumor destroyed

Payout

TUMOR DESTROYED: its dividing cells were a feast. Every cell of the tumor dies with the core and a pile of loot drops.

• Nucleotides: 30 in the Nasal Passage, 45 Lungs, 66 Bloodstream, 84 Lymph Node, 102 Gut, 120 Liver, 141 Bone Marrow, 165 Brain (before modifiers)
• +25% nucleotides for every growth stage
• A chest and a mutation orb
• Chaperones: 2 in the Nasal Passage, +1 per organ deeper (9 in the Brain)

Drops during the fight

Loot

Satellite parts pay a few nucleotides as you destroy them; the core pays only when the tumor collapses.

• Nodules, polyps, lobes and glial nodes drop a few nucleotides each
• Starting clone cells, blasts and harmless lymphocytes sometimes drop a few
• Cells budded mid-fight pay nothing

Oncolytic

Challenge

Destroy your first tumor.

• Destroy 1 tumor
• First step of a 3-step challenge ladder

Tumor Hunter

Challenge

Destroy 5 tumors.

• Destroy 5 tumors

Remission

Challenge

Destroy 20 tumors.

• Destroy 20 tumors
• Top step of the tumor challenge ladder

Cancer Day

Daily challenge

A daily challenge: destroy a tumor today.

• Destroy 1 tumor

Tumor Week

Weekly challenge

A weekly challenge: destroy 3 tumors this week.

• Destroy 3 tumors

Discover tumor rooms

Challenge

Exploration challenges can ask you to discover tumor rooms.

• Discover 1 tumor room, or several

Oncolytic Payload

Cancer trait

A Cancer trait from mutation orbs: deal more damage to tumors and all their cells, assassins included.

• Common +40%, Uncommon +52%, Rare +64%, Epic +80%, Legendary +100%, Mythic +128%, Prismatic +168%
• Picking it again stacks
• Offered only once cancer is unlocked, and less often than most traits
• Multiplies with other tumor-damage bonuses

Oncolytic Strain

Run modifier

A run modifier crafted between runs: tumors take double damage and pay out double, but every organ grows a tumor.

• Upside: tumors take 2x damage and pay 2x
• Drawback: every organ grows a tumor
• Cost: 25 A, 25 T, 12 shards, 2 chaperones
• In the Power-ups & tumors group

Carcinogen Exposure

Run modifier

A run modifier crafted between runs: tumors pay out triple, but grow twice as fast and start a stage bigger.

• Upside: tumors pay 3x
• Drawback: tumors grow twice as fast and start at stage 2
• Cost: 30 C, 15 G, 3 chaperones

Tumor Harvest

Modifier combo

Load Oncolytic Strain and Carcinogen Exposure together and destroying a tumor heals you fully.

• Needs Oncolytic Strain + Carcinogen Exposure

Cancer Cartel

Modifier combo

Oncolytic Strain, Carcinogen Exposure and Nutrient Cache together: tumors pay 50% more and destroying one heals you fully.

• Needs Oncolytic Strain + Carcinogen Exposure + Nutrient Cache

Metastatic Cancer

Host condition

The host is riddled with cancer: every organ grows a tumor that starts a stage bigger, grows faster and spreads twice more. Tumors pay out triple.

• Every organ guaranteed a tumor, starting at stage 2
• Tumors grow 50% faster and can spread 2 more times
• Tumors pay 3x, and the whole run pays +30%

Chemotherapy

Host condition

The drugs wipe out immune cells and shrink tumors, but poison you too.

• Tumors take 50% more damage
• Immune cells have 30% less health and hit 20% softer
• You have 20% less max health

Strong p53 Gene

Host trait (good)

A helpful host gene: p53, the guardian of the genome, slows tumor growth.

• Tumors grow 25% slower at the lowest tier, more on rarer hosts (up to 75%)

BRCA Mutation

Host trait (bad)

A harmful host gene found only in people: cells can't repair DNA, so cancers grow faster and spread further.

• Tumors grow 30% faster at the lowest tier, more on rarer hosts
• Tumors can spread one more time

Contingencia Ambiental

Pandemic city policy

Take Mexico City in Pandemic Game Mode and this policy puts a tumor in every organ, growing faster but paying double.

• A tumor in every organ
• Tumors grow 50% faster
• Tumors pay 2x

CRISPR vs. tumors

Power-up

While CRISPR is active, tumor cells you touch are cut apart, but cores and the leukemic stem cell resist.

• Ordinary tumor cells are cut apart instantly
• Tumor cores and the leukemic stem cell take 4x your damage per touch, up to twice a second