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A criticism of the haematogenous theory of cancer metastasis

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Summary and Conclusion

The arguments used to support the haematogenous theory of carcinomatous metastasis are as follows: (1) the presence of secondary deposits in the parenchyma of organs, (2) the distance at which the deposits may be found, (3) the invasion of distant parts in the absence of secondary deposits in the regional nodes of the primary tumour, (4) the discreteness of the deposits, (5) the bilaterality of most metastases of paired organs, (6) the multiplicity of metastases, (7) the presence of tumour cells in blood vessels, (8) the tendency to regional distribution of metastases to the liver in tumours of the portal area and to the lungs in extraportal tumours, (9) the invasion of the brain which is an organ reputed to have no lymphatics, and (10) the frequency with which lung cancer metastasizes to the brain. A critical examination reveals the assumptive nature of each of these concepts. It is shown that a lymphogenous theory of visceral metastasis is not invalidated by these assumptions. Perhaps a shift in emphasis from the haematogenous to the lymphogenous theory would resolve some present difficulties and open new prospects.

Zusammenfassung

Die Annahme einer vorwiegend hämatogenen Metastasierung maligner Geschwülste gründet sich auf folgende Befunde: 1. Nachweis von Metastasen in parenchymatösen Organen; 2. Nachweis von Fernmetastasen; 3. Nachweis von regionalen Lymphknotenfernmetastasen bei Fehlen von Nahmetastasen; 4. Nachweis von Gruppen von Kleinmetastasen im Versorgungsbezirk eines Gefäßes; 5. Bilateralität der Metastasen in paarigen Organen; 6. Multiplizität der Metastasen; 7. Nachweis von Tumorzellen im Blut; 8. Überwiegen von Lebermetastasen bei Primärgeschwülsten im portalen Einzugsgebiet, von Lungenmetastasen bei Primärgeschwülsten im cavalen Einzugsgebiet; 9. Nachweis von Gehirnmetastasen, einem Organ, von dem angenommen wird, daß es keine Lymphgefäße besitzt und nicht durch Lymphgefäße mit den übrigen Organen verbunden ist; 10. Häufigkeit von Gehirnmetastasen bei Lungencarcinomen.

Diese befunde sind nie auf ihre Beweiskraft für den hämatogenen Ursprung von Metastasen überprüft worden. Die Annahme einer lymphogenen Metastasierung in die visceralen Organe wird durch diese Befunde nicht entkräftet, sondern im Gegenteil würde die Annahme einer lymphogenen Metastasierung für sog. ungewöhnliche Metastaseformen die bessere Erklärung abgeben.

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  1. Department of Pathology, The University and Western Infirmary, Glasgow, Scotland

    Wilson I. B. Onuigbo

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  1. Wilson I. B. Onuigbo
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Onuigbo, W.I.B. A criticism of the haematogenous theory of cancer metastasis. Z Krebs-forsch 65, 30–36 (1962). https://doi.org/10.1007/BF00525991

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