Clonality, Growth and Spread of Cancer
Jeremy R. Jass in Understanding Pathology, 2020
Once cancer cells penetrate into the lumen (central cavity) of a vessel they can travel large distances with relative ease (Willis, 1952). Two types of vessel may be invaded: lymphatics and veins. One function of the lymphatic system is to prevent tissue swelling by draining excess fluid from the spaces between cells, returning it to the blood. The passage of fluid is interrupted by the presence of lymph nodes, whose principal function is to monitor invasion by micro-organisms and mount an appropriate immune response. Cancer cells may be trapped in lymph nodes, where they form secondary deposits. Eventually some cells will break away and continue along the lymphatic chain, spreading from node to node. It is for this reason that cancer surgery removes not only the main tumour but also the draining lymph nodes which may have succeeded in limiting the extent of spread. Once cancer has spread to lymph nodes, the chances of cure are reduced. By setting up colonies in lymph nodes the cancer has indicated it is capable of metastasis.
Miscellaneous procedures
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha in Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
Lymphoedema, also known as lymphedema and lymphatic oedema, is a condition whereby localised fluid retention causes tissue swelling due to a compromised lymphatic system. In the normal lymphatic system interstitial fluid returns to the bloodstream. Imaging using radioactive substances may be used to confirm or negate the presence and site of lymphoedema. For lower limb studies the patient is injected with 99mTc-nanocolloid into the first webspace of both feet. If the upper limb lymphatics need to be imaged the nanocolloid is injected into the first web space of both hands. The examination is a safe, well-established, and minimally invasive technique for assessing lymphatic drainage in limbs for lymphoedema. This section is based on the BNMS 2011 professional guidelines [50].
Lymphedema: Physical and medical therapy
Peter Gloviczki, Michael C. Dalsing, Bo Eklöf, Fedor Lurie, Thomas W. Wakefield, Monika L. Gloviczki in Handbook of Venous and Lymphatic Disorders, 2017
A useful tactic in advising a patient with “occult” post-surgical lymphedema who is at risk of developing clinically manifest lymphedema or one who is at risk of exacerbating established lymphedema is to avoid “extremes.” Temperature extremes, whether hot or cold, can increase the lymphatic load.46 When possible and appropriate, wearing light, loose, non-constricting clothing is recommended in order to dissipate heat, moisture, and perspiration, as well as avoiding compressing of the delicate superficial lymphatic vessels. Exercise overuse may also increase the lymphatic preload, which can lead to worsening swelling in the setting of lymphatic outflow obstruction. The NLN position paper on excessive exercise notes that a “sudden increase in an individual’s usual exercise duration or intensity may trigger or worsen lymphedema.7 It is likely that a program of slowly progressive exercise for the affected body part will decrease the potential for common daily activities to result in overuse.” While most activities in moderation are not problematic, it is likely that abrupt or sizeable challenges to the lymphatic system can be associated with the appearance and/or exacerbation of lymphedema.
The application of indocyanine green (ICG) and near-infrared (NIR) fluorescence imaging for assessment of the lymphatic system in reconstructive lymphaticovenular anastomosis surgery
Published in Expert Review of Medical Devices, 2021
Albert H. Chao, Steven A. Schulz, Stephen P. Povoski
Preoperative imaging evaluation of a patient’s lymphatic system is preferable whenever possible since not every patient will be a candidate for LVA surgery. Approximately 0.1 cc of a solution of ICG (25 mg in 10 cc of sterile water) is injected subcutaneously at 3–4 sites along the distal aspect of the affected extremity. Then, with use of a NIR camera, ICG fluorescence is visualized. A normal lymphatic system will demonstrate linear patterns of dye progression proximally over time. (Figure 1) A dysfunctional lymphatic system may initially demonstrate linear progression of dye but then terminate where subcutaneous lymphatic channels are diseased, often resulting in back flow of dye into the microscopic dermal lymphatic channels (i.e. dermal backflow). (Figure 2) Characteristic patterns of dye have been described (splash, stardust, diffuse) which correspond to progressively more severe lymphedema[35]. These patterns can often be visualized relatively immediately within a few minutes of injection[38]. However, some investigators have also recommended more prolonged observation up to 1–24 hours following injection. Doing so can allow for full visualization of dye patterns to provide for a more comprehensive pathophysiologic examination of lymphedema [39,40].
The tumor microenvironment and triple-negative breast cancer aggressiveness: shedding light on mechanisms and targeting
Published in Expert Opinion on Therapeutic Targets, 2022
Natsuki Furukawa, Vered Stearns, Cesar A. Santa-Maria, Aleksander S. Popel
The physiological roles of the lymphatic system are to collect interstitial fluid from tissues, absorb lipids from the digestive system, and immune surveillance. In the TME, cancer cells release growth factors and cytokines such as VEGF-C to induce lymphangiogenesis. As a result, TNBC cells may invade these lymphatic vessels, migrate to the lymph node, and eventually exit the lymphatic system to enter the venous system. Disseminated TNBC cells may reach and metastasize to organs such as lung, bone, liver, and brain via the circulatory system [144]. During the invasion process, cancer cells remodel the lymphatic endothelial cells to facilitate invasion. Lee et al. demonstrated that TNBC cells induced expression of CCL5 from lymphatic endothelial cells. CCL5 recruited CCR5-positive TNBC cells to lymphatic vessels and facilitated invasion of the lymph nodes [145]. Other chemokine signaling pathways known to recruit TNBC cells to the lymphatic vessel are CCL21/CCR7, CXCL12/CXCR4, and CCL27/CCR10 [146].
Drug delivery to the intestinal lymph by oral formulations
Published in Pharmaceutical Development and Technology, 2022
Takayuki Yoshida, Hiroyuki Kojima, Kazuhiro Sako, Hiromu Kondo
Drug delivery systems (DDS) are applied to target lymphocytes in the lymphatic vessels and lymph nodes to increase the efficacy and safety of chemotherapy (Holmberg et al. 1990; Porter and Charman 2001; Gershkovich and Hoffman 2005; Trevaskis et al. 2008; Trevaskis et al. 2010a; Yáñez et al. 2011; Lawless et al. 2015; Trevaskis et al. 2015; Yoshida et al. 2016; Ms et al. 2020; Feng et al. 2021; Lee et al. 2021; Ye et al. 2021). The lymphatic vessels and nodes contain lymphocytes and macrophages, maintain and protect the body, maintain fluid balance and the intestinal absorption of lipids, and contribute to host defense against pathogens (Guy-Grand and Vassalli 1993; Fischer et al. 1996; Cesta 2006; Kaplan and Mcpherson 2007; Fanous et al. 2007). Numerous diseases involve the lymphatic system, such as lymphedema, lymphatic and metastatic cancers, rheumatoid arthritis, asthma, inflammatory bowel disease, psoriasis, transplantation rejection, and infection (for example, acquired immunodeficiency disease, hepatitis, filariasis, Ebola) (Wang and Oliver 2010; Trevaskis et al. 2015; Bora et al. 2017).