Reactive oxidative species and cytokines formed as part of an inflammatory disease state can initiate oncogenesis, and conversely,[38] existing cancer can provoke an inflammatory response that allows the genetic transformation of a low grade malignancy into a high grade one.[39] These genetic influences are upregulated through transcription factors such as nuclear factor kB, signal transducer, and activator of transcription 3 and hypoxia inducible factor 1a.[40] As part of this process, downregulation of the adaptive immune system creates a self-perpetuating tumor stimulating environment. This evidence concerns the gene STAT3 and cancer.