Circulatory System & Spread of Systemic Disease

Question 1

how does cancer metastize? two main roots

Answer 1

1. through the lymph system & nodes
2. through the blood vessels, veins to distance organs

** carcinomas: spread through lymphatics first** - carcinoma: epithelial tissue cancer
sarcoma: rarely spread through lymph: mostly blood sarcoma: connective tissue cancer

Question 2

describe the lymph system
nodes
primary and secondary organs
ducts & drainage

Answer 2

lymph: system of drainign interstital fluid from tissues, the circulation of immune cells and a way for the body to fight infections
contains…
organs: (primary and secondary)
nodes
vessels, ducts and fluid

primary: thymus (kids only) & bone marrow: where lymphocytes develop
secondary: spleen, lymph nodes & tonsils: where lymphoctyes become active via antigen interaction

Nodes: organizied collection of the lymph as it passes back to the blood

drainage
- all of the upper right quadratn drains to the upper right lymphatic duct and into right subclavian vein
- all else drains to the upper left subclavian

Question 3

where do head and neck cancers spread to?
breast?
prostate?

what is the throacic duct? the cisterna chyli?

Answer 3

head and neck cancers: will spread to the cervical nodes for metastsis

breast cancer: to the axillary

prostate: inguinal nodes

the lymphatic ducts then drain into blood (subclavian veins) and thats how the cancers spread to the bloodstream

thoracic duct& CC: CC is the dialted sac of the duct where all lymph from the intestines and lumbar regions go to before flowing up

Question 4

explain the drainage pattern of the lymph through the lungs

Answer 4

superfiscial and deep plexus drain into the hilar nodes
deepest: the hilar nodes (bronchopulmonary) drain into…
the tracheobronchial nodes
into….
paratracheal nodes
into….
right lymphatic duct OR thoracic duct (left side)
into the right and left subclavian veins

hilar nodes: sarcoidosis, TB disease settle here

Question 5

what is the sentinel lymph node?
- how does it relate to metastisis?
- why might it need to be biopsed? what is the rationale?

Answer 5

sentinel lymph node: the first lymph node of a sequence – specifically the first place of drainage of lymph will do from a tumor

think about breast cancer – the first stop/first place the cancer will invade when it begins to spread

biopsy?
- if you want to determine the stage, prognosis and spread of the cancer from the tumor– bx. of the sentinel node would tell you…
- - + = if there is cancer cells detected in that node –> indicates spread & warrants further investigation and a total lymph node dissection to determine extent of spread
- - = no cancer detected in that node so there should be no cancer cells past the node — no need for further dissection

** such a detection and biopsy is done with radioactive tracers to see where the lymph spread will go from the cancer cells – detected with a probe**

gross or microscope examination of the node can indicate cancerous prescence

Question 6

how does hematogenous spread of cancer work? steps?

Answer 6

sarcomas are commonly spread through hematogenous
1. primary tumor in a specific area of the body
2. the tumor gets its own proliferation/angiogenisis of blood vessels (becuase the body just think it needs to feed itself!!) mediated by VEGF factors
3. the cancer cells then have a way to migrate through the blood– the proliferation of the vessels to the tumor provides the pathway
4. they circulate through the blood, find a distant organ (one with high blood flow usually like liver, kidneys , lungs) and adhere

Question 7

most common routes of hematogenous spread & where they lead to

Answer 7

concern for spread to the mediastinum – or from the mediastinum can go anywhere
- azygous vein : right side of the body running parellel to the throacic vertebra
- hemiazygous vein : leftside of thoracic vertebrae
- & accessory hemiazygous: a feeder vein into the hemiazygous on the left

** these veins drain blood from the thorax & upper lumbar regions– create collateral curculation with the SVC and IVC** thus a point of hematogenous spread for cancer – can get anywhere

spread
1. from azygous to either the SVC –> into right atria –> circulation
2. from azygous vein to the vertebral sinus plexus, into the dural sinuses into the brain

** the hemi and accessory both empty into the azygous**

Question 7

most common routes of hematogenous spread & where they lead to

Answer 7

concern for spread to the mediastinum – or from the mediastinum can go anywhere
- azygous vein : right side of the body running parellel to the throacic vertebra
- hemiazygous vein : leftside of thoracic vertebrae
- & accessory hemiazygous: a feeder vein into the hemiazygous on the left

** these veins drain blood from the thorax & upper lumbar regions– create collateral curculation with the SVC and IVC** thus a point of hematogenous spread for cancer – can get anywhere

spread
1. from azygous to either the SVC –> into right atria –> circulation
2. from azygous vein to the vertebral sinus plexus, into the dural sinuses into the brain

** the hemi and accessory both empty into the azygous**

Question 8

what is a Pancoast Tumor?
- loaction
- near what structures
- clinical manifestations

Answer 8

a tumor which is defined by location –> not by cell histology –> because its loaction is so unique and it a problem!! pancoast tumors are commonly a metastisis from another tumor &tricky to find

loacation: in the apex of the lung in the apical pleuropulmonary groove/superior sulcus

near….
- phrenic nerve : diaphragm dysfunction
- vagus nerve: sympathetic
- sympathetic trunk : HORNER’s SYndrome!! PAM (and flushing) small dry drooping eye
- brachial plexus : shoulder and arm pain
- recurrent larynegal nerve : hoarsness
- subclavian artery and vein : upper extremity edema (probelm with blood flow)