Seeding of epithelial cells into circulation during surgery for breast cancer: the fate of malignant and benign mobilized cells

Abstract

Frequently before but regularly during surgery of breast cancer, epithelial cells are mobilized into circulation. Part of these cells, most probably normal or apoptotic cells, are cleared from the circulation as also shown to occur in benign conditions. After resection even if complete and of small tumors, cells can remain in the circulation over long times. Such cells may remain "dormant" but might settle and grow into metastases, if they find appropriate conditions, even after years.

Behavior of circulating epithelial tumor cells (CETC) and FISH (fluorescence <i>in situ</i> hybridisation) of epidermal growth factor receptor (EGFR)-gene amplification in lung cancer patients during the course of therapy

“…It had been shown already in previous analyses in lung [14] and breast cancer patients [15] that increasing cell numbers after surgery are correlated with a higher risk of relapse, that patients with a good initial response to neoadjuvant treatment have improved relapse free survival [27], as well as that a stable number of CETCs can be detected without disease recurrence even after several years [8].…”

“…Even therapeutic manipulation such as surgery can contribute to the seeding of epithelial cells [14,15]. These cells may, however, differ in their proliferative and metastatic potential [16,17].…”

Is there a measurable association of epidural use at cystectomy and postoperative outcomes? A population-based study

“…Early retrospective studies in breast, colon, and prostate cancer populations [13][14][15] reported improved recurrence-and metastasis-free survival in patients who received neuraxial analgesia. Despite these encouraging early findings and a plethora of basic science evidence to support the biologic plausibility, [16][17][18] more recent analyses have been less encouraging. 19,20 This phenomenon has not been specifically investigated in the RC population.…”

Circulating and Disseminated Tumor Cells in the Clinical Management of Breast Cancer Patients: Unanswered Questions

“…Subsequently, CETC numbers decreased, but sometimes cells remained in the circulation over long periods. This suggests that there are long-lived circulating breast cancer cells in peripheral blood [38]. However, this conclusion was questioned partly on the basis that epithelial cells detached from neighboring cells and stroma have been shown to enter an apoptotic program with a very short half-life [39].…”

“…By MainTrac analysis, Pachmann and colleagues [38] investigated the spreading of tumor cells (defined as circulating epithelial tumor cells, CETCs) before and after surgery. Surprisingly, CETCs were already present before surgery in all patients, and in the 3 or 4 days after surgical intervention they started increasing up to 1,000-fold.…”