Hi to everyone,

I have a question--why are neck metastases to the lymph nodes "the single most important factor in determining prognosis"? (please google the text in quotes to find the source--this verbiage shows up in numerous articles).

I realize this is a question for my doctor, but I was hoping someone may have insight on this from experience.

My very simplistic understanding of anatomy is that lymph nodes catch the bad things and hold them until the posse comes--in the case of scca, the posse is overwhelmed, and the nodes swell with the bad cells. After enough swelling, the bad cells go to another adjacent node, and/or rupture the node lining (extracapsular spread), freeing the culprits to wreak havoc.

What happens if the one node swells to over 3 cm, does not rupture, and maintains the boundary, not allowing any bad cells to leave, and is then surgically removed?

This is what happened to me... my only symptom was a swollen node--fna was negative, node was growing...when this node was sugically removed, it was sent to pathology while I was still in the OR, and scca was found. Searching for the primary, they removed my tonsil, salivary gland, and a chain of other nodes. The pathologist found a found a small tonsillar tumor, no ecs, and no other positive nodes.

So, again, the question is positive nodes--why are these so important to a prognosis? Is it because
--they are indicative of an agressive cancer?

--they indicate that the cancer has already spread, and is most likely elsewhere in the head/neck/body (microscopic mets)?

Again, any practical experience is appreciated.

Thank you in advance,


Oscar

Oscar,
Positive nodes, are one of the indicators used to stage many cancers. A lot of emphasis is put on nodes, but they are not the "be all",but are very important when thinking about stopping further spread and what should be removed during surgery.
The lymphatic system is where some cells go to die and some cells are produced. Brian, Gary or anyone who wants to jump in if you have a better explanation or something to add, I'm sure Oscar would welcome the info.
If you think of the lymph system as the cardiovascular system's sewer then this is basically what it does. Immune cells and other body protective mechanisms are not as active in this system. So a cancer cell that is not brought into the lymphatic system bound by an immune cell to be eliminated can lodge itself or invade other tissues. To simplify the lymphatic system it parellels the blood vascular system but is not as smart. If a mutagenic cell happens to take up residence and reproduce in a lymph node it can be transported to any other area in the body via this system.
Swelling of one node due to reproduction of a malignant cell does not mean that all the cells that were produced in this node by the cancer cell stayed there. Think of the lymph system as the toll highway or short cut through the body. There are less cops to regulate the law breakers.
Positive nodes give the doctors a heads up that un-restrained cells have free reign to go where ever they want. A positive node means that the bodies immune system couldn't keep up with the need to eliminate the problem.
Removing other nodes in the same chain allows doctors to, hopefully cut off the transportation of other bad cells that could not be controlled and left the overwhelmed lymphnode.
Salient lymph node testing is a method that oncologists use in some situations to detect wheter or not cancer has spread beyond a positive node. Prior to removal of the positive node a radioactive marker is injected into and around the node. Then after a presribed waiting period usually a few hours a scan is done that will show the doctor where the dye has travelled. If other nodes are positive then they and other nodes should be removed during surgery. It is a way of figuring out the potential for how far a cancer has spread and what needs to be done to "cut it off at the pass" so to speak.

I hope this is useful.

Mike

Dr. Mike: a somewhat related question for you, if you will...
Prior to Buzz having surgery, we were told that he had a 'necrotic' mass in his neck. I could never get a satisfactory answer to my question...could this have been a positive node eroded with cancer cells? If so, why wouldn't the cancer just move on to another close node rather than causing necrosis in the one?
And, if only ONE node was positive, and was removed during neck disection, were the IMRT txs and chemo merely 'insurance', just in case there were more cancer cells lurking about?
Oscar: SORRY to hijack your thread! Forgive me, please!

Lois & Buzz in NC

Lois,
Long story short, necrosis occurs when a growing tissue exceeds its blood vascular supply. The center of the growing tissue has no energy supply so it dies, the cells die releasing their toxic genetics to be taken up by other cells.
This is not a good situation. Necrosis in a tumor means that the cells that have died due to lack of oxygen or blood supply have released their DNA to be taken up by other cells.

Not to hijack Oscar's thread as you suggested, e-mail me on this. I do have some info for you.

Cheers.

Mike

Oscar, I think it's important to realize that when anyone talks about nodes being "the most important factor in determining prognosis" they are talking about it being the most important factor statistically. That is, across multiple cases, degree of nodal involvement ends up being a strong predictor. That does not mean that for any one case, including yours, the state of the nodes is the most important factor in determining prognosis.

Your doctor can tell you how important it is in your specific case. They can explain to you much better than anyone here OR than any statistical study can because they know your specific case the best.

Nelie

Oscar,
Nelie summed it up much mor eloquently and briefly than my long winded dissertation.

Mike

Oscar, Do a bit or reading about "staging" a cancer. That process is a system of classifying the size of the tumor and whether or not it has metastisized to another location. Our type of cancer, with primary tumors that are physically close to the lymph system in the neck, often metastisizes through the lymph nodes. That may have a bearing on that statement you are asking about. My primary tumor was in the base of my tongue and had then spread to the lymph nodes in my neck. Those factors together made my cancer a stage 4. Hope that helps. Tom J