title: Unique patterns of metastases in common and rare types of malignancy.
abstract: This review on the unique patterns of metastases by common and rare types of cancer addresses regional lymphatic metastases but also demonstrates general principles by consideration of vital organ metastases. These general features of successfully treated metastases are relationships to basic biological behavior as illustrated by disease-free interval, organ-specific behavior, oligo-metastatic presentation, genetic control of the metastatic pattern, careful selection of patients for surgical resection, and the necessity of complete resection of the few patients eligible for long-term survival after resection of vital organ metastasis. Lymph node metastases, while illustrating these general features, are not related to overall survival because lymph node metastases themselves do not destroy a vital organ function, and therefore have no causal relationship to overall survival. When a cancer cell spreads to a regional lymph node, does it also simultaneously spread to the systemic site or sites? Alternatively, does the cancer spread to the regional lymph node first and then it subsequently spreads to the distant site(s) after an incubation period of growth in the lymph node? Of course, if the cancer is in its incubation stage in the lymph node, then removal of the lymph node in the majority of cases with cancer cells may be curative. The data from the sentinel lymph node era, particularly in melanoma and breast cancer, is consistent with the spectrum theory of cancer progression to the sentinel lymph node in the majority of cases prior to distant metastasis. Perhaps, different subsets of cancer may be better defined with relevant biomarkers so that mechanisms of metastasis can be more accurately defined on a molecular and genomic level.
authors.affiliation: Center for Melanoma Research and Treatmnet and Department of Surgery, California Pacific Medical Center and Research Institute, San Francisco, California 94115, USA. leongSX@cpmcri.org
authors.forename: Stanley P L
authors.initials: SP
authors.lastname: Leong
authors.forename: Eric K
authors.initials: EK
authors.lastname: Nakakura
authors.forename: Raphael
authors.initials: R
authors.lastname: Pollock
authors.forename: Michael A
authors.initials: MA
authors.lastname: Choti
authors.forename: Donald L
authors.initials: DL
authors.lastname: Morton
authors.forename: W David
authors.initials: WD
authors.lastname: Henner
authors.forename: Anita
authors.initials: A
authors.lastname: Lal
authors.forename: Raji
authors.initials: R
authors.lastname: Pillai
authors.forename: Orlo H
authors.initials: OH
authors.lastname: Clark
authors.forename: Blake
authors.initials: B
authors.lastname: Cady
mesh_terms: D014408:Biomarkers, Tumor / Q000378:metabolism; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000556:secondary / Q000601:surgery; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis / Q000473:pathology; D008545:Melanoma / Q000401:mortality / Q000473:pathology / Q000556:secondary / Q000628:therapy; D009362:Neoplasm Metastasis / Q000473:pathology*; D009382:Neoplasms, Unknown Primary / Q000401:mortality / Q000473:pathology / Q000628:therapy; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery; D011379:Prognosis; D012509:Sarcoma / Q000401:mortality / Q000473:pathology / Q000556:secondary / Q000601:surgery; D015996:Survival Rate; D013964:Thyroid Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery
chemical_list: D014408:Biomarkers, Tumor