Fig. 6 Schematic representation of EMT during the metastatic cascade.

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Fig. 6 Schematic representation of EMT during the metastatic cascade. Schematic representation of EMT during the metastatic cascade. Tumor cells can undergo gradual or full EMT (E, E/m, M/e, and M) that is associated with decreased proliferation, loss of EpCAM expression, and increased migration. In the metastatic cascade, M > M/e > E/m cells have increased ability to intravasate into the lymphovascular system. Once tumor cells intravasate into blood vessels, they are termed CTCs. E- and E/m-type CTCs have enhanced capacity to adhere, hence to extravasate into distant site. After homing into distant organs, including the bone marrow, systemic tumor cells are termed DTCs. E and E/m systemic tumor cells are associated with improved capacity in proliferation and metastatic outgrowth, and M/e- and M-type cells are related to long-term tumor recurrence. Xiao Liu et al. Sci Adv 2019;5:eaav4275 Copyright © 2019 The Authors, some rights reserved; exclusive licensee American Association for the Advancement of Science. No claim to original U.S. Government Works. Distributed under a Creative Commons Attribution NonCommercial License 4.0 (CC BY-NC).