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Senior Citizen Health & Medicine
Colon Cancer Treatment Improved by Targeted Exam of
Lymph Node
June 19, 2006 – Colon cancer is the second most
common cause of cancer death in the U.S. but the accuracy of determining
the cancers progress can be improved by examining the lymph notes to
which colorectal cancer is most likely to have spread. This can also
spare some patients the cost and toxicity of chemotherapy, according to
a report in the June issue of the Archives of Surgery, one of the
Journal of the American Medical Association journals.
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May 23, 2006 – Two studies reported in today's
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Health & Medicine |
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To determine the stage to which the cancer has
progressed as well as assess treatment options, physicians surgically
remove and examine cancer patients' lymph nodes. Patients whose cancer
has spread to the lymph nodes have been shown to benefit from
chemotherapy in addition to surgery, while those whose cancer has not
spread to the lymph nodes (referred to as node negative) may not see any
benefit to combination treatments over surgery alone.
"One-third of patients with tumor-free lymph nodes
have recurrences, and therefore, adjuvant (supplemental) chemotherapy
may be beneficial in these patients," the authors write.
"However, if all node-negative patients are
treated, 70 percent will be subjected to unnecessary chemotherapy
because surgery alone is curative. A better understanding of high-risk,
node-negative patients and improved methods of lymph node evaluation are
therefore needed."
Anton J. Bilchik, M.D., Ph.D., John Wayne Cancer
Institute and Saint Johns Health Center, Santa Monica, Calif., and
colleagues studied 132 patients (63 men and 69 women, median age of 74
years) with stage I and II colon cancer who were recruited from four
referral cancer centers between March 2001 and June 2005.
In a process known as lymphatic mapping, blue dye
was injected near the site of each participant's tumor. The dye stained
the sentinel (first) lymph nodes down the lymph channel, the pathway
through which lymph-a fluid containing lymphocytes and the bacteria,
cancer cells and other organisms they have attacked-drains from the
spaces between body tissues.
The tumor, sentinel nodes and other lymph nodes in
the region were then removed and examined.
"The sentinel node paradigm is based on the premise
that lymphatic drainage from a primary organ site occurs in an orderly
and progressive fashion," the authors write.
"The sentinel lymph node is the first node to
receive lymphatic drainage from a primary anatomical site and is
therefore the most likely node to harbor a metastasis."
Of the 132 participants, 33 (30 percent) had stage
I cancer, 46 (41 percent) had stage II and 32 (29 percent) stage III.
Twenty-eight patients (23.6 percent) were classified at a more severe
stage based on the analysis of sentinel nodes.
The sensitivity of the lymphatic mapping/sentinel
node procedure was 88.2 percent, meaning that 45 of 51 patients whose
cancer had spread to their lymph nodes had tumors in their sentinel
nodes.
False negatives, when an individual's cancer had
spread to lymph nodes but was not detected in the sentinel node,
occurred in six of 81 (7.4 percent) of patients who were determined to
be node negative. Eighteen percent of the sentinel nodes had tumors,
compared with 6 percent of the other lymph nodes.
The results "suggest that lymphatic mapping and
sentinel lymph node techniques are feasible and accurate in colon
cancer," the authors write.
"The improved risk stratification afforded by
standardization of both surgical and pathological techniques may improve
the selection of patients for chemotherapy, thereby avoiding the
unnecessary toxic effects and expense for those cured by surgery alone."
Editor's Note: This study was supported in part by
a grant from the National Cancer Institute and by funding from the Rod
Fasone Memorial Cancer Fund (Indianapolis), the Henry L. Guenther
Foundation (Los Angeles), the William Randolph Hearst Foundation (San
Francisco), the family of Jeanne and Eric Li, the Davidow Charitable
Fund (Los Angeles) and the Harold J. McAlister Charitable Foundation
(Los Angeles).
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