PROPOSED PhDs (15) MDs (7) MD/PhDs (6) All (28) Primary [P] y 12 7 6 25 Detachment [A] y 11 6.5 6 23.5 Invasion [I] y 10 5 3 18 Breach ECM [R] y 9 5 2.5 16.5 Intravasation [V] y 10.5 4 4 18.5 [B] = {I, R, V} y 9 4 2 15 Motility [O] y 9 6 2.5 17.5 Migration [T] y 9 6 4 19 [C] = {O, T} y 9 6 2.5 17.5 Extravasation [D] y 7.5 4 3.5 15 Colonization [L] y 13 8 6 27 Proliferation [X] y 13 6 5 24 Angiogenesis [S] y 12.5 6 4 22.5 [E] = {L, X, S} y 12 6 4 22 Micrometastasis [F] y 13 6 6 25 Macrometastasis [G] y 12 6 5 23 P --> A y A --> B y B --> C y C --> D y D --> E y E --> F y F --> G y {A, B, C} n 3 2 0 5 A --> C --> B --> E n 3 1 1 5 C --> {A, B} --> D n 1 1 0 2 {A, C} --> B --> D n 1 0 0 1 B --> D --> C --> E n 0.5 0 0 0.5 (vessel infiltration) [P] n 0 1 0 1 (interaction with stroma) [P] n 1 1 0 2 (events at primary) [P] n 1 0 0 1 (EMT starts) [A] n 0.5 0 0 0.5 (lymph- & angio- genesis starts) [A] n 0.5 0 0 0.5 (ECM remodelling) [A] n 2 0 0 2 (EMT) [B] n 0.5 0 0 0.5 (lymph- & angio- genesis) [B, D] n 0.5 0 0 0.5 (lymph- & angio- genesis) [C, E, F, G] n 1 0 0 1 (progressive growth) [E] n 2 0 0 2 {E1, E2, E3… En} = [E] n 1 0 0 1 (interactions with stroma) [F] n 1 0 0 1 (interactions with stroma) [G] n 2 0 0 2 (something happens to cell) (P, A) n 0 0 2 2 go somewhere (P, A) n 1 0 0 1 survival in circulation (C, D) n 2 1 1 4 energy pertubations (C, D) n 1 0 0 1 metastatic niche (D, E) n 1 1 0 2 trigger (D, E) n 0 1 0 1 angiogenesis (F, G) n 0.5 0 1 1.5 oligometastasis [X] && G --> X n 1 0 0 1 oligometastasis [X] && G --> X && (interactions with stroma) [X] n 1 0 0 1 oligometastasis [X] && wide metastasis [Z] && G --> X --> Z n 1 0 0 1 metastatic seeding (A, E) n 0 1 0 1 EMT starts (P, ) n 1.5 0 0 1.5 floating around (A, C) n 0 0 1 1 adhesion (A, E) n 1 0 0 1 angiogenesis ( , B) n 1 0 0 1 MET ( , E) n 1 0 0 1