Skip to main content
. Author manuscript; available in PMC: 2015 Mar 6.
Published in final edited form as: Cell Stem Cell. 2014 Mar 6;14(3):306–321. doi: 10.1016/j.stem.2014.02.002

Figure 1. Deadly seeds left behind in a typical course of metastatic cancer.

Figure 1

At diagnosis a primary tumor (a carcinoma of the lung or breast in this example) may have already seeded distant organs with cancer cells, including cells with tumor-initiating capacity that are defined here as metastatic stem cells (MetSCs). After diagnosis, the primary tumor may be removed by surgery and irradiation, and disseminated cancer cells may be eliminated by systemic chemotherapy, leading to a cure. Alternatively, residual MetSCs may remain in a latent state, eventually giving rise to overt metastasis. New rounds of therapy may then induce regression of the metastatic lesions, but chemoresistant MetSCs selected during each round of treatment may eventually give rise to uncontrollable metastasis. This process is responsible for 90% of deaths from cancer.