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 flows through the mesenteric lymph nodes before entering the systemic circulation. Approximately 60-80% of patients with ileal NETs already have mesenteric lymph node involvement at diagnosis, while liver metastases are present in about 30-50% of cases at initial presentation, as seen in a study published in the Journal of surgical oncology 1. Some key points to consider include:

  • The presence of mesenteric lymph node metastases often causes a characteristic radiographic appearance of lymph node masses with surrounding fibrosis and mesenteric retraction, which can be detected on imaging studies before liver lesions become apparent.
  • A study published in the Annals of surgical oncology found that mesenteric lymph node involvement was associated with a higher risk of liver metastasis in patients with ovarian cancer 2.
  • Another study published in Diseases of the colon and rectum found that peri-ileal lymph node metastasis was rare in patients with right-sided colon cancer, but occurred mainly in stage IV disease 3.
  • However, a study published in Nature communications found that liver metastases can manifest without prior lymph node involvement in a model of metastatic colorectal cancer 4.
  • A recent case report published in the International journal of surgery case reports described a rare case of upper rectal cancer with atypical lymphatic spread to the mesorectal and common iliac lymph nodes 5. Overall, while there may be some variability in the pattern of spread, mesenteric lymph node metastases are generally considered to occur before liver metastases in ileal NETs, and this sequence is important for staging and treatment planning.

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