Overlooked Lymph Nodes May Improve Staging, Treatment
The future staging and treatment of malignant pleural mesothelioma could be improved significantly by a new tool recently uncovered by researchers at the Perelman School of Medicine at the University of Pennsylvania.
The findings involved previously overlooked posterior intercostal lymph nodes that had accurate predictive power for mesothelioma, a cancer that has been difficult to diagnose and stage correctly in the past.
Surgeon Joseph Friedberg, M.D., co-director of the Penn Mesothelioma and Pleural Diseases Program, presented the research last week at the 15th World Conference on Lung Cancer in Sydney, Australia.
The study included 48 surgical patients at Penn Presbyterian Medical Center who underwent a radical pleurectomy for mesothelioma. They found that more than half had metastatic cancer in these particular lymph nodes. In many of those patients, those lymph nodes were the only that showed metastasis.
Researchers also found those individuals without cancer in the posterior intercostal nodes lived an average of 2.5 years longer than those who did.
Doctors May Be Looking at Wrong Lymph Nodes
Doctors typically examine lymph nodes to stage most cancers, including mesothelioma, but they don’t use posterior intercostal ones, which are located between the ribs and near the spine, and might be better predictors.
Friedberg believes that using these lymph nodes as a predictor could better help guide the course of treatment for a patient. He also believes that doctors should begin to biopsy these nodes routinely as part of any surgical-based treatment.
“I am unaware of any other group that is sampling these nodes,” Friedberg said in a UPenn news release. “They are not currently part of the staging system for mesothelioma, or any other cancer for that matter. What we have shown here is that even though these lymph nodes are not described in relation to this cancer, they are highly significant.”
Better Staging Means Better Decision Making
Staging reflects the severity or extent of cancer, which often reflects the course of treatment for a patient. Many physicians still rely on a system for mesothelioma that was developed almost 20 years ago by the International Mesothelioma Interest Group.
There has been concern recently over the validity of the system being used, particularly because of the poor prognosis still received by most patients who are diagnosed. The staging system typically involves a tumor’s size, the lymph node involvement and the metastasis of the cancer.
There is no cure for mesothelioma, and the typical life expectancy after a diagnosis is only six to 24 months. Although major surgery can be effective in prolonging a patient’s life, there are times when it becomes so overwhelming for an older patient that it only lessens the quality of life remaining.
Better staging, researchers belief, would lead to better decision-making on the part of doctors and patients.
“Ultimately, it means that the presence or absence of cancer in these lymph nodes could help guide the treatment of pleural mesothelioma,” Friedberg said.
The study was one of a dozen from Penn Medicine that were presented at the World Conference on Lung Cancer last week. The next World Conference will be held in Denver, Colorado in 2015.