Radiation Biology and Circulating Tumor Cells

The metastatic process is multifactorial, and the biological mechanisms and microenvironmental factors that drive tumor cells to leave the primary site and colonize distant secondary sites are areas of active research. An excellent 2017 review, "Emerging biological principles of metastasis," describes the known biological programs that promote the metastatic dissemination of cancer cells (1). Metastatic cells acquire genetic and epigenetic alterations and phenotypic changes that promote invasion into circulatory systems, a process described as epithelial-mesenchymal transition (2).

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