Lymph node metastasis

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When lymph node metastasis ( LKM ) is defined as the Absiedelung ( metastasis ) of cancer cells in a lymph node .

A lymph node metastasis must be distinguished from malignant lymphoma (lymph node cancer), in which the cancer cells originate from the lymph node itself.

pathology

As a rule, metastases form first in the lymph nodes that are closest to the primary tumor . The reason for this is that the lymph fluid (lymph) of the organ affected by the primary tumor is first filtered by these lymph nodes. Via this lymphatic path, the tumor cells reach the lymph nodes, where they linger and proliferate . This growth of cancer cells in the lymph nodes also leads to enlargement of the affected lymph nodes.

The lymphatic metastasis is one of the regionären metastases. In contrast, there are distant metastases such as bone metastases , liver metastases or brain metastases . In turn, tumor cells can detach from lymph node metastases, enter the bloodstream and lead to distant metastases via hematogenous metastasis. However, some scientific studies speak against the fact that metastases can themselves metastasize.

The probability of metastasis in the lymph nodes depends on the density of the lymph vessels in the area of ​​the primary tumor. For example, hypopharyngeal or nasopharyngeal carcinoma metastasize extremely quickly to the nearby tissue areas rich in lymphatic vessels.

classification

Lymph node metastases are classified according to the TNM classification (T = tumor, N = nodes = lymph nodes, M = metastasis). Mean:

  • N0: no signs of lymph node involvement.
  • N1, 2 or 3: increasing lymph node involvement depending on the location of the primary tumor. Classification z. B. after ipsi- or contralateral involvement and mobility, as well as localization in relation to the primary tumor.
  • NX: no statements about lymph node involvement possible.

However, this classification depends on the type of primary tumor.

frequency

The likelihood of metastasis in lymph nodes depends very much on the nature of the primary tumor. In sarcomas , for example, lymph nodes are very rarely involved. With the much more common carcinomas - especially with particularly aggressive types - the probability is considerably higher. Above all, however, it depends on the local spread of the primary tumor, its depth of infiltration and the size of the tumor. 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 breast cancer , too, in the majority of cases the first metastases are found in the lymph nodes, namely in the axillary lymph nodes .

Clinical picture and diagnosis

Lymph node metastases are painless in most cases. In contrast, in lymphadenitis (inflammation of the lymph nodes), in which the lymph nodes are also enlarged, the lymph nodes are sensitive to pain. The enlargement of the lymph nodes, by sampling ( palpation be determined). Sonography (ultrasound) can be used as a further diagnostic procedure. In some cases, lymph node metastases are the first symptom of cancer.

Therapy and prognosis

Lymphadenectomy of a lymph node in the neck

As a rule, the lymph node metastases are treated together with the treatment of the primary tumor. If the primary tumor is operable, all lymph nodes in the lymphatic drainage area of ​​the diseased organ are often removed. This procedure is known as lymphadenectomy (removal of the lymph nodes). With the sentinel lymph nodes , some cancers, especially breast cancer and prostate cancer , have a different concept. The sentinel lymph node is the first lymph node in the drainage area of ​​the lymph from the tumor. 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 very controversial.

Chemotherapy initiated in addition to the operation can also have a positive effect on the eradication of the lymph node metastases. Targeted radiation therapy can be therapeutically useful.

The type of treatment of lymph node metastases originating from the radical removal to observing and waiting (watchful waiting) can range, has the long-term survival can not influence. In contrast, the number of affected lymph nodes in all carcinomas is an important prognostic factor. The prognosis worsens significantly in the presence of lymph node metastases. The course of the disease itself is primarily determined by distant metastases in other organs.

Web links

Individual evidence

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  8. ↑ Jürgen F. Riemann , Peter R. Galle, Wolfgang Fischbach: Gastroenterology in clinic and practice: The reference work for clinic and practice Volume 1: Intestinum. Georg Thieme Verlag, 2007, ISBN 978-3-13-158361-1 , p. 1798. limited preview in Google book search
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  12. ↑ M. Stuschke: Radiation therapy of lymph node metastases. In: The Urologist. Volume 48, Number 1, 2009, pp. 59-61. doi : 10.1007 / s00120-008-1762-x