Circulating tumor cell

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Circulating tumor cells (CTC) or circulating epithelial tumor cells (CETC) are cells that have detached from a primary tumor and entered the lymph vessels or circulated in the bloodstream . Since the primary tumors are epithelial tumors, one speaks of circulating epithelial tumor cells. Among the circulating tumor cells, there is a subpopulation that is able to repopulate in distant organs and grow new tumors called metastases , which is responsible for the vast majority of cancer-related deaths. The detection and analysis of CTCs can help assess patient prognoses at an early stage and find appropriate, tailored treatments.

CTCs were first observed in the blood of a man with metastatic cancer in 1869 by Thomas Ashworth, who postulated that "cells identical to those of cancer in the blood tend to shed some light on how multiple tumors develop that exist in the same person ". A thorough comparison of the morphology of circulating cells with tumor cells from different lesions led Ashworth to conclude that "One thing is certain, if they [the CTC] were from an existing cancerous structure, they must have passed through most of the cancerous cell's circulatory system to arrive at the internal saphenous vein of the healthy leg. "

The importance of CTCs in modern cancer research began in the mid-1990s with the evidence that CTCs exist early in the disease process. Modern cancer research has shown that CTCs are derived from clones in the primary tumor, confirming Ashworth's remarks. Significant efforts to understand the biological properties of CTC have shown that circulating tumor cells play a critical role in the metastatic spread of carcinoma.

However, circulating tumor cells from a simple blood sample do not only help in making a prognosis during cancer. They can also be used as reliable markers to test drugs for their effectiveness and to check therapy-relevant properties. In addition, highly sensitive single cell analyzes showed a high degree of heterogeneity at the single cell level. The CTC reflected both the primary biopsy and the changes in the metastases.

Tissue biopsies have serious diagnostic drawbacks: they are invasive, cannot be used repeatedly, and are ineffective in understanding the risk of metastasis, disease progression, and treatment effectiveness. CTCs, on the other hand, could therefore be viewed as a "liquid biopsy" that reveals the metastasis in action and provides live information on the patient's disease status. Blood tests are easy and safe to do, and multiple samples can be taken over time. In contrast, analysis of solid tumors requires invasive procedures that can limit patient compliance. The ability to monitor disease progression over time could make it easier to adjust a patient's therapy appropriately and potentially improve their prognosis and quality of life. An important aspect of being able to predict the future course of the disease is eliminating the need for surgery (at least temporarily) when the CTC repeats are low and not increasing.

Individual evidence

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  2. ↑ Gaorav P. Gupta, Joan Massagué: Cancer Metastasis: Building a Framework . In: Cell . tape 127 , no. 4 , November 2006, pp. 679–695 , doi : 10.1016 / j.cell.2006.11.001 ( elsevier.com [accessed August 5, 2019]).
  3. ↑ Kurt Lobodasch, Frank Fröhlich, Matthias Rengsberger, Rene Schubert, Robert Dengler: Quantification of circulating tumor cells for the monitoring of adjuvant therapy in breast cancer: An increase in cell number at completion of therapy is a predictor of early relapse . In: The Breast . tape 16 , no. 2 , April 2007, ISSN  0960-9776 , p. 211-218 , doi : 10.1016 / j.breast.2006.12.005 .
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  8. ↑ Katharina Pachmann: Current and potential use of MAINTRAC method for cancer diagnosis and prediction of metastasis . In: Expert Review of Molecular Diagnostics . tape 15 , no. 5 , April 5, 2015, ISSN  1473-7159 , p. 597-605 , doi : 10.1586 / 14737159.2015.1032260 .
  9. ↑ D. Marrinucci, K. Bethel, JM Fisher, D. Lazar, P. Kuhn: Bronchioloalveolar lung CTCs retain cytomorphologic features of primary tumor type . In: Journal of Clinical Oncology . tape 26 , 15_suppl, May 20, 2008, ISSN  0732-183X , p. 19118–19118 , doi : 10.1200 / jco.2008.26.15_suppl.19118 .
  10. ↑ Katharina Pachmann, Robert Dengler, Kurt Lobodasch, Frank Fröhlich, Torsten Kroll: An increase in cell number at completion of therapy may develop as an indicator of early relapse . In: Journal of Cancer Research and Clinical Oncology . tape 134 , no. 1 , July 5, 2007, ISSN  0171-5216 , p. 59-65 , doi : 10.1007 / s00432-007-0248-3 .
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  12. ↑ Stefan Sleijfer, Jan-Willem Gratama, Anieta M. Sieuwerts, Jaco Kraan, John WM Martens: Circulating tumor cell detection on its way to routine diagnostic implementation? In: European Journal of Cancer . tape 43 , no. December 18 , 2007, pp. 2645–2650 , doi : 10.1016 / j.ejca.2007.09.016 ( elsevier.com [accessed August 5, 2019]).
  13. ↑ DF Hayes, J. Smerage: Is There a Role for Circulating Tumor Cells in the Management of Breast Cancer? In: Clinical Cancer Research . tape 14 , no. 12 , June 15, 2008, ISSN  1078-0432 , p. 3646-3650 , doi : 10.1158 / 1078-0432.CCR-07-4481 .