Lymph Nodes- is there any point

Lymph fluid is basically water that leaks through cell walls and blood vessels into the spaces between them, and is mopped up by the lymphatic system which collects this and adds in loads of antibodies and T cells to kill any bacteria and viruses present. Areas of injury or infection also get swamped with lymph to try and clean them up and disinfect them.

Lymph nodes filter out and kill any cells in lymph fluid, including cancer cells. While they're successfully doing this, you're OK. Eventually however, either some cancer cells leak through, or they're filtered out but not killed, and grow in the lymph node. Then you're in trouble.

Lymph fluid passes through many lymph nodes as it passes back through your body heading towards your collar bone area, where after multiple filtering, it drains back in to your blood stream. If cancer is found only in the lymph nodes immediately draining your prostate of lymph, that's likely to be more curable than if it's found further along the pathway, which is why staging identifies it as N1 when near the prostate, rather than distant lymph nodes which is identified as M1a as it's already leaked through many lymph nodes and further micro-mets are likely to have been established even if not yet found.

With radiotherapy of high risk cases, prophylactic treatment of pelvic lymph nodes is sometimes undertaken in higher risk cases even if it wasn't found in them, just in case micro-mets had already set up in there but not shown on scans. (One of the objectives of the PIVOTALboost trial is to see how effective this is at preventing spread which would otherwise have happened from micro-mets in lymph nodes.) Similarly with surgery, pelvic lymph node dissection (PLND) is sometimes included, hoping to go as far as taking all nodes with any mets in them, which you can only be reasonably sure of if you've gone as far as the first node in the chain with no mets in them. The trouble here is that may involve taking nodes which drain other areas such as groin and/or legs, leaving those areas with no lymph no drainage anymore, and lymphedema where water can't drain anymore, which is debilitating and not resolvable. (So I tend to suggest anyone going in to surgery with the expectation of extensive PLDN really considers radiotherapy to include pelvic lymph nodes instead, as that can cure cancer in the lymph nodes with a better prospect of leaving them still working afterwards.)

Interestingly, if you have a tattoo done, much of the ink will leak and be mopped up by the lymph system, and it tattoos the lymph nodes as it passes through them and they filter out the dyes. When bodies have been recovered from crime sites after attempts to prevent their identity, which often involves destroying identifying features such as tattoos, they have still be identified from the missing tattoos by finding matching coloured inks staining the relevant lymph nodes.

Edited by member 12 Dec 2023 at 08:54  | Reason: Not specified

There are two types of lymph node involvement:

1. When prostate cancer is identified in lymph nodes away from the immediate pelvic area, they have indeed set off down the highway and RT to the prostate bed / pelvic area would be pointless. This is described as M1a on the diagnosis letter.

2. imagine the lymph nodes immediately next to the prostate are like a colander / sieve - as the lymphatic fluid flows through the prostate, it picks up tiny cancer cells and carries them into the nearest lymph node where the colander / sieve filters them out and stops them going off down the highway. This is described as N1 or N0 and RT to the pelvic area is very much worthwhile!

Edited by member 23 Dec 2023 at 18:37  | Reason: to clarify info

While that is believed to be the case, lymph vessels are mostly extremely small and almost impossible to see. The pictures are based on just a few careful studies using specialised techniques, and I don't think those definitely rule out the possibility of there being occasional vessels which bypass the nearest nodes.

In addition:

(1) all of us are different. While the descriptions may well be true for the majority of people as far as the scientists could tell that doesn't mean they are necessarily true for everyone and for you in particular.

(2) what makes a cancer establish a secondary in one place and not another is also poorly understood. It is possible most cells were stopped at the first lymph node they got to and destroyed without establishing a secondary there, but a few cells managed to pass beyond and succeeded in establishing a secondary at a more distant node.

Reading don't have one either. They send patients to Oxford or Mount Vernon for PET scans.

However, hospitals without their own PET scanner offer far fewer PET scans to their patients. I had assumed this might down to cost, but an oncologist said to me it's also familiarity - oncologists in centres without PET scanners are less experienced in using them, often don't realise how useful they are (some have even been skeptical), and how often they cause in changes to treatment which improve outcomes.

There is a big shortage of PET scanning capacity though. This is causing a waiting period which is itself unsuitable for some patients, resulting in treatment having to go ahead without waiting for a scan.

Rory, I had surgery nearly ten years ago, followed by salvage RT three years later. In the past eighteen months I have twice had  SABR treatment to two separate lymph node tumors. For me a possible cure route was preferable to a life time of control.

Thanks Chris 

Strictly speaking, N0 indicates that there are no mets in the lymph nodes. N1 indicates that there is cancer in the lymph nodes close to the prostate. M1a indicates that the cancer has metastasised to lymph nodes further afield. The problem is that we are seeing more and more commonly now that men with just one or two potentially affected nodes in the pelvis are being scored as N0 and offered treatment as if the nodes were not affected.   

Hi Roger, there may have been only one lymph node showing as affected on the scans but,  as you will have realised, there is a possibility of micromets in many lymph nodes which may show themselves at some point in the future. That is pretty much what happened to Chris-J - the scans were clear for ages. I suppose it also matters whether your one lymph node was adjacent to the prostate or somewhere remote like under your armpit :-/   Either way, you have given it all barrels and will hopefully still be posting here in 10 years! 

John

It seems to me that it's all a bit.of a lottery. I don't feel that I have had the best treatment. My lymph nodes have not been radiated, but that's just how it is. I have also noted that although my PSA is 0.34 after radiation and 12 months HT and the medics seem happy I cannot but note others down to levels significantly lower and often down from greater highs. 

What can one do, not a lot other than enjoy each day. I love the positivity of all those who heroically declare that their cancer won't define them. My cancer may not have defined me but it has certainly changed my life. Happy Christmas ⛄.

Rory