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. Author manuscript; available in PMC: 2012 Jul 18.
Published in final edited form as: Adv Drug Deliv Rev. 2011 Jun 2;63(8):568–581. doi: 10.1016/j.addr.2011.04.008

Figure 3. The metastatic cascade.

Figure 3

Malignant tumor cells become mobilized and invade the local microenvironment (1a) and intravasate into the tumor vasculature (1b). Circulating tumor cells travel to a secondary tissue (bone) via the blood supply (2) and arrest in the venous supply of the recipient organ (3). Arrested cells subsequently extravasate (4) and invade the bone microenvironment (5). Within the bone, tumor cells can enter a protective niche where it remains as occult or dormant disease. When the tumor cell engages a favorable microenvironment it can engage the osteoblasts and initiate a feed-forward loop (vicious cycle) that promote growth in further infiltration of the bone microenvironment (6).