The lack of a specific targeting strategy against cancer stem cells in current cancer treatment regimens is at least partly responsible for life-threatening cytotoxicity for patients undergoing traditional chemotherapy. An effective cancer stem cell targeting system is urgently required for the next generation of cancer medicine. Epithelial cell adhesion molecule (EpCAM) is overexpressed in most solid cancers and it has recently been identified as a cancer stem cell marker. In this study, we isolated a 40-base RNA aptamer that binds to EpCAM from a random oligonucleotide library using systematic evolution of ligands by exponential enrichment. The aptamer was further truncated to 19 bases. This 19-nt RNA aptamer interacts specifically with a number of live human cancer cells derived from breast, colorectal, and gastric cancers that express EpCAM, but not with those not expressing EpCAM, as analyzed using flow cytometry and confocal microscopy. The binding affinity of the EpCAM RNA aptamer to human cancer cells is approximately 55 nM. Importantly, this EpCAM RNA aptamer is efficiently internalized after binding to cell surface EpCAM. To our knowledge, this is the first RNA aptamer against a cancer stem cell surface marker being developed. Such cancer stem cell aptamers will greatly facilitate the development of novel targeted nanomedicine and molecular imaging agents for cancer theranostics. (Cancer Sci 2011; 102: 991-998) T he epithelial cell adhesion molecule EpCAM (also known as CD326 or ESA) is a pleiotropic molecule, capable of both promoting and preventing epithelial cell-cell adhesion.(1) It is a 30-40 kDa type I glycosylated membrane protein expressed at a low level in a variety of human epithelial tissues. EpCAM is overexpressed in most solid cancers.(2-4) For example, intense expression of EpCAM is found in more than 98% patients with colorectal cancer.(5) Two decades of studies have shed light on the roles that EpCAM plays in tumorigenesis. Rather than antagonising apoptosis, EpCAM acts by inducing proliferation with a direct impact on cell cycle control, upregulating the proto-oncogene c-myc and cyclins A and E, and signal transduction into the cell nucleus by way of the wnt pathway. (2,3,(6)(7)(8) Recently, it has been recognized that a small proportion of cancer cells possess unlimited proliferation potential and are able to self-renew and to generate differentiated cancer cell progeny. These so-called cancer stem cells (also known as cancer initiating cells) are resistant to chemotherapy and radiotherapy.(9) It is thought that cytotoxic drugs and radiation kill mainly the bulk tumor cells but spare the cancer stem cells and thus a cure or even long-term control of macroscopic solid cancers by chemotherapy is still an exception rather than the rule.(10) Therefore, in order to eradicate cancer, one must target and eliminate cancer stem cells.Epithelial cell adhesion molecule has been identified to be a cancer stem cell marker in a number of solid cancers, including breast cancer, (11) colorectal c...