Disseminated metastatic cells that intravasate into circulation (called circulating tumor cells or CTCs) are expected to have poor survival rates due to lack of matrix adhesion, increased fluid mechanical stresses of blood circulation and action of immune cells. Yet, some of these cells are found to effectively avoid anoikis, undergo epithelial-to-mesenchymal transformation en route to intravasation, avoid immune surveillance in circulation and undergo arrest or adhesion at distal site vasculature to form metastatic colonies.

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