To form clinically evident metastases - the main cause of
death in cancer patients -, tumor cells (TC) must complete
a highly complex series of steps called the metastatic
cascade, including local invasiveness, intravasation,
circulation, adhesion and extravasation, survival, proliferation
and angiogenesis. Since failure of any one of
these steps results in metastatic failure, understanding
the metastatic cascade may guide us to new therapeutic
concepts. Here we review the role of specific TC adhesion
and migration processes for organ-selective metastasis
formation. TC adhesion in the microvasculature of
host organs is a specific and highly regulated process
mainly mediated by selectins for TC÷endothelial cell
binding and by integrins for TC÷extracellular matrix interactions.
Defined expression of the adhesion molecules
and their corresponding ligands in the host organs and
on the TC governs organ – selective non-random TC arrest.
TC motility and subsequent chemotactically guided
extravasation of adherent cells is the second rate-limiting
step in organ-specific metastasis formation. Only if cells
have completed adhesion and extravasation the growth
of micrometastases and finally clinically evident metastases
can occur.