Navigating circulating tumour cells and tumour microemboli: Where we stand in bridging their molecular dynamics with clinical translation

Abstract

Circulating tumour cells (CTCs) and circulating tumour microemboli (CTM) are key liquid biopsy biomarkers that reflect tumour invasiveness and metastatic potential. CTM, compared to single CTCs, exhibit greater heterogeneity, epithelial–mesenchymal plasticity, immune evasion, stemness and metastatic potential. Technological developments in microfluidics, nanomaterials, and biosensing have enabled high-sensitivity, label-free isolation and molecular classification of CTCs/CTM, simplifying real-time diagnosis, prognosis, and treatment monitoring. While promising, challenges such as heterogeneity, low abundance, and lack of standardization limit their clinical translation. Integrating robust, scalable enrichment and detection platforms with molecular profiling may unlock their full potential in oncology. Our present review provides a comprehensive and comparative investigation of CTC/CTM biology, highlights recent advancements in their isolation and detection technologies, underlines their growing role along with associated challenges in oncology and clinical management.