The Esophagus
E. George Elias in CRC Handbook of Surgical Oncology, 2020
Table 1 shows the TNM and staging of esophageal cancer. The esophagus is considered into three main parts that consist of four regions, namely, the cervical, upper and mid thoracic, and lower thoracic esophagus. The cervical esophagus extends from the pharyngeal-esophageal junction, i.e., the cricopharyngeal sphincter, down to the level of the thoracic inlet, which constitutes the upper one third of the esophagus. It is estimated that this part ends at about 18 cm from the upper incisors. The second part of the esophagus extends from the thoracic inlet to a point about 10 cm above the esophagogastric junction, which is at the level of the lower border of the eighth thoracic vertebrae. This point is about 31 cm from the upper incisors. The third part, which is about 10 cm in length, extends down to the esophagogastric junction, which is about 40 cm from the upper incisors. As mentioned before, cervical lymph nodes are regional lymph nodes for cervical esophagus, but are considered as distant metastasis for the intrathoracic part of the esophagus. While the cervical lymph nodes are accessible for clinical evaluation, the medistinal and paraaortic lymph nodes can be staged surgically or by CT scanning. However, all efforts should be made to obtain a histological diagnosis.
Pulmonary Lymph and Lymphatics
Waldemar L. Olszewski in Lymph Stasis: Pathophysiology, Diagnosis and Treatment, 2019
The question of where the lymph capillaries in the lung tissue begin was not easy to answer until the development of the electron microscope.28 It was felt that there were no lymph capillaries in the alveolar wall.23,29 Serial electron microscopic studies suggest that the alveolar wall does not have its own lymph capillary network, but lymph capillaries extend to the respiratory bronchioles and into the septi between alveolae.30 The course of the efferent lymph vessels is directed to the right duct and the upper left lung drains into the thoracic duct.31 There is evidence that some lymph vessels of the lower pulmonary lobes pass through the diaphragm to terminate in the abdominal viscera or periaortic lymph nodes.32
External Beam Radiotherapy and Brachytherapy
Karl H. Pang, Nadir I. Osman, James W.F. Catto, Christopher R. Chapple in Basic Urological Sciences, 2021
Stage I seminoma: adjuvant radiotherapy following radical orchidectomy.Field:Paraaortic lymph nodes alone extending from T11/12 to L5/S120 Gy in 10 fractions (MRC trial showed non-inferiority compared with 30 Gy in 15 fractions).Reduces relapse rate to 1–3% (from ~15–20% with orchidectomy alone).
Is there any benefit of paraaortic field irradiation in pelvic lymph node positive endometrial cancer patients? A propensity match analysis
Published in Journal of Obstetrics and Gynaecology, 2020
Cem Onal, Sezin Yuce Sari, Berna Akkus Yildirim, Melis Gultekin, Ozan Cem Guler, Ferah Yildiz
Unfortunately, the optimal target volume for RT in patients with stage IIIC EC remains controversial (Rose et al. 1992). The involved nodal fields or extended nodal fields may be used to treat the pelvis with or without paraaortic nodal inclusion. Among the stage IIIC1 patients, the question of whether there may be improved outcomes with the use of extended field RT to prophylactically treat the paraaortic lymph nodes is particularly unclear. Adjuvant combined ChT and RT has been demonstrated to be more effective than RT or ChT alone, and pelvic field RT together with systemic ChT may be efficient, without causing any increase in the toxicity in patients with pelvic lymph node metastases. Thus, we aimed to evaluate the survival outcomes and recurrence patterns in patients with stage IIIC1 EC who received RT to the pelvis (P-RT) or to the pelvis plus paraaortic lymph nodes (PA-RT) with or without systemic ChT.
Survival Benefit of Patients with Advanced Primary Fallopian Tube Cancer Undergoing Systematic Lymphadenectomy? Dilemmas and Queries
Published in Journal of Investigative Surgery, 2022
C. Iavazzo, A. Fotiou, V. Psomiadou, N. Vrachnis, J. Spiliotis
The diagnosis of PFTC is rarely achieved preoperatively. The role of systematic lymphadenectomy is controversial. An anatomy study mentioned that the nodal spread in such patients is mainly found between the level of inferior mesenteric artery (IMA) and left renal vein [3]. A clinicopathological study of 67 patients with PFTC showed no statistically significant survival benefit of systematic lymphadenectomy [4]. On the other hand, Kim et al as well as Gungorduk et al revealed survival benefit in both PFS and OS [5,6]. Koo et al found that a comprehensive paraaortic lymphadenectomy is essential for accurate staging and highlighted that in their study the role of paraaortic lymph node involvement is significant as no patients were diagnosed with pelvic lymph node metastasis alone [7].
Diagnosis and management of uterine serous carcinoma: current strategies and clinical challenges
Published in Expert Opinion on Orphan Drugs, 2020
Omar Najjar, Britt K. Erickson, Amanda N. Nickles-Fader
Nodal involvement is common in USC and may be difficult to predict with high sensitivity using pre-operative imaging [21,25]. Therefore, pelvic and para-aortic lymphadenectomy remain critical steps in surgical management. A SEER study of USC cases from 1998 to 2009 found that the incidence of pelvic-only and paraaortic lymph node involvement by apparent pre-operative stage was as follows: IA (6%, 4%), IB (18%, 21%), II (25%, 16%), and III/IV (27%, 21%) [25]. All patients with apparent stage I–II disease who were later found to have lymph node involvement were upstaged.
Related Knowledge Centers
- Aorta
- Celiac Lymph Nodes
- Gastrointestinal Tract
- Lumbar Vertebrae
- Lymph Node
- Abdomen
- Preaortic Lymph Nodes
- Superior Mesenteric Lymph Nodes
- Inferior Mesenteric Lymph Nodes
- Internal Iliac Lymph Nodes