@JTT,
All of the above.
I don't know that 3rd and 4th level mutations are any more indicative of a malignancy than a 2nd mutation in some cases and an 8th or 9th in others. It's possible, but I don't think so. It all depends on how out of balance the cell replication cycle is with the b and t cells (specialized white blood cells) that are tasked with destroying them. That's the difference between aggressive cancers and cancers that are slower in developing/establishing. Even same-type cancers (breast cancer, for instance) can behave differently in different people. There are classes of cancers, grades within classes, hormone resistant and non-resistant... too many variables to draw any sweeping generalizations.
I've long believed that stress is a major contributor to whatever disease we are at risk to develop. I also think we are all at risk of some diseases over others (based on genetics, environment, etc.). I've known many people who suffered through an extremely stressful event (critical illness of a loved one, for instance) only to become ill themselves within a short time. Some folks/families are prone to heart attacks or ulcers while others are predisposed to cancers. Strokes and blood cancers (leukemia, multiple myeloma, other lymphomas) run in my family. I'll probably never have a heart attack. My B's family, on the other hand, is full of heart disease and there's no history of cancer. He'll probably never get cancer unless he gets exposed to high doses of benzene or some other highly carcinogenic substance.