TWIST1 and neoplasm: Furthermore, early disseminated cancer cells (eDCCs) are cancer cells that disseminate from the primary tumor site before a tumor is detectable and one study found that Her2+ breast eDCCs exhibit a hybrid E/M phenotype, marked by decreased E-cadherin and high cytokeratin 8 and 18 (epithelial marks) expression and increased Twist1 and invasion [102].