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The identification of cancer stem cells in vivo and in vitro relies onspecific surface markers that should allow to sort cancer cells inphenotypically distinct subpopulations. Experiments report that sorted cancercell populations after some time tend to express again all the originalmarkers, leading to the hypothesis of phenotypic switching, according to whichcancer cells can transform stochastically into cancer stem cells. Here weexplore an alternative explanation based on the hypothesis that markers are notperfect and are thus unable to identify all cancer stem cells. Our analysis isbased on a mathematical model for cancer cell proliferation that takes intoaccount phenotypic switching, imperfect markers and error in the sortingprocess. Our conclusion is that the observation of reversible expression ofsurface markers after sorting does not provide sufficient evidence in supportof phenotypic switching.

Do cancer cells undergo phenotypic switching? The case for imperfect cancer stem cell markers