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. 2018 Jan 22;4:76. doi: 10.3389/fsurg.2017.00076

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Copyright © 2018 Humphries, Wickremesekera, Marsh, Brasch, Mehrotra, Tan and Itinteang.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

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A schema proposing that cancer stem cells within the primary colorectal cancer undergo epithelial-mesenchymal transition and metastasize to the liver by seeding new tumors (metastases). These primitive cells can be identified by their expression of OCT4 which are present within the peritumoral stroma (A), or the lack of expression of OCT4 on the cancer stem cells within the tumor nests (B), and the downstream acquisition/loss of genes that results once the tumor has been seeded in the liver giving rise to the subpopulations seen in colorectal cancer metastasis to the liver.