ESMO E-Learning: Circulating Tumour Cells

Learning Objectives

  • To understand the role of circulating tumour cells (CTCs) and disseminating cancer cells (DCCs) in metastatic process
  • To learn about basic techniques for CTCs isolation, their molecular profile analysis, and predictive and prognostic characteristics
  • To discuss most important reports regarding implementation of CTCs in Biomarker studies and to correlate their molecular profiles with clinical data
Title Duration Content CME Points CME Test
Circulating Tumour Cells 43 min. 62 slides 1 Take Test
Nicola Normanno
Nicola Normanno
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antonella de luca
Antonella De Luca
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Tumour cell dissemination is an early event in tumorigenesis and is relevant for metastatic progression of solid tumours. Tumour cells that have been detached from a primary tumour can circulate in the bloodstream, in the case of circulating tumour cells (CTCs), or enter distant organs like the bone marrow, in the case of disseminated tumour cells (DTCs). Recent technical developments allow for detection and characterisation of these cells.

This E-Learning module elaborates on the importance of CTCs detection in solid tumours and methods for CTCs detection. Detection and characterisation of CTCs might provide new insights into the molecular mechanisms of tumour metastases. It might allow early detection of metastatic spread and CTCs levels seem to be correlated with the aggressiveness of the disease. In addition, CTC variation during treatment might reflect drug sensitivity.

Several different approaches can be used to detect, isolate and characterise CTCs, but this module focuses on the immunological methods and in particular on the identification and enumeration of CTCs with the CellSearch system. This system is apparently approved by FDA for the detection of CTCs in patients with metastatic breast, colon and prostate cancer. The module explains precisely how the system operates and how CTCs are identified and phenotypically differentiated. In addition, it provides essentials on staining patterns used in the interpretation of CTCs.

Clinical evaluation of CTCs has been performed in several tumour types. Currently, the most extensive evidence for their clinical utility is in metastatic breast, colon and prostate cancer and this E-Learning module extensively covers experience with CTCs in clinical studies for these tumour types. Furthermore, the module discusses CTC as prognostic Biomarker in small- and non-small cell lung cancer.

However, despite the acceptance of CellSearch technology in the research community, several questions remain open and the module critically covers such areas. It also provides future directions from the aspects of limited clinical utility in early-stage tumours, predictive role of CTC count, and Molecular profiling of CTCs.

This module summarises current evidence and experience with CTCs. Their detection might provide important prognostic information in metastatic patients with different cancer types. However, these data still need to be confirmed in large studies. CTCs variation following therapy might also provide predictive information that can be used for treatment decision. The prognostic value of CTCs in patients with limited disease is an interesting field of research. Molecular characterisation of CTCs can allow monitoring of the disease and increase our knowledge of the mechanisms underlying the development of metastases.

Last update: 28 January 2013

The authors have reported no conflicts of interest.