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The Role of the Thoracic Duct Lymph in Cancer Dissemination

British Journal of Cancer
Nature Publishing Group
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608 THE ROLE OF THE THORACIC DUCT LYMPH IN CANCER DISSEMINATION J. I. BURN,* A. L. WATNE AND G. E. MOORE Fromt the Department of Surgery, Roswell Park Mem,orial Institute (New York State Department of Health), Buffalo 3, N. Y., U.S.A. Received for publication September 11, 1962 THE identification of cancer cells in the circulating blood and the thoracic duct lymph implicates both of these systems as potential routes for cancer dis- semination. In 1798, Astley Cooper first described involvement of the thoracic duct by malignant disease. Virchow's observation in 1849 of left supraclavicular lymph node metastases associated with abdominal cancer indicated spread by way of the thoracic duct. Stevens, in 1907, pointed out that the thoracic duct plays an important role in the dissemination of intra-abdominal malignant disease, either by being directly involved by tumour or by acting as a " simple carrier " of tumour emboli. In recent years, such investigators as Young (1956) and Celis, Kuthy and del Castillo (1956) have shown that the thoracic duct is frequently involved by malignant disease; and in 1960, Watne, Hatiboglu and Moore were able to identify free tumour cells in the thoracic duct lymph. The relative im- portance of the role of the thoracic duct as a conduit for cancer dissemination to the lungs and other organs is still unknown, however. The following investiga- tions were designed to shed some light on this phenomenon. CLINICAL OBSERVATIONS Methods Thoracic duct cannulation was carried out in 98 patients with advanced malignant disease, using a technique described previously (Watne, Hatiboglu and Moore, 1960). Cytological preparations by means of the Papanicolaou preserva- tion and staining technique were made on aliquots of the daily lymph flow, and were screened for malignant cells. Leucocytes and cancer cells were isolated from 10 ml. antecubital vein blood samples, using the modified streptolysin 0 technique described by Long and his associates (1959). Clinical and autopsy rec

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