Circulating Tumor Cells | Dr. Dan Rubin | Ryan Sternagel

KEY TAKEAWAYS

1.

What are CTCs and what do they mean?

  • Cells from a collection of cancer cells, tumor or metastatic deposit
  • Sometime seen on scans but not always
  • Circulate in the blood or lymphatic tissues
  • Can only test for the CTC in blood. Need biopsy to detect in lymphatic tissue
  • The presence of CTCs doesn’t necessarily indicate metastatic cancer
  • CTCs don’t live very long in the blood – persistent CTC is cause for concernCancer spreads in two ways
  • Metastasize (means “evil spread”) – cells travel via blood vessels
  • Direct invasion – cells invade the tissues and then access lymphatic system or blood streamWhat to look for in CTC testing
  • Only available for certain cancers – ovarian, pancreatic, colon, lung, breast, prostate
  • Looking for two different populations of CTCs- cytokeratin(CK)-positive and CK-negative
    • ➔  CK is an anchor molecule for cells
    • ➔  CK-negative cells are cells that have down regulated their CK and can leave thetissue space to ‘circulate’ as a CTC
    • ➔  CK-positive cells are rarely found in CTC tests unless through trauma or if the tumor is invasive
    • ➔  CK-negative cells can revert back to CK-positive and “anchor in” to a new tissue site
  • Test results provide highly individual information about that person’s specific tumor
  • Can also see some markers you’d see on pathology specimens – things that sit on the surface of cells such as androgen and estrogen receptorsHosted By:

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  1. When to test for CTCs
    • At diagnosis and before treatment, when cancer is the highest
    • During treatment to gauge therapeutic response
    • Post treatment testing to determine if cancer is still present or to identify recurrences
  2. What to do with CTC test results
    • Depends on the patient – their history, the cancer, how aggressive, treatment proto- cols undertaken. Every situation/person is different
    • Run other lab tests to look at supporting factors in the blood and fix those: ➔ Inflammatory markers
      ➔ Cell markers
      ➔ Immune markers➔ Tissue markers

      ➔ Hormones

      ➔ Tissues at risk – liver, lung, bones

      ➔ Nutrient levels

      ➔ Vitamin D – 25-Hydroxy and 1,25-Dihydroxy

      ➔ Look at lifestyle – diet, toxins, air, water

    • Goal is to shut down the flow of CTC into the bloodCASE STUDIES / CLINICAL EXAMPLES / DIAGNOSES REFERENCED

      Breast cancer Colon cancer Lung cancer Ovarian cancer Pancreatic cancer Prostate cancer

      STUDIES / ARTICLES / CLINICAL TRIALS REFERENCED

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BOOKS REFERENCED

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SUPPLEMENTS REFERENCED

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THERAPIES REFERENCED

IV Vitamin C
IV Quercetin Mistletoe therapy

OTHER RESOURCES

Biocept

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