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Although distant metastases are the most dreaded situation in the evolution of cancer of every organ, the medical literature has surprisingly given little attention to the anatomical relationship between the primary tumor and metastasic sites. Only risk factors, treatment possibilities, and survival results are extensively examined. Stimulated by the occurrence in his practice of some puzzling and unexpected metastases, the author reviewed more than 12,000 references. He looked for anatomical relationships highlighting the relation between the location of the primary tumors and the particular patterns of metastasis observed. It would seem that the `pathways and flows' are apparently a more decisive factor in the implantation of the metastases than the `seed and soil' properties of the cancer cells and the metastatic site. Aided by his colleague Dr. T. Geukens, M.D., the author includes original anatomical drawings, illustrating the sometimes unexpected pathways the cancer cells follow in order to reach the organs where they will become lodged and give rise to metastatic tumors. The subject has apparently not been exhausted in the literature and several ideas are given for further research.
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TxNxM1 This Page Intentionally Left Blank TxNxM1 The Anatomy and Clinics of Metastatic Cancer by Dr. J.M. Debois KLUWER ACADEMIC PUBLISHERS NEW YORK, BOSTON, DORDRECHT, LONDON, MOSCOW eBook ISBN: Print ISBN: 0-306-47678-9 0-7923-6793-6 ©2002 Kluwer Academic Publishers New York, Boston, Dordrecht, London, Moscow Print ©2002 Kluwer Academic Publishers Dordrecht All rights reserved No part of this eBook may be reproduced or transmitted in any form or by any means, electronic, mechanical, recording, or otherwise, without written consent from the Publisher Created in the United States of America Visit Kluwer Online at: and Kluwer's eBookstore at: http://kluweronline.com http://ebooks.kluweronline.com I dedicate this book to Doctor James Paget (1814-1899) He was the first to observe the non-random nature of the metastatic process Reproduced by kind permission of the President and Council of the Royal College of Surgeons of England I must acknowledge the continuous support of my wife Kristin, the encouragement of Prof.Marc M.Mareel, M.D. the artistic devotion of colleague Tony Geukens, MD. the endeavour of the Editorial Staff of Kluwer Academic Publishers This Page Intentionally Left Blank CONTENTS Part I - The METASTASIS and its PRIMARY Introduction Chapter 1 - Metastases to the Thoracic Organs Metastases to the Lung Parenchymal Lung Metastases Lymphangitic Carcinomatosa of the Lung Pulmonary Arterial Tumor Embolism Metastases to the Tracheo-Bronchial Tree Metastases to the Pleura Metastases to the Heart and Pericard Metastases to the Thymus Metastases to the Diaphragm Metastases to the Mediastinal Nodes Metastases to the Cardiophrenic Nodes Metastases to the Female Breast Metastases to the Male Breast References 1 3 3 3 11 12 16 19 25 34 35 36 39 39 41 42 Chapter 2 - Metastases to the Abdominal organs Metastases to the Liver Metastases to the Spleen Metastases to the Pancreas Metastases to the Gallbladder Metastases to the Bile Duct Metastases to the Adrenal References 54 54 66 68 71 71 72 76 Chapter 3 - Metastases to the Digestive System Metastases to the Esophagus Metastases to the Stomach Metastases to the Duodenum Metastases to the Small Intestine Metastases to the Appendix Metastases to the Colon Metastases to the Rectum Metastases to the Anus Metastases to the Peritoneum Metastases to the Mesenterium References 80 80 82 85 86 88 89 90 91 91 99 100 Chapter 4 - Metastases to the Urogenital System Metastases to the Urinary System Metastases to the