Disseminated tumor cells: diagnosis, prognostic relevance, and phenotyping

Malignant tumors of epithelial tissue are the most common form of cancer and are responsible for the majority of cancer-related deaths in Western industrialized countries. As a result of progress in surgical treatment of these tumors, lethality is linked increasingly with early metastasis, which is generally occult at the time of primary diagnosis. The decision as to whether systemic adjuvant therapy should be applied for secondary prevention of metastatic relapse following resection of the primary tumor is based solely on the statistical prognosis. For this reason, the direct identification of minimal residual cancer is of particular importance. The studies described below demonstrate the utility of immunocytochemical and molecular analysis in the diagnosis and characterization of minimal residual cancer. These methods give access for the first time to this critical stage of tumor progression and also contribute to the development of new approaches to therapy aimed at preventing manifest metastasis.