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Below you will find some interesting research results on cancer, for example that metastases themselves no longer metastasise or chemotherapy may have the opposite effect to what that intended. You can navigate to the different articles at the end of each page or directly via the table of contents at the the top right.

A dogma of cancer medicine falls

07.02.2009 · Metastases in the body, it is said, can spread cancer cells just as much as the primary tumour. This is why lymph nodes are often removed radically. This is wrong, as Munich researchers have now clearly demonstrated.

The importance of cancer registries in this country is still underestimated. They are not only essential to assess the quality of medical care but also provide an opportunity to advance science if they consistently track the disease progression of a population. Examples of this are findings on the metastasis of tumours that have now been published the Munich Cancer Registry ( "Zentralblatt für Chirurgie", Vol. 133, p 1).

The research group led by Dieter Hölzel of the Institute for Medical Informatics, Biometry and Epidemiology, University of Munich destroys one dogma of cancer by regarding the routine removal of lymph nodes, lymphadenectomy, "as out of date". The group notes that the affected lymph nodes metastases do not contribute to the further spread of the tumour disease. Their conclusion: "lymph nodes do not metastasise."

"Metastases do not metastasise"

They even go a step further. Based on data obtained from the cancer registry, the broader hypothesis that "metastases do not metastasise" is highly plausible. This would mean that secondary tumours in organs such as the lungs or liver are not involved in the spread of other cancer cells. The immediate consequence of these findings for the Munich scientists is to remove only the lymph nodes, which are essential for local checks, determination of the prognosis and decisions regarding the resultant treatment.

The importance that is attached to the lymph nodes is based on the fact that the chances of survival of the patient are worse the more lymph nodes are affected by cancer cells, regardless of the size and the malignancy of the tumour. Even more than one hundred years ago, surgeons sought to remove a tumour as completely as possible - including the lymph drainage paths.

But there have been doubts for some time whether the radical procedures with the most comprehensive lymphadenectomies is beneficial to patients. In addition, broadened intervention is associated with stresses. It does not increase mortality, but it can - apart from longer hospital stays - cause permanent disabilities. Time and again the idea was challenged that the removal of lymph nodes increases the survival time of the patients. There is no unequivocal lessons which the tumour register in Munich clearly demonstrates for a whole range of cancers.

Lymph node attack an epiphenomenon

One of the arguments lies in the fact that the risk of metastases would exist indefinitely, even if the original tumour site was completely removed. An international study published in the journal "Lancet" (Vol. 373, p 125) has also clearly demonstrated for cancer of the endometrium that lymphadenectomy in the early stages of this tumour does not affect the survival or the incidence of recurrence. The Munich researchers have no doubt that lymph node attack is an epiphenomenon. They refer to it as a good "water level meter", but not however the cause of the flooding.

Finally, Hölzel’s working group looked detail at the progression of metastasis in bowel cancer and colorectal cancer( "Chirurg"). The data in the Munich tumour registry relating to the average survival after the occurrence of distant metastases correspond to the results of comparable international cancer registry over 17 months. This consistancy shows that there is a process in metastasis which is largely independent of the characteristics of the primary tumour. Metastases are already present in 20 percent of patients where tumours were detected early, in advanced stages in around 30 percent, and in total in 83 percent of patients.

Uniform scheme of progression in metastatis

The survival data provide estimates of the growth period of secondary tumors. The period from the start to the detection of metastasis is about six years, the original growth probably growing much more slowly. The molecular biological data suggest that every affected lymph node and each growth has arisen in a metastatised organ from a different cell of the original tumour.

The timing of the metastasis is crucial for the success of chemotherapy. Even today there is no cure for most tumours after diagnosis of metastases. Only metastases that have just been initiated or might exist as "vulnerable" micrometastases can be destroyed. Earlier occurring metastases are no longer reversible.

The complex process of metastasis is obviously genetically controlled and therefore is comparable across all cancers. Metastasis is uniform and is not related to our arbitrary classification of tumour types. Because many details of metastasis are still not clear, the Munich scientists are calling for greater support for the study of pathogenetic processes of metastasis. This might result in new therapies, but could also mean more efficient use of current procedures.

Public health implications

In the publication, "Chirurg" the scientists also criticise current health policy developments. The Munich tumour registry that has been expanded by Hölzel despite many obstacles into an unusually powerful instrument, conforms to international standards. It was added to the global collection of cancer registries in 1998. It covers a catchment area of 4.5 million citizens, which is equivalent to 5.4 per cent of the Federal Republic. It now extends far beyond Munich to Bavaria and the Landshut region.

The data show, Hölzel says, that the German health system provides a high quality of care. This undermines the demands for continuous structural reforms. Oncology in Germany is "talked down", in part to achieve autosuggestive goals such disease management programs or cancer centres. What is important is a meticulously monitored cancer registry cohort with clinical data. But the Zeitgeist is against this despite overwhelming evidence.

Source: FAZ

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