Abstract
Circulating tumor cells (CTCs) and circulating tumor microemboli (CTM) have been shown to correlate negatively with patient survival. Actual CTC counts before and after treatment can be used to aid in the prognosis of patient outcomes. The presence of circulating tumor materials (CTMat) can advertise the presence of metastasis before clinical presentation, enabling the early detection of relapse. Importantly, emerging evidence is indicating that cancer treatments can actually increase the incidence of CTCs and metastasis in pre-clinical models. Subsequently, the study of CTCs, their biology and function are of vital importance. Emerging technologies for the capture of CTC/CTMs and CTMat are elucidating vitally important biological and functional information that can lead to important alterations in how therapies are administered. This paves the way for the development of a “liquid biopsy” where treatment decisions can be informed by information gleaned from tumor cells and tumor cell debris in the blood.
Highlights
Cancer remains a leading cause of death in all areas of the world [1]
The initial steps are understood to include the local invasion of the tumor into neighboring tissues followed by intravasation into the circulation, involving either the epithelial to mesenchymal transition (EMT) or the physical shedding of tumor cells into leaky, poorly formed vessels
Many technologies have reported on the capture of circulating tumor microemboli (CTM), but this novel approach enriches for them while allowing single Circulating tumor cells (CTCs) to pass through [89]
Summary
Cancer remains a leading cause of death in all areas of the world [1]. The primary cause of death is not the primary tumor but metastases. The initial steps are understood to include the local invasion of the tumor into neighboring tissues followed by intravasation into the circulation, involving either the epithelial to mesenchymal transition (EMT) or the physical shedding of tumor cells into leaky, poorly formed vessels. Both EMT and shedding lead to the dissemination of tumor cells into the lymphatic and hematogenic systems [2]. Detached cells are termed circulating tumor cells (CTCs) or, in the case of cell clusters, circulating tumor microemboli (CTM) These cells circulate until they either attach to the vessel endothelium or become lodged in small capillaries. The intent of this review is not to exhaustively catalog technologies, but to discuss the principles behind several stand-outs, the importance of CTC isolation in general, possible applications in functional studies and the clinical importance of CTCs in view of biology and new ideas in dissemination modality
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