Esophageal mucosa, submucosa and muscular lymphatic abundant, easily accessible lymphatic plexus and the formation of dense network of lymphatic vessels, usually on the esophagus 2 / 3 majority of the flow of lymphatic cranial side of the lower 1 / 3 of the flow of the caudal lymphatic . Mainly along the longitudinal direction of lymphatic drainage, the flow is 6 times the horizontal, so the lymphatic channel is not only the main transfer pathway of esophageal cancer, and has spread within the esophageal wall formation, satellite lesions, lymph node and distant skip metastasis and so on.
Lymphatic spread and metastasis of esophageal cancer (1) the proliferation of esophagus. This is the most common ways of esophageal cancer proliferation. Transfer does not occur in situ of esophageal cancer, the proliferation of cancer cells when the evolution of early invasive carcinoma, the intrinsic membrane and along the submucosal esophageal lymphatic longitudinal diffusion, especially in lymph of thoracic esophageal muscularis into the esophagus through the outer membrane in lymphatic vessels in the prior often submucosal longitudinal stretch up or down a great distance. Internal diffusion in the esophagus, the upward diffusion of distance than the distance down the proliferation of big. In addition, if the spread of cancer cells along the lymphatic vessels do not stay along the way, and in distant parts of residence and the infiltration of growth, the formation of several membrane surface uplift of the nodules are called "satellite lesions."
Esophageal cancer and metastatic lymph node spread (2) lymph node metastases. Esophageal metastatic sites and the lymphatic drainage patterns related. Lymphatic drainage of the esophagus is broadly as follows: neck on the deep cervical lymph node can be divided into deep cervical lymph and lymph node under the main sink go deep cervical lymph nodes in the neck were injected into the right lymphatic duct and thoracic duct. Esophageal cervical lymph nodes can also be through the retropharyngeal lymph nodes and cervical trachea indirectly into the deep cervical lymph nodes, a few can enter the subclavian lymph nodes. Esophageal lymphatic drainage in the chest above the level of tracheal bifurcation to the esophagus first draining lymph nodes, and then drain into the paratracheal lymph nodes, and then draining into the inferior thyroid artery parts of the lymph nodes, and finally into deep cervical lymph nodes; below the level of tracheal bifurcation downward into the thoracic lymph para-aortic lymph nodes and the tracheobronchial lymph nodes; pulmonary vein following section down most of the esophageal lymphatic drainage, breast muscle by the esophageal hiatus into the abdominal lymph nodes. Lymphatic drainage into the abdominal esophagus cardia lymph nodes, stomach and upper abdominal lymph nodes.
Esophageal cancer can occur any period of neck, mediastinal and abdominal lymph node metastasis, etc.. The autopsy found that 70% of patients with lymph node metastasis in esophageal cancer. Lymph node metastasis rate and depth of invasion, tumor invasion of muscular, full-thickness and peripheral lymph node metastasis rates were 8.7%, respectively, 40.6% and 70.3%. Once the lymph node metastasis of esophageal cancer, the survival rate decreased significantly.
Lymphatic spread and metastasis of esophageal cancer in the clinical setting, often transferred to the upper esophageal subclavian artery lymph nodes, paratracheal lymph nodes, deep cervical lymph nodes and supraclavicular lymph nodes, physical examination may be in the bottom of sternocleidomastoid and anterior scalene muscle Interchange palpable lymph nodes. Patients, such as a hoarse voice, often due to compression of recurrent laryngeal nerve lymph nodes of it. Upper esophageal carcinoma can also be transferred to the abdominal lymph nodes down to retrograde. Generally transferred to the middle of the esophagus esophageal lymph nodes, hilar lymph nodes, carina lymph node, pericardial lymph nodes, may also shift up or down. Esophageal cancer can be transferred to the lower esophageal lymph nodes, pericardial lymph nodes, lungs, and cardiac lymph nodes under the ligament lymph nodes. Whether upper, middle, lower esophagus, in addition to transfer to the supraclavicular lymph nodes, may be retrograde to the abdominal lymph node metastasis. In addition, free of cancer cells through the esophagus into the regional lymph nodes before the muscle can be a wide gap between longitudinally into the distant parts of the lymph nodes in advance, or by means of thoracic duct to enter distant parts of the lymph nodes, arising from the phenomenon of distant skip metastasis .
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