Lymph nodes in surgical oncology:
Gespeichert in:
| Format: | Buch |
|---|---|
| Sprache: | English |
| Veröffentlicht: |
Philadelphia [u.a.]
Saunders
1996
|
| Schriftenreihe: | Surgical oncology clinics of North America
5,1 |
| Schlagworte: | |
| Online-Zugang: | Inhaltsverzeichnis |
| Beschreibung: | XIV, 214 S. Ill., graph. Darst. |
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| 245 | 1 | 0 | |a Lymph nodes in surgical oncology |c Roger S. Foster, guest ed. |
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Datensatz im Suchindex
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| adam_text | LYMPH NODES IN SURGICAL ONCOLOGY
CONTENTS
Foreword xi
Blake Cady
Preface xiii
Roger S. Foster, Jr
General Anatomy of the Lymphatic System 1
Roger S. Foster, Jr
Following a historic review of major discoveries about lymphatic
anatomy and physiology, the major methods of studying the lym¬
phatics are briefly reviewed. The general anatomy of the lymphat¬
ics, from lymphatic capillaries to collecting lymph vessels and
lymph nodes, to lymphatic trunks and terminal collecting ducts, is
reviewed.
The Pathobiology of Metastasis Within the Lymphatic System 15
Leonard Weiss
This article focuses on the pathobiology of lymphatic metastases.
The dynamics of metastasis within the lymphatic system are re¬
viewed. Topics discussed include lymphatic channels, lymphati
covenous communication, metastatic inefficiency (which is a driv¬
ing force in many aspects of the pathobiology of metastasis), and
lymphogenous and hematogenous metastasis.
Surgical Pathology of Lymph Nodes in Cancer Staging:
Routine and Specialized Techniques 25
Robert J. Siegel
The processing of lymph node bearing tissue for pathologic staging
follows relatively well accepted techniques for gross dissection and
SURGICAL ONCOLOGY CLINICS OF NORTH AMERICA
VOLUME 5 • NUMBER 1 • JANUARY 1996 V
microscopic examination. In addition, a variety of special tech¬
niques have been offered for increasing the sensitivity of detection
of metastatic disease, including xylene clearance, serial macro¬
scopic of microscopic sectioning, irnmunohistochemistry, and oth¬
ers. These techniques are presented with a consideration of the
expected increased yield or lymph node metastases. At present, the
biologic significance of occult micrometastases and submicro
scopic metastases is uncertain, and therefore, the role of these spe¬
cialized techniques in the routine evaluation of lymph nodes is
unclear.
The Gamma Probe Guided Resection of Radiolabeled Primary
Lymph Nodes 33
James C. Alex and David N. Krag
The histologic status of the first draining (primary) lymph node is
reportedly predictive of regional micrometastases in cutaneous
melanoma and carcinoma of the breast. We review our experience
with gamma probe localization and biopsy—an easy, accurate, and
minimally invasive technique by which the radiolabeled primary
lymph node is resected.
Thyroid Cancer Nodal Metastases: Biologic Significance
and Therapeutic Considerations 43
Stefan K. G. Grebe and Ian D. Hay
Lymph node metastases are common in papillary and medullary
thyroid cancer (about one third of patients at presentation) but are
rare in other types of thyroid malignancy. For papillary thyroid
cancers, lymph node metastases at presentation do not seem to
adversely effect survival but do increase the risk of locoregional
tumor recurrence. Primary treatment is removal of macroscopically
affected nodes at initial surgery, optionally supplemented with ad¬
juvant radioiodine treatment in an attempt to reduce recurrence
risk. Extensive lymph node dissection at presentation offers no ad¬
vantage (and may cause increased morbidity) in papillary carci¬
noma but may be useful in medullary thyroid carcinoma, where
nodal metastases seem to increase the risk of cause specific mor¬
tality. In all tumor types, postoperative nodal recurrences should
primarily be treated surgically.
Cervical Lymphatics and Squamous Cell Carcinoma of
the Head and Neck: Biologic Significance
and Therapeutic Considerations 65
Grant W. Carlson
Cervical nodal metastases are the single greatest prognostic factors
in head and neck cancer. Treatment has evolved largely through
vi CONTENTS
nonrandomized, retrospective trials and has been hampered by the
lack of effective systemic therapy. Modifications of the radical neck
dissection have reduced shoulder morbidity, and adjuvant radia¬
tion therapy has improved locoregional control.
The Biologic and Clinical Significance of Lymphatic
Metastases in Breast Cancer 79
Roger S. Foster, Jr
The best treatment approach for the regional lymph nodes in breast
cancer patients continues to undergo debate and reassessment.
Most patients with invasive breast cancers are currently being
treated by axillary dissections, in part because pathologic staging
of the axillary nodes is the most important prognostic factor in
patients with primary operable breast cancer and helps select pa¬
tients for systemic therapy. As is discussed in this article, however,
many factors are leading surgeons to become increasingly selective
in choosing patients for axillary dissection. Emerging technology
may soon lead to accurate axillary staging of many patients with¬
out full axillary dissection, and it is quite probable that the role of
axillary dissection will continue to be redefined during the next
few years.
Melanoma Nodal Metastases: Biologic Significance
and Therapeutic Considerations 105
Douglas Reintgen
Stimulated by novel lymphatic mapping techniques, the surgical
care of the melanoma patient is undergoing a change toward more
conservative nodal resections that promise to give equal staging
information without the added morbidity of more radical surger¬
ies. In addition, molecular biology techniques have been developed
to more accurately identify those patients with occult metastases,
compared with routine histologic examination. With effective ad¬
juvant therapies on the horizon, including the recently reported
trials using adjuvant interferon in high risk for recurrence mel¬
anoma patients, these assays become even more important in iden¬
tifying those patients that benefit the most from the protocols. A
more selective and rational approach to adjuvant therapy will ex¬
pose only those patients at a high risk for recurrence to the toxic
ities of the treatment.
Soft Tissue Sarcoma Nodal Metastases: Biologic Significance
and Therapeutic Considerations 121
Kristin A. Skinner and Frederick R. Eilber
Nodal metastases from soft tissue sarcomas are uncommon and
rarely represent an isolated site of spread. They occur almost ex¬
clusively in high grade lesions and are seen more commonly in
CONTENTS vii
certain histologic types of sarcomas. When lymph node metastases
do occur, they should be treated with lymph node dissection, and
consideration should be given to systemic therapy because nodal
metastases are usually markers for disseminated disease.
Gastric Cancer Nodal Metastases: Biologic Significance
and Therapeutic Considerations 129
Scott A. Hundahl
Stage migration as well as marked variation in stage distribution
confounds the direct comparison of survival rates associated with
varying degrees of lymphadenectomy for gastric cancer. Data from
prospective randomized trials document increased mortality and
morbidity associated with D 2 lymphadenectomy. Evidence for im¬
proved survival with D 2 lymphadenectomy comes from retro¬
spective and prospective nonrandomized studies that have yet to
be validated by any prospective randomized trial. Although it is
of value for accurate staging, D 2 lymphadenectomy has yet to be
proven therapeutically superior to D l resection.
Pancreatic Nodal Metastases: Biologic Significance
and Therapeutic Considerations 145
Charles J. Yeo and John L. Cameron
Characteristics of the resected tumor can be used to predict out¬
come in patients with adenocarcinoma of the head of the pancreas.
Multivariate analysis has determined that the most powerful in¬
dependent predictors of survival include ploidy, nodal status, mar¬
gin status, and tumor diameter. Standard pancreaticoduodenec
tomy (not radical or extended resection) remains the resection
strategy of choice. Improvements in overall outcome will likely
arise from more widespread use of chemoradiation therapy post
resection and from future developments in early detection and
antitumor therapies.
Gastrointestinal Endocrine Cancers and Nodal Metastasis:
Biologic Significance and Therapeutic Implications 159
Gary R. Peplinski and Jeffrey A. Norton
Lymph node involvement of gastrointestinal endocrine tumors
consists mainly of metastatic gastrinomas and carcinoids. Unlike
many other types of cancer, lymph node involvement alone, with¬
out hepatic or distant metastases, does not appear to negatively
influence survival for patients with these tumors. Surgery is the
only potentially curative treatment, and complete resection of all
tumors, including localized or regional nodal metastases, provides
the highest probability of cure. Surgery may also be the most ef¬
fective treatment for hepatic metastases if most or all of the tumor
can be resected.
Viii CONTENTS
Colon Cancer Nodal Metastasis: Biologic Significance
and Therapeutic Considerations 173
George W. Daneker, Jr and Lee M. Ellis
The controversy surrounding the extent of lymphatic resection for
colon carcinoma has spanned several generations of surgeons. At
present, two schools of thought exist: (1) lymphadenectomy is im¬
portant for staging and therapy, and (2) lymphadenectomy is pre¬
dominately useful for staging and prognosis but has minimal in¬
fluence on overall survival. In this article, we review colonic
lymphatic anatomy and pathology, methods of lymphadenectomy,
the results of extended and conservative lymphadenectomy, the
patterns of failure following colectomy, the adjuvant therapy of
regional nodal metastasis, the effect of colon cancer biology on
nodal metastasis, and the implications of nodal metastasis on tu¬
mor immunology. After review of data, we conclude with a state¬
ment of our current philosophy and recommendations for regional
lymph node resection in colon cancer.
Nodal Metastases in Rectal Cancer: The Role of Surgery
in Outcome 191
John K. MacFarlane
The role of lymph node metastases in rectal cancer, their preop
erative diagnosis, and their surgical and postoperative manage¬
ment are reviewed in this article. The results of traditional surgical
approaches with and without adjuvant radiotherapy (XRT) and
chemotherapy (CT) are detailed and contrasted with the results of
mesorectal excision (MRE) in the high risk patient with rectal can¬
cer. A proposal is presented for a clinical trial to incorporate the
improved surgical results of MRE on local, regional, and distant
recurrence with selected use of XRT or CT.
Anal Squamous Cell Cancer Nodal Metastases: Prognostic
Significance and Therapeutic Considerations 203
Alfred M. Cohen and W. Douglas Wong
Anal squamous cell carcinoma has three primary nodal drainage
patterns: the mesorectal nodes, the lateral hypogastric artery
nodes, and the inguinal nodes. The initial treatment of anal cancer
using chemoradiation should include all these areas within the ra¬
diation portals. Metachronous inguinal nodal metastases should be
resected because as many as one third of all patients with such
metastases can be salvaged.
Index 211
Subscription Information Inside back cover
CONTENTS ix
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| spelling | Lymph nodes in surgical oncology Roger S. Foster, guest ed. Philadelphia [u.a.] Saunders 1996 XIV, 214 S. Ill., graph. Darst. txt rdacontent n rdamedia nc rdacarrier Surgical oncology clinics of North America 5,1 Noeuds lymphatiques Lymph Nodes pathology Lymphknotenmetastase (DE-588)4168370-5 gnd rswk-swf (DE-588)4143413-4 Aufsatzsammlung gnd-content Lymphknotenmetastase (DE-588)4168370-5 s DE-604 Foster, Roger S. Sonstige oth Surgical oncology clinics of North America 5,1 (DE-604)BV007071205 5,1 HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=007093085&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
| spellingShingle | Lymph nodes in surgical oncology Surgical oncology clinics of North America Noeuds lymphatiques Lymph Nodes pathology Lymphknotenmetastase (DE-588)4168370-5 gnd |
| subject_GND | (DE-588)4168370-5 (DE-588)4143413-4 |
| title | Lymph nodes in surgical oncology |
| title_auth | Lymph nodes in surgical oncology |
| title_exact_search | Lymph nodes in surgical oncology |
| title_full | Lymph nodes in surgical oncology Roger S. Foster, guest ed. |
| title_fullStr | Lymph nodes in surgical oncology Roger S. Foster, guest ed. |
| title_full_unstemmed | Lymph nodes in surgical oncology Roger S. Foster, guest ed. |
| title_short | Lymph nodes in surgical oncology |
| title_sort | lymph nodes in surgical oncology |
| topic | Noeuds lymphatiques Lymph Nodes pathology Lymphknotenmetastase (DE-588)4168370-5 gnd |
| topic_facet | Noeuds lymphatiques Lymph Nodes pathology Lymphknotenmetastase Aufsatzsammlung |
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