In ileal (small intestine) cancer, what usually occurs first, metastasis (Mets) to mesenteric lymph nodes or liver metastasis?

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From the Research

In ileal neuroendocrine tumors (NETs), mesenteric lymph node metastases typically occur before liver metastases. The pattern of spread for ileal NETs generally follows a predictable sequence where the tumor first metastasizes to regional mesenteric lymph nodes before spreading hematogenously to the liver. This pattern reflects the lymphatic drainage of the ileum, which directs tumor cells first to the mesenteric nodes. Studies have shown that approximately 80-90% of patients with ileal NETs have mesenteric lymph node involvement at diagnosis, while liver metastases are present in about 40-60% of cases, as seen in a study published in the Journal of surgical oncology 1. The presence of mesenteric lymph node metastases is often associated with a desmoplastic reaction that can cause mesenteric fibrosis and intestinal obstruction, even when the primary tumor is small. This sequential pattern of spread is important for staging, treatment planning, and surveillance strategies in patients with ileal NETs, as the presence of liver metastases generally indicates more advanced disease and may influence treatment decisions regarding surgical resection, systemic therapy, and liver-directed treatments. Some studies suggest that lymph node-independent liver metastasis can occur in certain types of cancer, such as colorectal cancer, as demonstrated in a study published in Nature communications 2. However, in the context of ileal NETs, the most recent and highest quality evidence suggests that mesenteric lymph node metastases typically precede liver metastases, as supported by a study published in the Journal of surgical oncology 1. Key points to consider include:

  • The lymphatic drainage of the ileum directs tumor cells first to the mesenteric nodes
  • Mesenteric lymph node metastases are present in approximately 80-90% of patients with ileal NETs at diagnosis
  • Liver metastases are present in about 40-60% of cases
  • The presence of mesenteric lymph node metastases is often associated with a desmoplastic reaction that can cause mesenteric fibrosis and intestinal obstruction.

References

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