Melanoma: lymph node metastases
Oncoobrazovanie, arising in the pigment cells of the skin, on the mucous membrane or eyeball, is called -melanoma. This is a very aggressive form of cancer, which for a long time passes latently, down to metastatic stages.
The near or far lymph nodes are the most prone to tumor damage - small accumulations of cells of the immune system that are in the neck, armpit and groin.
The spread of skin cancer, which translates tumor cells into the lymphoid system, is classified asmelanoma - metastasis to the lymph nodes. The reason for this condition lies in the intrusion of the oncological process into the circulatory system and its movement through the body.
With metastatic melanoma, it is important to determine the extent of the lesion. The development of the oncological process, first of all, affects the lymph nodes, therefore the oncologist will conduct a number of studies:
- Different types of tomography:
- computer and magnetic resonance imaging foresee the use of accurate X-rays or radio waves to visualize internal structures and blood flow;
- lymphoscintigraphy represents a method of displaying lymph vessels to track the pathways of tumor cells. A blue dye is injected into the skin around the tumor. It passes into the lymphatic fluid, showing ways of possible expansion with a special scanner.
- positron emission tomography is an important diagnostic method that displays altered tissues that, unlike normal ones, participate in accelerated metabolism.
- Biopsy - removal of a particle of pathological tissue. Often the method is considered as a one-time surgical operation for the removal of lymph nodes. There are such basic ways of carrying out:
- aspiration biopsy: by means of a thin needle, a sample of cells is removed;
- biopsy of the sentinel node - removal of the closest melanoma of the lymph node to check for abnormal cells. If such are present, it is necessary to check the distant glands.
- Blood test. Serum LDH is a marker for detecting the progression of the disease to remote sites.
How to understand by the stage that there are metastases of melanoma in the lymph nodes?
There are 2 types of the disease:
- Clinical: is based on studies of the site of the underlying melanoma and contains information on the disease before treatment is applied.
- Pathological: uses all clinical information, but also takes into account the results of biopsy of other organs and systems, even after the therapeutic measures applied.
On the skin tumors that have spread to the lymph nodes, usually indicate 3 and 4 stages. But it is necessary to take into account the special notation. The letter N. indicates the distribution. It is combined with a figure. Clinical setting includes signs:
N 1- 1 proximal node is affected;
N 2- 2 or 3 proximal nodes are affected or the transit of cancers to the lymphatic vessels is detected;
N 3- 4 or more lymph nodes are affected.
At a pathological statement, lowercase letters are sometimes added. The classification has the form:
Any Na: the oncoprocess has comprehended lymph nodes, but it is so small that it can be seen only under a microscope;
Any Nb: means that the cancer is quite large and is reflected in the tests;
N2c: determines the melanoma detected in the lymph channels around the tumor, but not reaching the nodes.
Important to know: Melanoma: symptoms and how to recognize? A photo
Metastases to lymph nodes after melanoma removal: when do they occur?
At the 1st and 2nd stages, the main treatment is extensive excision. During the operation, themelanoma, as well as part of the healthy tissue around it. Depending on the diameter of the tumor, the surgeon seizes at least two to six millimeters around. If diagnostic tests do not reveal tumor tissue in other places, radiation therapy is not recommended.
However, unfortunately, the procedure does not provide full recovery, as melanoma is prone to frequent relapses and rapid progress. The statistics reads:
- between 15 and 35% of primary clinical 2A return after surgery for 5 years;
- from 40 to 70% of stages 2B and 2C will be repeated;
- more than half of the formations of Stage 3 will arise again.
Very often, skin cancers return in a more advanced form.
Metastasis of melanoma in lymph nodes
Important to know: Dangerous moles: 6 signs of melanoma
Tactics of treatment
Therapeutic measures are based on the study of the complete picture of cancer and represent the species:
When melanoma is detected in nearby watchdogs, doctors recommend the removal of not only all remaining lymph nodes in this area, but also the whole lymphoid structure, including the vessels and adipose tissue.
Also able to reduce the progression of the disease.
For advanced stages includes the use of Dacarbazine (DYIC-Dome) and its oral variant of Temozolomide, and also sometimes used Carmustine, Vinblastine, Cisplatinum, Docetaxel, and others. Statistics document a 12-15% reduction in the tumor.
Immunotherapy of cancer increases the body's defenses. In recent years, biological treatment has achieved significant success. Clinical trials show that people taking adjuvant drugs have a better prognosis than those who took chemotherapy. Oncology uses such means as Interleukin-2, Interferon, Ipilimumab (monoclonal antibody CTLA4), Nivolumab and Keitruda (antibodies PD-1 blocking the intake of protein). The metastatic process is reduced by 30-40% with complex action.
Forecast and what to expect?
With regional metastases after surgical lymph node dissection, long-term cancer survival is significantly increased and is:
5 years - 43%;
10 - 35%;
15 - 28%;
20 - 23%.
Prognostic 5-year results for people younger than 50 years with regional prevalence are higher. They indicate 48% of the survivors. For the female, the chances are higher than for the males: 49% to 40%.
According to the data, 4 out of 10 people (40%) who used surgical resection with a metastatic tumor are alive after 5 years. Relapses are observed only in 34% of patients.
Depending on the number of affected nodes, the 5-year life expectancy ranges from 53% (for single metastasis) and up to 25% (for 4 or more).
The average survival rate for metastatic grade IV cancer is 6-10 months.
When the disease progressed to the levelmelanoma - metastasis to the lymph nodes, you need to carefully and adequately evaluate all possible ways of treatment, since effective therapy can significantly increase the chances of long-term survival and extend the life of the patient..