Utrera-Barillas María Dolores, Castro-Manrreza Marta Elena, Gutiérrez-Rodríguez Margarita, Benítez-Bribiesca Luis
Unidad de Investigación Médica en Enfermedades Oncológicas, Centro Médico Nacional Siglo XXI, IMSS, México D.F., México.
Gac Med Mex. 2009 Jan-Feb;145(1):51-60.
It is well-known that there are different tumor-type-dependent metastatic patterns. For example, in carcinomas metastatic spread is preferentially via the lymphatic system by which they reach regional lymph nodes through pre-existent afferent lymph vessels and/or newly formed lymph capillaries; while in sarcomas the favored pathway is through bloodvessels. These metastatic patterns have been used for many years by clinicians and surgeons for staging and tumor resection, particularly in the case of breast cancer. Recently this knowledge has been applied to detection and resection of sentinel lymph nodes. The lymphatic system drains the interstitial fluid from tissues and reincorporates it into the blood flow; in addition, it forms part of the host's immune defense and in pathological conditions, induces different types of lymph edema and participates in tumor invasion and metastasis. Although, the study of lymphangiogenesis was stagnated for several decades, it was not until a few years ago that biomolecular mechanisms were discovered and many specific markers are now in use to study the process of tumor dissemination and metastasis. There is a tendency to utilize molecular knowledge in clinical settings for grading and estimating prognostic significance of tumors as well as to develop specific therapeutic strategies.
众所周知,存在不同的肿瘤类型依赖性转移模式。例如,在癌中,转移扩散优先通过淋巴系统,癌细胞通过已有的传入淋巴管和/或新形成的淋巴毛细血管到达区域淋巴结;而在肉瘤中,最常见的途径是通过血管。多年来,临床医生和外科医生一直利用这些转移模式进行分期和肿瘤切除,尤其是在乳腺癌的情况下。最近,这一知识已应用于前哨淋巴结的检测和切除。淋巴系统从组织中引流组织液并将其重新纳入血流;此外,它构成宿主免疫防御的一部分,在病理情况下,会引发不同类型的淋巴水肿,并参与肿瘤侵袭和转移。尽管淋巴管生成的研究停滞了几十年,但直到几年前才发现生物分子机制,现在有许多特异性标志物用于研究肿瘤播散和转移过程。目前有一种趋势,即在临床环境中利用分子知识对肿瘤进行分级和评估预后意义,并制定特定的治疗策略。