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• W2354112854 abstract "Nodal status is the most important prognostic indicator for patients’ outcomes with solid cancer. The physiologic definition of a sentinel lymph node (SLN) by Morton et al (1) in 1992 ushered in a new era to target the SLNs for assessing the status of the draining nodal basin from the primary cancer site. Micrometastasis is a strong prognostic marker for melanoma (2) and breast cancer (3), but the therapeutic benefit of removing a positive SLN has yet to be demonstrated (2,4). The concept that, in general, cancer cells from the local tumor microenvironment spread to the regional SLNs first then beyond to the systemic sites, has been well established in melanoma and breast cancer and is being tested in other solid cancers including cancers of the head and neck, gastrointestinal tract, genitourinary tract, gynecological sites and the lung (5). The Nature milestones on cancer (http://www.nature.com/milestones/milecance r/timeline.html) have summarized major developments of cancer metastasis since the “seed and soil” theory of Paget (6). It is well accepted that cancer development is a genetically driven process with progression within the tumor microenvironment to distant body sites, often through the gateway of the SLNs. However, in a minority situation (~20% of the time), the cancer cells may spread through the blood vascular system to the distant sites bypassing the SLNs (5). Thus, cancer progression is most consistent with Hellman’s spectrum theory (7). This theory states that for any given malignant lesion, development of nodal and systemic metastasis from localized disease is a progressive process. The challenge is to identify patients with truly localized disease versus those patients with metastasis to the nodal and/or systemic sites. It is critical to understand the process of lymphangiogenesis and hemangiogenesis in the tumor microenvironment regarding the initial steps of cancer cells entering into the lymphatic and vascular systems (8-12). Furthermore, it is important to define the spread of cancer cells through the lymphatic system (incubator hypothesis) or simultaneously through the lymphatic and blood vascular system (marker hypothesis) (5,13) on a molecular basis so that rational therapy can be developed to curb the process of specific routes of metastasis. The melanoma model has been described to illustrate these patterns of metastasis (14). Whether the lymphogenous or hematogenous spread of cancer is independent or interconnected has not been conclusively determined to date. For these" @default.
• W2354112854 created "2016-06-24" @default.
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• W2354112854 date "2011-08-20" @default.
• W2354112854 modified "2023-09-28" @default.
• W2354112854 title "Editorial THE ROLE OF THE LYMPHOVASCULAR SYSTEM IN CANCER METASTASIS" @default.
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