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. 2014 Dec;7(3):161-76.
doi: 10.1007/s12307-014-0164-4. Epub 2014 Dec 20.

Circulating Tumor Cells: Who is the Killer?

Patrizia Paterlini-Bréchot  1
Affiliations

Circulating Tumor Cells: Who is the Killer?

Patrizia Paterlini-Bréchot. Cancer Microenviron. 2014 Dec.

Abstract

This article is a critical note on the subject of Circulating Tumor Cells (CTC). It takes into account the tumor identity of Circulating Tumor Cells as cancer seeds in transit from primary to secondary soils, rather than as a "biomarker", and considers the help this field could bring to cancer patients. It is not meant to duplicate information already available in a large number of reviews, but to stimulate considerations, further studies and development helping the clinical use of tumor cells isolated from blood as a modern personalized, non-invasive, predictive test to improve cancer patients' life. The analysis of CTC challenges, methodological bias and critical issues points out to the need of referring to tumor cells extracted from blood without any bias and identified by cytopathological diagnosis as Circulating Cancer Cells (CCC). Finally, this article highlights recent developments and identifies burning questions which should be addressed to improve our understanding of the domain of CCC and their potential to change the clinical practice.

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Figures

Fig. 1
Fig. 1
Expected clinical utility of the field of Circulating Tumor Cells in subjects at risk of developing solid cancer (blue thick arrows on the left) and in patients with already diagnosed solid cancer (blue thick arrows on the right)
Fig. 2
Fig. 2
Types of circulating rare cells complicating the diagnosis of presence of tumor cells in blood. Circulating Cancer Cells (CCC) may contain tumor cells in Epithelial to Mesenchymal Transition (EMT) not expressing epithelial antigens. Circulating atypical and normal cells from organs express epithelial antigens but are not tumor cells
Fig. 3
Fig. 3
Summary of comparative studies targeting CTC detection by using ISET and CellSearch
Fig. 4
Fig. 4
Invasive, semi-invasive and non-invasive theranostic analyses rely on pathological and cytopathological identification of tumor cells
Fig. 5
Fig. 5
Different possible perceptions of “what is a Circulating Tumor Cell” according to “CTC test developers” and “CTC test users”
See this image and copyright information in PMC

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