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| General history of cancer | Lymphatic metastases | |
The most deleterious effect of cancer is the development of metastases. This development is the logical consequence of the local invasion process that we described earlier. The same mechanisms are used by the cancerous cells to invade lymphatic and blood vessels, thus allowing distant metastases.
The lymphatic drainage of normal tissues explains the rapid invasion by tumour cells as soon as they reach the lymph wall. The cancer cells are carried away by the lymphatic flow towards the cortical sinus of the first lymph nodes. When the abnormal cells reach the node, a specific reaction is often observed, called non specific chronic lymphadenitis.
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When the cancer cells leave the initial tumour, they are drained along the flow of adjacent lymphatic vessels towards a satellite lymph node [1]. In the node, many situations may arise:
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In [5], on the contrary, the cancer cells multiply and totally invade the lymph node, giving it a typical neoplasic aspect (hard, painless, fixed node). This fixation to neighbouring tissue is due to the invasion of the node capsule [6]. The cancer cells can then migrate towards the next lymph node, giving birth to carcinomatous lymphangitis either following the normal flow [7] or against the current. [8] These lesions explain the lymphatic stase and oedema. |
The presence of lymphatic invasion on surgical resection specimens or, even worse, the presence of invaded lymph nodes are typical of an aggressive tumour. They are correlated with poor prognosis and prompt oncologists to prescribe adjuvant treatment (radiotherapy and/or hormonotherapy-chemotherapy).
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