Lymphatic metastasis

Introduction Lymphatic metastasis is the most common form of metastasis of cancer. It refers to the invasion of tumor cells through the lymphatic wall. After shedding, the lymph fluid is brought to the lymph nodes of the confluence area, and the same tumor is grown as the center. Lymph node metastasis usually begins with the first set of lymph nodes closest to the tumor, and then to the distant distance. When the tumor cells infiltrate and grow at each station, they also spread to adjacent lymph nodes in the group. However, there are exceptions. In some patients, it is also feasible to bypass the lymph nodes in the pathway to directly transfer to distant lymph nodes. The mode of clinical transfer is called a jump transfer. These features increase the complexity of tumor metastasis, resulting in clinical lymph node metastasis that is difficult to find the primary lesion.

Cause

Pulmonary metastases are metastasis of malignant tumors in other parts of the body, which can be by blood dissemination, lymphatic metastasis or direct invasion by adjacent organs. It is more common in choriocarcinoma and breast cancer, followed by malignant soft tissue tumor, liver cancer, osteosarcoma and pancreatic cancer; thyroid cancer, kidney cancer, prostate cancer and renal embryo cancer.

Lymphatic metastasis is mostly transferred from the blood to the pulmonary arterioles and capillary beds, and then invades the bronchial perivascular lymph nodes through the blood vessel wall. The cancer cells proliferate in the lymphatic vessels and form multiple small nodular lesions. Often occurs in the perivascular stromal, interlobular septum and subpleural stroma, and spread in the lungs through the lymphatics. The primary disease in which the tumor directly metastasizes into the lung becomes a malignant tumor of the pleura, chest wall, and mediastinum. When the metastatic tumor of the lung is small, symptoms rarely occur, especially hematogenous metastasis, and blood in the cough and sputum is rare. A large amount of lung metastases can cause shortness of breath, especially lymphatic metastasis. It usually progresses quickly and progresses rapidly, and it quickly increases in a few weeks. Chest tightness or chest pain when pleural metastasis. Metastatic tumors in the lungs change rapidly, and tumors increase and increase in the short term, and some after primary tumor resection or after radiotherapy and chemotherapy. Sometimes it can be reduced or disappeared.

There are two ways to transfer along the lymphatic vessels, namely continuous diffusion and discontinuous diffusion. Continuous diffusion refers to the progressive proliferation of gastric cancer cells in the lymphatic vessels, which continuously spread along the lumen to the associated lymph nodes (or retrograde), reaching a certain distance or reaching the lymph nodes of the drainage area. Discontinuous diffusion refers to the fall of cancer cells into the lymphatic vessels, does not form a continuous line of cancer cells, floats or floats in the lymphatic lumen, or swims out of the lymphatic vessels in the form of amoeba-like movement, or It is the lymphatic flow that reaches the drainage in the lymphatic flow. The above two modes of diffusion are not isolated, especially in the lymphatic vessels, and sometimes only reach a certain distance, then the cancer cells fall into the lymphatics, and the diffusion is transferred in the second way.

Metastatic lymph nodes appear to be larger and stiffer than normal lymph nodes, and even several are fused together to form a massive mass. Most epithelial malignancies, such as various cancers, are prone to lymphatic metastasis.

Since the lymphatic vessels are ultimately connected to the blood vessels, the malignant tumor cells can enter the vein with the lymph fluid. Therefore, lymphatic metastasis will eventually lead to blood bank metastasis.

an examination

Related inspection

Lymphocyte transformation rate atypical lymphocyte tumor sentinel lymph node imaging

Check medical records, blood tests and chest X-rays to check the general health of the patient. The only way to make a positive diagnosis is to remove the swollen lymph nodes and examine those cells under the microscope. This procedure is called biopsy. It is a minor operation, usually performed under general anesthesia.

The tests to establish the stage of the disease include:

Blood test: During the treatment period, blood samples are taken regularly to check general health and cells in the blood.

Chest X-ray: Check for signs of disease spreading to the chest lymph nodes.

Bone marrow sample: In this test, a bone marrow sample is usually taken from the hip bone to check for any lymphoma cells.

Ultrasound scan: Ultrasound is used to depict images in the abdomen to check for any abnormalities. The examination is performed in the scanning department of the hospital.

CT scan (CAT scan): CT scan is another type of X-ray. Take multiple photos on the chest and abdomen and enter the computer to display detailed images of the body.

Differential diagnosis

Differential diagnosis of lymphatic metastasis:

1. Retrograde metastasis: Because there are channels that are consistent with each other in the draining lymphatic vessels of various regions of the gastric cancer, even under normal circumstances, there is a countercurrent, and in the lymphatic vessels or lymph nodes, the obstruction due to cancer metastasis is more likely to cause reflux. Therefore, retrograde metastasis of lymphatics is a common phenomenon in gastric cancer metastasis.

2. Jump transfer: Sometimes the lymphatic metastasis does not occur from shallow to deep, but does not go through the shallow lymph nodes and directly reach the deep lymph nodes via the lateral accessory. The presence of this condition suggests the need for clinicians to clear distant lymph nodes during surgery.

3. virchow metastasis: the upper abdominal organs, with the stomach and duodenum as the center, including the liver, pancreas, spleen, etc., are a lymphatic drainage unit, and are collected into the lymph nodes around the celiac artery. The lymph nodes of the group and the mesenteric lymph nodes (the terminal lymph nodes of the intestinal lymph) are injected into the intestinal lymphatics. The part of the intestinal lymph nodes communicates with the lymph nodes of the lumbar lymph nodes or the aorta. Most of the lymph fluid is injected into the thoracic duct through the chyle. There is a set of left supraclavicular lymph nodes in the left internal jugular vein injected into the thoracic duct. The metastasis of this group of lymph nodes is called virchow metastasis. This means that there may be extensive metastasis around the aorta along the retroperitoneum.

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