??the end of lymph node biopsy and lymphedema approaching???

[Lani]

ABSTRACT: Regional Lymph Node Metastases; a Singular Manifestation of the Process of Clinical Metastases in Cancer: Contemporary Animal Research and Clinical Reports Suggest Unifying Concepts [Annals of Surgery]
Research results from laboratory animals and human clinical reports provide insight into cancer cell disseminations and elaborate the complex metastatic cascade of cells into both regional lymph nodes and other distant organs. Critical appraisal of clinical trials indicates that lymph node metastases are themselves non-lethal, but indicate prognosis, confirming laboratory conclusions. Distant vital organ metastases can be resected with long term survival in highly selective situations, demonstrating metastatic specificity in oligometastatic disease.
Appreciating lymphatic system embryology, anatomy, and physiology is necessary for understanding lymph node metastases. The primary lymphatic system function was to return interstitial fluid to the circulation. Later evolutionary insertion of lymphocyte collections in lymph nodes interrupting lymph flow completed a system of analyzing external antigens to enable adaptive immunologic responses. Human cancers seldom elicit major immunological responses; they are not generally "foreign" enough. Therefore, lymphatic metastases have little meaning in evolutionary terms.
Organ specificity of both lymphatic and distant metastases occurs as metastatic cells lie dormant, but grow selectively only in liver, lung, bone, or lymph nodes. These organ specific metastatic cells have little ability to produce different organ site clinical metastases.
Thus, laboratory findings and clinical correlations emphasize that surgical lymph node removal should be de-emphasized or omitted. More physiological approaches to the highly manipulable multi-step processes of clinical metastases arising from host microenvironments will eventually prevail.

[Caroline UK]

Lani, thanks so much for posting this. Very interesting. I had to read it a few times, but I think I understand most of it now. I wondered, though, if you or anyone else might be able to make something clearer for me:

If this is saying that metastatic disease is organ-specific, and doesn't spread to other organs easily, why does it matter how many lymph nodes are found to contain cancer cells? My understanding is that anything over 4 lymph nodes is considered a higher risk for recurrence later. I had assumed that this was because it meant that the cancer was a particularly fast-growing or aggressive type. Is this saying that it doesn't spread from the lymph nodes? I.e. that for example, breast cancer cells may have metastasised to the liver, or brain, or bones, and may grow there, but won't spread to other organs?


Hope my question makes sense to someone!

[tousled1]

I too had to read the article several times. I had 26 nodes remove 14 of which were positive. I was old tht with having so many positive nodes increased my chances of mets. Does this aticle contradict this?