From the Guidelines
Para-aortic lymph nodes can become enlarged due to various causes, including malignancies such as cervical cancer, which is a common cause of para-aortic lymphadenopathy, as noted in the 2019 NCCN clinical practice guidelines in oncology 1.
Causes of Enlargement
The causes of para-aortic lymph node enlargement can be categorized into:
- Infections, such as tuberculosis and HIV
- Malignancies, including lymphomas, testicular cancer, ovarian cancer, cervical cancer, and metastatic disease from gastrointestinal or genitourinary cancers
- Inflammatory conditions, such as sarcoidosis and autoimmune disorders The para-aortic lymph nodes receive lymphatic drainage from the lower extremities, pelvic organs, and abdominal organs, making them susceptible to a wide range of conditions.
Evaluation and Treatment
When para-aortic lymphadenopathy is detected, further evaluation with imaging studies like CT scans or PET scans, and possibly biopsy, is typically needed to determine the underlying cause and guide appropriate treatment, as recommended in the 2013 guidelines for cervical cancer 1.
Key Considerations
- The location and function of the para-aortic lymph nodes make them a common site for metastasis from various cancers
- Accurate diagnosis and staging are crucial for determining the appropriate treatment approach
- Treatment options may include surgery, radiation therapy, chemotherapy, or a combination of these, depending on the underlying cause and extent of disease. In the context of cervical cancer, the presence of positive para-aortic lymph nodes is a significant factor in determining the treatment approach, with extended-field EBRT, concurrent platinum-containing chemotherapy, and brachytherapy being recommended for patients with positive para-aortic and pelvic lymph nodes 1.
From the Research
Causes of Para-Aortic Lymph Nodes
- Lymphoma is a potential cause of para-aortic lymph node enlargement, as it can manifest as painless adenopathy, with systemic symptoms of fever, unexplained weight loss, and night sweats occurring in more advanced stages of the disease 2.
- Cervical cancer can also cause para-aortic lymph node metastasis, with a study showing that the overall incidence of retroperitoneal lymph node metastasis assessed by systematic pelvic and para-aortic lymphadenectomy was 12.0% in stages I to IV endometrial carcinoma 3.
- Endometrial carcinoma is another potential cause, with a study showing that patients with para-aortic lymph node metastasis had a lower 5- and 10-year overall survival rate compared to those with negative para-aortic lymph nodes 3.
- The management of para-aortic lymph node disease in patients with cervical cancer is a complex issue, with various treatment approaches available, including chemoradiotherapy and surgery 4.
Diagnosis and Staging
- 18F-fluoro-deoxyglucose positron emission tomography (PET)/computed tomography (CT) scans play an important role in the management of lymphoma patients, including staging disease and assessing response to therapy 5.
- A study proposed a computerized tomography (CT) atlas to provide guidance for contouring the para-aortic lymph node clinical target volume (CTV) in patients with cervical cancer, which can aid in accurate staging and treatment planning 6.
Treatment and Prognosis
- Surgery with systematic pelvic and para-aortic lymphadenectomy followed by adjuvant chemotherapy may improve long-term survival in patients with para-aortic lymph node metastasis 3.
- The treatment of para-aortic lymph node disease in patients with cervical cancer is an area of ongoing research, with various studies investigating the best approach to management 4.