Chromosomal instability in ETMRs is not directly associated to TP53 mutations as seen in other cancers [115], since only a small subset of cases with high levels of chromosomal instability have TP53 mutations, suggesting that other mechanisms may play a role in this, such as R-loops (as further discussed below), which have shown to be abundantly present in ETMRs [80]. Here, TP53 is linked to cancer.