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Unique patterns of metastases in common and rare types of malignancy
Author(s) -
Leong Stanley P.L.,
Nakakura Eric K.,
Pollock Raphael,
Choti Michael A.,
Morton Donald L.,
Henner W. David,
Lal Anita,
Pillai Raji,
Clark Orlo H.,
Cady Blake
Publication year - 2011
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.21841
Subject(s) - medicine , lymph node , malignancy , cancer , lymph , lymphatic system , melanoma , metastasis , stage (stratigraphy) , sentinel lymph node , breast cancer , oncology , pathology , cancer research , biology , paleontology
This review on the unique patterns of metastases by common and rare types of cancer addresses regional lymphatic metastases but also demonstrates general principles by consideration of vital organ metastases. These general features of successfully treated metastases are relationships to basic biological behavior as illustrated by disease‐free interval, organ‐specific behavior, oligo‐metastatic presentation, genetic control of the metastatic pattern, careful selection of patients for surgical resection, and the necessity of complete resection of the few patients eligible for long‐term survival after resection of vital organ metastasis. Lymph node metastases, while illustrating these general features, are not related to overall survival because lymph node metastases themselves do not destroy a vital organ function, and therefore have no causal relationship to overall survival. When a cancer cell spreads to a regional lymph node, does it also simultaneously spread to the systemic site or sites? Alternatively, does the cancer spread to the regional lymph node first and then it subsequently spreads to the distant site(s) after an incubation period of growth in the lymph node? Of course, if the cancer is in its incubation stage in the lymph node, then removal of the lymph node in the majority of cases with cancer cells may be curative. The data from the sentinel lymph node era, particularly in melanoma and breast cancer, is consistent with the spectrum theory of cancer progression to the sentinel lymph node in the majority of cases prior to distant metastasis. Perhaps, different subsets of cancer may be better defined with relevant biomarkers so that mechanisms of metastasis can be more accurately defined on a molecular and genomic level. J. Surg. Oncol. 2011;103:607–614. © 2011 Wiley‐Liss, Inc.