Planting spread

Introduction Implantation metastasis refers to a tumor in an organ in a body cavity. When the tumor spreads to the surface of the organ, the tumor cell can be detached, and the liquid in the body cavity is planted on the surface of other body cavity organs to form a metastatic tumor.

Cause

Direct spread can break through the serosa layer and invade neighboring organs such as liver, gallbladder, bladder, uterus, vagina, etc. Or cause intra-abdominal implantable dissemination.

an examination

Related inspection

Serum carcinoembryonic antigen carcinoembryonic antigen (CEA) laparoscopic blood routine

There are three types of planting methods commonly used for planting and disseminating.

(1) Abdominal implantation: When cancer cells invade the serosa, they can fall off the surface of other organs in the abdominal cavity, causing the abdominal cavity to spread. Abdominal implant metastasis is a complex biological process. The most common sites are omentum, mesenteric, bladder rectal recess, uterine rectal recess, etc., which are more common in the pelvic Douglas nest (rectal uterus depression); Induration, can also be widely planted in the abdominal cavity to form cancerous peritonitis.

(2) Intestinal cavity implantation: There are often detached cancer cells in the intestinal lumen near the colorectal cancer. When the mucosa is intact, the cancer cells will not grow, but if the intestinal mucosa is damaged, it can be planted in the damaged area. This may also be one of the causes of multiple lesions in colorectal cancer.

(3) Medical source planting: During the operation, it is implanted in the anastomosis and abdominal wall incision. Precautions should be taken during surgery to avoid it.

Differential diagnosis

1 Direct infiltration: Once the cancer occurs on the mucous membrane, it can infiltrate and grow in three directions on the intestinal wall: A. It grows around the circumference of the intestine, and it usually takes about one and a half years for the intestinal tube to be involved for one week. B. Longitudinal growth along the intestinal tube, generally the diffusion in the distal intestinal wall rarely exceeds 3 cm, and the vast majority is within 2 cm. C. Infiltration into the deep layer, the deeper the infiltration, the higher the chance of lymphatic and hematogenous metastasis. The rate of direct infiltration is related to the degree of malignancy of the tumor.

2 lymphatic metastasis: cancer cells undergo lymphatic metastasis by directly infiltrating the lymphatic vessels or infiltrating the lymphatic vessels through the extracellular space. The rectal lymphatic drainage above the peritoneal reflex is only upward, and the rectal lymphatic drainage below the reflex is mainly upward, and can also be turned to the sides, and only when the upward lymphatic drainage is blocked, it is reversed. These lymphatic drainage directions actually represent the direction of lymphatic metastasis of the tumor. The incidence of lymphatic metastasis is closely related to the extent, depth, tumor type and malignancy of cancer.

Fenoglo et al clearly pointed out that there is no lymphatic vessel in the colorectal mucosa, and lymph node metastasis does not occur when the cancer is confined to the mucosa. Lymphatic metastasis may occur only after the cancer invades the submucosa. Yu Baoming et al. studied the relationship between local infiltration and lymphatic metastasis of 886 cases of colorectal cancer, and found that there was no lymphatic metastasis in the tumor (Tis) confined to the mucosa; 6.98% lymph node metastasis in the invasive submucosal cancer (T1); There was 28.03% lymphatic metastasis in the infiltrating myometrium, and the lymphatic metastasis rate was as high as 42.86% when the highly malignant cancer invaded the muscular layer.

3 blood line spread: the rectal vein mainly flows to the portal system, so the liver is the most vulnerable organ. 10% to 15% of cases of colorectal cancer have liver metastases. There are many tumor cells that have metastasized to the liver, but most of the metastatic cancer cells are dormant, and only a few tumor cells develop into metastatic cancer. Metastatic cancer is mostly on the surface of the liver and is generally multiple. The lungs are the second most vulnerable organ. Others such as bones, brains, etc. can also metastasize. The incidence of hematogenous dissemination is closely related to the location of rectal cancer. The incidence of hematogenous dissemination of rectal cancer below the peritoneal reflex line is significantly higher than that of rectal cancer above the peritoneal reflex line. The closer to the anus, the higher the incidence of hematogenous dissemination. .

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