Tumor lymph node metastases staging

Formation of regional lymph node metastasis can be an important step in dissemination of cancer cells. In colorectal cancer, lymph node metastasis frequently occurs in patients (7, 8) and is an important factor in staging the disease. In particular, the metastatic lymph node ratio (LNR number of metastatic lymph nodes/number of examined lymph nodes) is predictive of overall survival (OS) and disease-free survival (DFS) in colorectal cancer patients (9, 10). Hence, an animal model of colorectal cancer with measurable lymphatic metastasis that allows for rapid evaluation of the effects of candidate treatment regimens on primary tumor growth and lymph node metastasis would be of great value. 

Fig. 7.2. Probability of lymph node metastasis by tumor stage...

The pathologic variables with known prognostic value are the presence of lymph node metastasis, tumor thickness, stage, grade, and lymphatic and venous embolization, pattern of invasion and vertical growth (Lopes et al. 2002 Ficarra et al. 2005 Guimaraes et al. 2006). 

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. 

Stage IIB, IIC, and III melanoma are considered to be high risk because of their potential for recurrence and distant metastasis. The primary treatment modality is surgical excision of the tumor and a lymphadenectomy for patients with positive lymph nodes. 

The TNM system standardizes the classification of tumors. The T stands for the stage of tumor (the higher the number, the worse the prognosis), the N stands for the number of lymph nodes that are affected by the tumor (again, the higher the number, the worse the prognosis), and M stands for the presence of metastasis (0 for none, 1 for the presence of metastatic cells). 

The most important determinant for outcome is accurate staging [10,36,37,81]. ESSCC should be assessed with regard to tumor margins and depth of tumor invasion in the bronchial wall. It is important to recognize the correlation between tumor size and nodal disease metastasis [83-86]. Involvement of lymph nodes precludes any curative treatment attempt with IBT alone [10,81,87]. Endobronchial... 

Pellegrini et al. (P2) reported that combining serum TIMP-1 levels with CEA measurements in patients with colorectal cancer was useful to predict prognosis. TIMP-1 levels have been reported to be more than 3-fold elevated in patients with Dukes D (stage IV) colorectal cancer as compared to healthy donors (H7). Similar increased levels of plasma TIMP-1 were found in patients with advanced breast cancer. Holten-Andersen et al. (H7) proposed that plasma measurements of TIMP-1 may be of value in the management of cancer patients. Yukawa et al. (Y9) further reported that the plasma concentration of TIMP-1 was increased in colorectal cancer patients with serosal invasion by tumor and metastasis to lymph node and liver. 

In patients with cancer, the demonstration or exclusion of lymph node metastases is an important component of tumor staging besides evaluation of local tumor extent and has crucial implications for the patient s prognosis and therapeutic strategy, especially when deciding on curative versus palliative treatment. CT, with its limited contrast resolution, cannot differentiate metastasis from normal lymph node tissue. Unfortunately, MRI is also not able to distinguish between benign and malignant lymph... 

---