Lymph node involvement

Staging [determination of the primary tumor size, extent of lymph node involvement, and the presence or absence of metastases, or sometimes referred to theTNM system (Table 85-2)]. Many tumors are staged according to the TNM system. Metastases are cancer cells that have spread to sites distant from the primary tumor site and have started to grow. The most frequently occurring sites of metastasis are the brain, bone, liver and lungs. 

Lymph node involvement. Patients with node-positive disease have a worse prognosis. 

Metastatic spread can occur by local extension, lymphatic drainage, or hematogenous dissemination.17 Lymph node metastases are more common in patients with large, undifferentiated tumors that invade the seminal vesicles. The pelvic and abdominal lymph node groups are the most common sites of lymph node involvement (Fig. 89-1). Skeletal metastases from hematogenous spread are the most common sites of distant... 

IMA Any tumor thickness with no ulceration with one lymph node involved and micrometastases Or any tumor thickness with no ulceration with two to three lymph nodes involved and micrometastases 63-70% 57-63%... 

KM underwent surgical resection of the primary tumor, and an SLN biopsy was positive for lymph node involvement. A lymphadenectomy was performed. After extensive discussion with his oncologist, the decision was made to start KM on interferon-oc2b. 

Interferon-a2b has diverse mechanisms of action, including antiviral activity, impact on cellular metabolism and differentiation, and antitumor activity.42 The antitumor activity is due to a combination of direct antiproliferative effect on tumor cells and indirect immune-mediated effects.42 Interferon-a2b is currently approved by the Food and Drug Administration (FDA) as adjuvant therapy for patients who are free of disease after curative surgical resection but are at high risk of MM recurrence. This includes patients with bulky disease or regional lymph node involvement such as stage IIB, IIC, or III disease.43 It is controversial if interferon-a2b (IFN) should be offered as adjuvant therapy for every high-risk MM patient. The reason is because clinical trials with different doses of IFN have not proved definitively that IFN improves overall patient survival. 

Stage is based on the size of the primary tumor (T ), presence and extent of lymph node involvement (N1 3), and presence or absence of distant metastases (Mq ). Simplistically stated, these stages may be represented as follows ... 

Stage I Small primary tumor without lymph node involvement. 

The World Health Organization has established a TNM staging classification for lung cancer based on the primary tumor size and extent (T), regional lymph node involvement (N), and the presence or absence of distant metastases (M). 

Ewing s hypothesis may explain certain patterns of metastasis observed in humans, such as the colonization of regional lymph nodes from some primary cancer in humans. There are, however, human cancers that form distant metastases in a variety of organs without any evidence of local lymph node involvement. 

Sawyer TE, Bonner JA, Gould PM, et al. The impact of surgical adjuvant thoracic radiation therapy for patients with nonsmall-cell lung carcinoma with ipsilateral mediastinal lymph node involvement. Cancer 1997 80 1399-1408. 

Initial staging N-staging. Assessment of locoregional lymph node involvement and determination of the N-stage are the most important indications for [ F]-FDG-PET in patients with lung cancer. In comparison to CT, [ F]-FDG-PET proved to be significantly more accurate in nearly all of the adequately... 

In a meta-analysis, Westreenen et at. analyzed 12 studies concerning the diagnostic accuracy of [ F]-FDG-PET in staging the locoregional lymph node status [75]. The pooled sensitivity and specificity of [ F]-FDG-PET in detecting locoregional lymph node involvement were 51% and 84%, respectively. 

In summary, the value of p F]-FDG-PET for staging esophageal carcinoma mainly resides in better characterization of distant metastases (lymph nodes and organs). However, [ F]-FDG-PET should be regarded a supplemental procedure (e.g. in addition to CT), as it does not enable accurate determination of the local tumor extent and locoregional lymph node involvement. Furthermore, [ F]-FDG-PET plays an important role for the early response evaluation of tumors to neoadjuvant chemo- and radiochemotherapy (see section about therapy monitoring). 

Fig. 10.7. Survival curves for breast cancer patients without lymph node involvement. Those with DNA aneuploid tumors (as diagnosed by propidium iodide flow cytometry of 10-year-old paraffin-embedded material) survived significantly less long than those with DNA diploid tumors. Graph from Yuan et al. (1991).

M26. Mollejo, M., Lloret, E., Menarguez, J., Piris, M. A., and Isaacson, P. G., Lymph node involvement by splenic marginal zone lymphoma Morphological and immunohistochemical features. Am. J. Surg. Pathol. 21, 772-780 (1997). 

A variety of diseases affect the lymphatic system early in their time course. For example, many cancers spread by lymphatic dissemination, and HIV, fungal, and bacterial infections are located primarily in the lymph nodes. The high prevalence of lymph node involvement in disease is due to the role of lymphatic tissue in the provision of the body s immune response. Intralymphatic and interstitial administration are two efficient access routes. However, the oral route may also prove to be important for the lymphatic uptake of lipophilic drags and macromolecules. 

A simpler system is commonly used to compare treatments. Stage I includes tumors confined to the lung without lymphatic spread stage II includes large tumors with ipsUateral peribronchial or hUar lymph node involvement stage III includes other lymph node and regional involvement and stage IV includes any tumor with distant metastases. 

The following factors are decisive for the success rate (7.) age of the patient, (2.) distribution pattern and number of metastases, (3.) size of the largest metastasis, (4.) stage of primary tumour, (5.) extrahepatic metastases, (6.) lymph node involvement, (7.) respective value of the tumour marker, and (5.) intraoperative blood loss. (323)... 

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