Lymph node metastases. Indicators, but not governors of survival

B. Cady

Regional lymph node filter function has traditionally been assumed to be critical in the prevention of the systemic spread of malignant cells shed from the primary cancer. However, in a multitude of clinical studies involving a variety of cancers, prophylactic removal of such regional lymph nodes, with or without metastases, does not improve cure rates compared with the observation of these lymph nodes. Furthermore, laboratory studies indicate that lymph node filter function may not be either complete or effective, and that many lymphatic and lymphaticovenous shunts exists that bypass regional lymph nodes and allow both lymphatic and hematogenous dissemination of malignant cells. These facts emphasize that regional lymph node metastases are indicators, but not governors, of survival in cancer. The timing of the clinical appearance of regional lymph node metastases and their number are, with few exceptions, excellent indicators of the biologic behavior of the primary cancer and the cells that are shed from it. This shedding of cells into the vascular and lymphatic vessels undoubtedly occurs simultaneously in the vast majority of cancers, but the later progressive growth of cells and micrometastases distributed hematogenously to vital organs is the ultimate governor of survival.

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

No Therapeutic Effect of Extended Lymph Node Dissection for Gastric Cancer
Lee
JCO 2005;23:1592-1593.
FULL TEXT  

It Is Still Not the Time to Change Surgical Strategy for Gastric Cancer
Lee et al.
Ann. Surg. Oncol. 2005;12:194-196.
FULL TEXT  

The Gastric Cancer Treatment Controversy
van de Velde and Peeters
JCO 2003;21:2234-2236.
FULL TEXT  

The Time Has Come to Change the Algorithm for the Surgical Management of Early Breast Cancer
Hansen et al.
Arch Surg 2002;137:1131-1135.
ABSTRACT | FULL TEXT  

Detection of Locoregional and Distant Recurrences in Breast Cancer Patients by Using FDG PET
Eubank et al.
RadioGraphics 2002;22:5-17.
ABSTRACT | FULL TEXT  

Radioguided Sentinel Lymph Node Biopsy in Breast Cancer Surgery
Mariani et al.
JNM 2001;42:1198-1215.
ABSTRACT | FULL TEXT  

Detection of Disseminated Colorectal Cancer Cells in Lymph Nodes, Blood and Bone Marrow
Weitz et al.
Clin. Cancer Res. 1999;5:1830-1836.
ABSTRACT | FULL TEXT  

Extended Lymph-Node Dissection for Gastric Cancer
Bonenkamp et al.
NEJM 1999;340:908-914.
ABSTRACT | FULL TEXT  

Sentinel node biopsy in breast cancer
Dixon
BMJ 1998;317:295-296.
FULL TEXT  

Guanylyl cyclase C is a selective marker for metastatic colorectal tumors in human extraintestinal tissues
Carrithers et al.
Proc. Natl. Acad. Sci. USA 1996;93:14827-14832.
ABSTRACT | FULL TEXT