Lymph node metastases: importance of detection and treatment strategies

ABSTRACT

Introduction: Lymphatic vessels are the preferential route of most solid tumors to spread their metastases in the body. The onset of metastatic nests in draining lymph nodes (LNs) are a significant indicator of cancer progression and a dismaying sign of worsen staging. Therefore, the individuation and elimination of cancer cells within the lymphatic system (LS) are an important goal. Nevertheless, the targeting of the LS with traditional contrast agents and/or chemotherapeutics is difficult, due to its anatomical structure. For this reason, many studies on new lymphatic delivery systems have been carried out, both to improve lymphatic imaging and to selectively carry chemotherapeutics to LNs, reducing the exposure of healthy tissues to the cytotoxic substances. This is an overview of the present situation in the field of detection and treatment strategies of lymphatic metastases, taking into account the use of nano-drug delivery systems. Nanocarriers, thanks to their small size and other physicochemical characteristics, are suitable vectors for imaging and chemotherapy of the LS.

Areas covered: The role of the LS in tumor progression and importance of treatment and imaging strategies of lymphatic metastases.

Expert opinion: The nanoparticles are a promising approach for treatment and detection of lymphatic metastases. However further studies are necessary in order to evaluate their efficacy in human clinical application.

KEYWORDS:

• Cancer
• lymphatic system
• lymph node metastases
• drug delivery systems
• nanoparticles

Article highlights

• The review briefly describes the role of LS in cancer diffusion.

• Recently, studies have been done to obtain new delivery systems with the ability to transport selectively imaging agents and/or anticancer drugs to cancerous tissues and cells.

• The LS has been explored as a possible pathway for drug delivery due to its organization and role in the body.

• Among the main routes for tumor cell diffusion, also dissemination via the bloodstream is involved, primary cancer spreads the malignant cells to its draining LNs especially via lymphatic vessels.

• Nano-sized drug delivery systems have been extensively investigated for cancer treatment and diagnosis.

• Nano-sized agents must vehicle a drug, or a contrast agent, selectively into the LS, including malignant lesions, releasing the chemotherapeutic inside the metastases.

This box summarizes key points contained in the article.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose

Additional information

Funding

This paper was not funded.