Lymph node metastasis

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Lymph node metastasis is the spread (metastasis) of cancer cells into a lymph node.

Contents

Lymph node metastasis is different from malignant lymphoma. Lymphoma is a cancer of lymph node, rather than cancer in the lymph node, because lymphoma originates from the lymph node itself, instead of originating elsewhere (e.g., the breast or colon) and spreading to the lymph nodes.

Pathology

Histopathology of a lymph node with metastatic invasive ductal carcinoma from the breast, H&E stain, with the presence of extranodal (or "extracapsular") extension (arrows), as tumor outside the fibrous capsule of the lymph node. Histopathology of a lymph node with metastatic invasive ductal carcinoma from the breast.jpg
Histopathology of a lymph node with metastatic invasive ductal carcinoma from the breast, H&E stain, with the presence of extranodal (or "extracapsular") extension (arrows), as tumor outside the fibrous capsule of the lymph node.

Generally, metastases form first in the lymph nodes that are closest to the primary tumor. This is because the lymphatic fluid (lymph) of the cancerous organ or tissue flows first to these nearby lymph nodes. The tumor cells reach the lymph nodes via this lymphatic pathway, where they remain and proliferate. These spreading cancer cells grow in the lymph nodes, which causes the affected lymph nodes to get bigger.

Lymphogenic metastasis is a type of regional metastases. This is in contrast to distant metastases, such as bone metastases, liver metastases or brain metastases, which could come from any part of the body. Tumor cells that grown in the lymph nodes can later detach from the lymph node metastases, enter the bloodstream, and lead to distant metastases via hematogenous spread. [1] However, the science is not settled on this point, and there is disagreement about whether metastases can metastasize themselves. [2] [3]

The probability of metastasis in the lymph nodes depends on the density of the lymphatic vessels in the area of the primary tumor. For example, hypopharyngeal or nasopharyngeal carcinomas metastasize extremely quickly to the nearby tissue areas, which are rich in lymphatic vessels. [4] [ better source needed ]

Classification

Lymph node metastases are usually classified according to the TNM staging system (T = tumor, N = nodes = lymph nodes, M = metastasis). N0 means that there are no signs of lymph node involvement, and the numbers indicate increasing levels of spread to lymph nodes.

However, staging systems varies according the type of primary tumor. [5]

Frequency

The probability of metastasis to lymph nodes depends on the nature of the primary tumor. In the case of sarcomas, for example, lymph nodes are only very rarely affected. In the case of the much more common carcinomas, especially for the particularly aggressive types, the probability is considerably higher. Above all, however, it depends on the local spread of the primary tumor, its infiltration level, and the tumor size. In many carcinomas, the first metastases are found in the lymph nodes. These include, for example, pancreatic cancer, head and neck cancer and malignant melanoma. In the majority of breast cancer cases, too, the first metastases are found in the lymph nodes, specifically in the axillary lymph nodes.

Symptoms and diagnosis

Lymph node metastases are usually painless. This contrasts with lymphadenitis (inflammation of the lymph nodes, such as due to a viral infection), in which the lymph nodes are both enlarged and painful when pressed on.

Enlarged lymph nodes can be identified by palpation (pressing on the spots to feel lumps under the skin). Sonography (ultrasound) can be used as a further diagnostic method. In some cases, lymph node metastases are the first symptom of cancer.

Treatment

Lymphadenectomy of a lymph node in the neck Lymph node NPC.jpg
Lymphadenectomy of a lymph node in the neck

The treatment of the lymph node metastases is usually part of the treatment of the primary tumor. If the primary tumor is operable, all lymph nodes located in the lymphatic drainage area of the diseased organ are often removed. This procedure is called a lymphadenectomy (lymph node removal). With sentinel lymph nodes, a different concept is used in some cancers, specifically breast cancer and prostate cancer . The sentinel lymph node is the first lymph node in the drainage area of the tumor lymph. If this is not affected, the more distant lymph nodes are very likely tumor-free and do not have to be removed. The need to remove lymph node metastases is a controversial topic. [6]

Related Research Articles

<span class="mw-page-title-main">Lymph node</span> Organ of the lymphatic system

A lymph node, or lymph gland, is a kidney-shaped organ of the lymphatic system and the adaptive immune system. A large number of lymph nodes are linked throughout the body by the lymphatic vessels. They are major sites of lymphocytes that include B and T cells. Lymph nodes are important for the proper functioning of the immune system, acting as filters for foreign particles including cancer cells, but have no detoxification function.

<span class="mw-page-title-main">Metastasis</span> Spread of a disease inside a body

Metastasis is a pathogenic agent's spread from an initial or primary site to a different or secondary site within the host's body; the term is typically used when referring to metastasis by a cancerous tumor. The newly pathological sites, then, are metastases (mets). It is generally distinguished from cancer invasion, which is the direct extension and penetration by cancer cells into neighboring tissues.

<span class="mw-page-title-main">Sarcoma</span> Medical condition

A sarcoma is a malignant tumor, a type of cancer that arises from cells of mesenchymal origin. Connective tissue is a broad term that includes bone, cartilage, fat, vascular, or other structural tissues, and sarcomas can arise in any of these types of tissues. As a result, there are many subtypes of sarcoma, which are classified based on the specific tissue and type of cell from which the tumor originates. Sarcomas are primary connective tissue tumors, meaning that they arise in connective tissues. This is in contrast to secondary connective tissue tumors, which occur when a cancer from elsewhere in the body spreads to the connective tissue. Sarcomas are one of five different types of cancer, classified by the cell type from which they originate. The word sarcoma is derived from the Greek σάρκωμα sarkōma 'fleshy excrescence or substance', itself from σάρξsarx meaning 'flesh'.

<span class="mw-page-title-main">Carcinoma</span> Malignancy that develops from epithelial cells

Carcinoma is a malignancy that develops from epithelial cells. Specifically, a carcinoma is a cancer that begins in a tissue that lines the inner or outer surfaces of the body, and that arises from cells originating in the endodermal, mesodermal or ectodermal germ layer during embryogenesis.

The TNM Classification of Malignant Tumors (TNM) is a globally recognised standard for classifying the anatomical extent of the spread of malignant tumours (cancer). It has gained wide international acceptance for many solid tumor cancers, but is not applicable to leukaemia or tumors of the central nervous system. Most common tumors have their own TNM classification. The TNM staging system is sometimes referred to as the AJCC/UICC staging system or the UICC/AJCC staging system.

Cancer staging is the process of determining the extent to which a cancer has grown and spread. A number from I to IV is assigned, with I being an isolated cancer and IV being a cancer that has metastasized and spread from its origin. The stage generally takes into account the size of a tumor, whether it has invaded adjacent organs, how many regional (nearby) lymph nodes it has spread to, and whether it has appeared in more distant locations (metastasized).

This is a list of terms related to oncology. The original source for this list was the US National Cancer Institute's public domain Dictionary of Cancer Terms.

<span class="mw-page-title-main">Invasive carcinoma of no special type</span> Medical condition

Invasive carcinoma of no special type, invasive breast carcinoma of no special type (IBC-NST), invasive ductal carcinoma (IDC), infiltrating ductal carcinoma (IDC) or invasive ductal carcinoma, not otherwise specified (NOS) is a disease. For international audiences this article will use "invasive carcinoma NST" because it is the preferred term of the World Health Organization (WHO).

<span class="mw-page-title-main">Sentinel lymph node</span> First lymph node to receive drainage from a primary tumor

The sentinel lymph node is the hypothetical first lymph node or group of nodes draining a cancer. In case of established cancerous dissemination it is postulated that the sentinel lymph nodes are the target organs primarily reached by metastasizing cancer cells from the tumor.

<span class="mw-page-title-main">Papillary thyroid cancer</span> Medical condition

Papillary thyroid cancer is the most common type of thyroid cancer, representing 75 percent to 85 percent of all thyroid cancer cases. It occurs more frequently in women and presents in the 20–55 year age group. It is also the predominant cancer type in children with thyroid cancer, and in patients with thyroid cancer who have had previous radiation to the head and neck. It is often well-differentiated, slow-growing, and localized, although it can metastasize.

<span class="mw-page-title-main">Vulvar cancer</span> Cancer involving the vulva

Vulvar cancer is a cancer of the vulva, the outer portion of the female genitals. It most commonly affects the labia majora. Less often, the labia minora, clitoris, or vaginal glands are affected. Symptoms include a lump, itchiness, changes in the skin, or bleeding from the vulva.

<span class="mw-page-title-main">Supraclavicular lymph nodes</span> Organs in the neck

Supraclavicular lymph nodes are lymph nodes found above the clavicle, that can be felt in the supraclavicular fossa. The supraclavicular lymph nodes on the left side are called Virchow's nodes. It leads to an appreciable mass that can be recognized clinically, called Troisier sign.

Cancer of unknown primary origin (CUP) is a cancer that is determined to be at the metastatic stage at the time of diagnosis, but a primary tumor cannot be identified. A diagnosis of CUP requires a clinical picture consistent with metastatic disease and one or more biopsy results inconsistent with a tumor cancer

Uterine clear-cell carcinoma (CC) is a rare form of endometrial cancer with distinct morphological features on pathology; it is aggressive and has high recurrence rate. Like uterine papillary serous carcinoma CC does not develop from endometrial hyperplasia and is not hormone sensitive, rather it arises from an atrophic endometrium. Such lesions belong to the type II endometrial cancers.

<span class="mw-page-title-main">Spiradenoma</span> Medical condition

Spiradenomas (SA) are rare, benign cutaneous adnexal tumors that may progress to become their malignant counterparts, i.e. spiradenocarcinomas (SAC). Cutaneous adnexal tumors are a group of skin tumors consisting of tissues that have differentiated towards one of the four primary adnexal structures found in normal skin: hair follicles, sebaceous sweat glands, apocrine sweat glands, and eccrine sweat glands. SA and SAC tumors were regarded as eccrine gland tumors and termed eccrine spiradenomas and eccrine spiradenocarcinomas, respectively. However, more recent studies have found them to be hair follicle tumors and commonly term them spiradenomas and spiradenocarcinomas, respectively. Further confusing the situation, SA-like and SAC-like tumors are also 1) manifestations of the inherited disorder, CYLD cutaneous syndrome (CCS), and 2) have repeatedly been confused with an entirely different tumor, adenoid cystic carcinomas of the salivary gland. Here, SA and SAC are strictly defined as sporadic hair follicle tumors that do not include the hereditary CCS spiradenomas and heridtary spiradenocarcinoms of CCS or the adenoid cystic carcinomas.

Colon cancer staging is an estimate of the amount of penetration of a particular cancer. It is performed for diagnostic and research purposes, and to determine the best method of treatment. The systems for staging colorectal cancers depend on the extent of local invasion, the degree of lymph node involvement and whether there is distant metastasis.

<span class="mw-page-title-main">Lymphovascular invasion</span>

Lymphovascular invasion is the invasion of a cancer to the blood vessels and/or lymphatics.

Carcinoma of the tonsil is a type of squamous cell carcinoma. The tonsil is the most common site of squamous cell carcinoma in the oropharynx. It comprises 23.1% of all malignancies of the oropharynx. The tumors frequently present at advanced stages, and around 70% of patients present with metastasis to the cervical lymph nodes. . The most reported complaints include sore throat, otalgia or dysphagia. Some patients may complain of feeling the presence of a lump in the throat. Approximately 20% patients present with a node in the neck as the only symptom.

Mammary secretory carcinoma (MSC), also termed secretory carcinoma of the breast, is a rare form of the breast cancers. MSC usually affects women but in a significant percentage of cases also occurs in men and children. Indeed, McDvitt and Stewart first described MSC in 1966 and termed it juvenile breast carcinoma because an increased number of cases were at that time diagnosed in juvenile females. MSC is the most common form of breast cancer in children, representing 80% of childhood breast cancers, although it accounts for less than 0.15% of all breast cancers.

Papillary carcinomas of the breast (PCB), also termed malignant papillary carcinomas of the breast, are rare forms of the breast cancers. The World Health Organization (2019) classified papillary neoplasms of the breast into 5 types: intraductal papilloma, papillary ductal carcinoma in situ (PDCIS), encapsulated papillary carcinoma (EPC), solid-papillary carcinoma (SPC), and invasive papillary carcinoma (IPC). The latter four carcinomas are considered here; intraductal papilloma is a benign neoplasm. The World Health Organization regarded solid papillary carcinoma as having two subtypes: in situ and invasive SPC.

References

  1. Jörg R. Siewert: Chirurgie. 7. Auflage. Springer, 2001, ISBN 3-540-67409-8, p. 150. Lymph node metastasis at Google Books
  2. D. Hölzel, R. Eckel u. a.: Distant metastases do not metastasize. In: Cancer and Metastasis Reviews. Band 29, Nummer 4, Dezember 2010, ISSN   1573-7233, S. 737–750. doi:10.1007/s10555-010-9260-1. PMID 20878451. (Review).
  3. Tait, Catherine R; Dodwell, D; Horgan, K (May 2004). "Do metastases metastasize?". The Journal of Pathology. 203 (1): 515–518. doi: 10.1002/path.1544 . ISSN   0022-3417.
  4. Annelie Mehlhorn: Untersuchung zum Einfluss prognostischer Faktoren und therapeutischer Maßnahmen auf den Krankheitsverlauf von Patienten mit Rezidiven von Plattenepithelkarzinomen der Mundhöhle – dargestellt am Krankengut der Chemnitzer Klinik für Mund-, Kiefer- und Gesichtschirurgie von 1984–2000. Dissertation, Friedrich-Schiller-Universität, Jena 2008.
  5. Michael Reiß: Facharztwissen HNO-Heilkunde. Springer, 2009, ISBN 978-3-540-89440-7, p. 126–127. Lymph node metastasis at Google Books
  6. D. Hölzel, J. Engel: (PDF; 462 kB) In: Zentralbl Chir. 133, 2008, p. 582–589. doi:10.1055/s-0028-1098738