ASO Author Reflections: Is Breast Cancer Dissemination Lymphatic, Hematogenous, or Both; and Does It Matter?

Excerpt

The evolution of surgical management of carcinomas of major organs in the early twentieth century depended upon the belief that cancers of ectodermal and endodermal origin metastasized to regional lymph nodes (RLNs). Halsted1 extrapolated this belief to the treatment of breast cancer (BC), showing that surgical removal of the entire organ (the breast) plus the RLNs and the intervening pectoralis muscles in one piece resulted in long-term cure in about a third of cases, suggesting that systemic metastasis (smets) could sometimes be averted. In the absence of adjuvant systemic and radiation therapy during those years this also meant that direct invasion into the bloodstream probably had not occurred in those patients and that the primary route of smets was through the RLNs. Surgical cure alone was possible. This persuasive conclusion was used by other surgeons to justify the concept of surgical resection of organs such as the stomach, pancreas, rectum, colon, uterus, prostate, and lung together with RLNs in one piece. …