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The important point is that the surface area to the volume ratio gets smaller as the cell gets larger. Thus, if the cell grows beyond a certain limit, not enough material will be able to cross the membrane fast enough to accommodate the increased cellular volume. When this happens, the cell must divide into smaller cells with favorable surface area/volume ratios, or cease to function. That is why cells are so small.
Pieces of the instructions on the genes can get knocked out or changed. When this occurs during the process of cell division, when the DNA is being copied to the new cell, a mutation occurs. If the mutation occurs in the wrong place -- in an active gene, for instance -- it can result in one of two things. It can disrupt the function of the cell, causing it to die. Or it can cause the cell to begin dividing wildly and become a cancer.