Cancer Genetics and Epigenetics 2024, Vol.12, No.5, 254-269 http://medscipublisher.com/index.php/cge 261 correlated with TNM staging, tumor size, and lymph node involvement, further validating their role as a prognostic marker (Pan et al., 2021). Clinical trials are also exploring the potential of CTCs in guiding treatment decisions and monitoring therapeutic response. For example, the detection of CTCs in patients undergoing adjuvant therapy has been associated with early identification of recurrence, allowing for timely intervention (Gazzaniga et al., 2012). These findings underscore the importance of incorporating CTC analysis into routine clinical practice to improve patient outcomes. Table 1 CTCs as Biomarkers for Colon Cancer Studies(Author , Year) Clinical relevance/value Prognostic significance of CTC count and characteristics Qi et al., 2018 CTCs undergoing EMT, identified by specific molecular markers, serve as prognostic markers linked to early recurrence and metastasis. Pan et al., 2021 The prognostic relevance of CTCs is supported by their correlation with TNM staging and other pathological features in CRC patients. Kahounová, Z.,2023 In CRC, retrospective studies link having over three CTCs with OS and PFS. Molecular profiling of CTCs Kantara et al., 2014 CTCs expressing CSC markers like DCLK1 and LGR5 in colon adenocarcinoma patients indicate their role in initiating metastatic tumors. Masuda et al., 2016 Detecting EMT markers in CTCs reveals their ability to evade immune surveillance and establish secondary tumors. Qi et al., 2018 Detecting CTCs in peripheral blood is associated with early-stage hepatocellular carcinoma, suggesting similar potential in colorectal cancer. Case studies and clinical trials Gazzaniga et al., 2012 Detecting CTCs in patients undergoing adjuvant therapy helps identify recurrence early, enabling timely intervention. Lu et al., 2017 A meta-analysis of 3,687 non-metastatic colorectal cancer patients highlighted the prognostic value of CTC detection, significantly associating it with disease progression and survival outcomes. Pan et al., 2021 A study of 149 colorectal cancer patients found that CTC counts correlated with TNM staging, tumor size, and lymph node involvement, validating their prognostic role. Abbreviations:CTC, circulating tumor cell; EMT, epithelial-to-mesenchymal transition; CRC, colorectal cancer; CSC,cancer stem cell 6 Advantages and Challenges of CTC-Based Diagnosis 6.1 Benefits of CTCs in non-invasive diagnosis 6.1.1 Minimally Invasive Nature Circulating tumor cells (CTCs) offer a minimally invasive method for cancer diagnosis and monitoring, as they can be detected in peripheral blood samples. This approach eliminates the need for more invasive procedures such as tissue biopsies, which can be painful and carry risks of complications. The ability to obtain diagnostic information from a simple blood draw makes CTC-based diagnostics particularly appealing for patients and healthcare providers alike (Paterlini-Bréchot and Benali, 2007; Marcuello et al., 2019; Sundling and Lowe, 2019). 6.1.2 Real-Time monitoring potential One of the significant advantages of CTCs is their potential for real-time monitoring of disease progression and treatment response. Since CTCs can be repeatedly sampled over time, they provide a dynamic view of the tumor's
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