Despite the use of modern high-resolution imaging technologies, it is not possible to detect tumor cell metastasis at a single cell level. To date, cancer treatment is initiated only after the clinical presentation of disease. This approach generally is unsuccessful and translates into the dogma that metastasis is a terminal process, generally viewed as fatal. Recent advances showing prolongation of survival in some tumor types and mitigation of clinical symptoms have stimulated both translational1 and clinical research to detect and characterize micrometastatic disease in the form of circulating tumor cells (CTCs)2 and disseminated tumor cells (DTCs),3 both of which are considered to be early accessible cellular determinants of subsequent overt metastasis. In this Commentary, we describe recent advances in CTC research, which raise the possibility that treatments with curative intent might be applied successfully to patients with micrometastatic cancer (ie, evidence of disease on a cellular level), thereby potentially preventing subsequent fatal metastatic disease.
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