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The Lymph Node as a Bridgehead in the Metastatic Dissemination of Tumors

  • Conference paper
Lymphatic Metastasis and Sentinel Lymphonodectomy

Part of the book series: Recent Results in Cancer Research ((RECENTCANCER,volume 157))

Abstract

The metastatic spread of tumors is not a random process. Distinct patterns of metastasis can be discerned which vary from tumor type to tumor type. A common pattern, particularly for carcinomas, is that regional lymph nodes are often the first organs to develop metastases. This pattern of metastasis is central to the utility of the sentinellymphonodectomy surgical technique. However, not all tumors and tumor types metastasize first to the regional lymph nodes. The mechanisms which determine whether regional lymph nodes or other sites first develop metastases remain poorly understood. In this article I review the anatomical, cellular and molecular factors which play a role in metastatic dissemination and determine patterns of metastasis. I then explore the importance of tumor heterogeneity and the selection of metastatically competent tumor cells during systemic dissemination, and suggest that some secondary sites are more readily colonised by metastasizing cells than others. Metastases at these sites act as bridgeheads, constituting a reservoir of tumor cells which, because they have already successfully metastasized, possess many of the properties required for metastasis to further sites. These tumor cells are therefore more likely than cells in the primary tumor to acquire all of the properties required for metastasis to less favourable secondary sites. To illustrate the bridgehead concept, I argue that features of the design and function of the lymphatic system make it highly amenable to the entry of metastasizing tumor cells and the formation of lymph node metastases, and suggest that lymph node metastases form a bridgehead for further metastatic spread.

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Authors and Affiliations

  1. Forschungszentrum Karlsruhe, Institut für Toxikologie und Genetik, Postfach 3640, 76021, Karlsruhe, Germany

    J. P. Sleeman

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  1. J. P. Sleeman
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  1. Klinik für Chirurgie und chirurgische Onkologie Robert-Rössle-Klinik, Universitätsklinikum Charité, Lindenberger Weg 80, 13122, Berlin, Germany

    Peter M. Schlag

  2. Istituto Europeo di Oncologia, Via Ripamonti 435, 20141, Milano, Italy

    Umberto Veronesi MD, PhD.

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© 2000 Springer-Verlag Berlin Heidelberg

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Sleeman, J.P. (2000). The Lymph Node as a Bridgehead in the Metastatic Dissemination of Tumors. In: Schlag, P.M., Veronesi, U. (eds) Lymphatic Metastasis and Sentinel Lymphonodectomy. Recent Results in Cancer Research, vol 157. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-57151-0_6

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  • DOI: https://doi.org/10.1007/978-3-642-57151-0_6

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-63070-5

  • Online ISBN: 978-3-642-57151-0

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