Abstract
Breast cancer is one of the most important causes of premature mortality among women and it is one of the most frequently diagnosed tumours worldwide. For this reason, routine screening for prevention and early diagnosis is important for the quality of life of patients. Breast cancer cells can enter blood and lymphatic capillaries, then metastasizing to the regional lymph nodes in the axilla and to both visceral and non-visceral sites. Rather than at the primary site, they seem to enter the systemic circulation mainly through the sentinel lymph node and the biopsy of this indicator can influence the axillary dissection during the surgical approach to the pathology. Furthermore, secondary lymphoedema is another important issue for women following breast cancer surgical treatment or radiotherapy. Considering these fundamental aspects, the present article aims to describe new methodological approaches to assess the anatomy of the lymphatic network in the axillary region, as well as the molecular and physiological control of lymphatic vessel function, in order to understand how the lymphatic system contributes to breast cancer disease. Due to their clinical implications, the understanding of the molecular mechanisms governing lymph node metastasis in breast cancer are also examined. Beyond the investigation of breast lymphatic networks and lymphatic molecular mechanisms, the discovery of new effective anti-lymphangiogenic drugs for future clinical settings appears essential to support any future development in the treatment of breast cancer.
Highlights
Breast cancer represents one of the most important causes of premature mortality among women and it is one of the most frequently diagnosed neoplastic diseases worldwide [1]
Breast cancer cells can enter blood and lymphatic capillaries. Molecular mechanisms allow this tumour to metastasise to the regional lymph nodes in the axilla and to both visceral and non-visceral sites
Cancer cells proliferate in this lymph node, where they encounter different types of vessels, including dilated high endothelial venules, and newly formed blood and lymphatic capillaries induced by vascular endothelial growth factors
Summary
Breast cancer represents one of the most important causes of premature mortality among women and it is one of the most frequently diagnosed neoplastic diseases worldwide [1]. Since the normal anatomy of the lymphatic system is important for predicting which lymph nodes may be affected by metastases after a primary tumour, topographic knowledge can help this approach This concept is relevant to understand the secondary lymphoedema occurring after lymph node removal in cancer patients [30]. Circulation through the sentinel lymph node, where a premetastatic niche was described In this case, cancer cells proliferate in this lymph node, where they encounter different types of vessels, including dilated high endothelial venules, and newly formed blood and lymphatic capillaries induced by vascular endothelial growth factors. Rather than at the primary site, breast cancer cells seem to gain entrance to the systemic circulation mainly through the sentinel lymph node and the biopsy of this fundamental indicator can influence the axillary dissection during the surgical approach to the pathology. Anatomical knowledge is important to establish surgical lymphatico-venular anastomosis to improve lymphatic drainage
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