› Forums › General Melanoma Community › Metastasis through Bloodstream vs. Lymph
- This topic has 21 replies, 3 voices, and was last updated 12 years, 2 months ago by
JC.
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- November 26, 2013 at 11:54 pm
Hi-
Recently diagnosed Stage 4. It appears that I never had or they can't fina a primary. Intilayy had small lump thought to be cyst…well it's melanoma. Oncologist was slightly shocked when pet scan lit up for metastasis to lung. No lymph node involvement etc… Wants to go straight to systemic treatment. Questions…
Is prognosis worse becuse of perceived spread through blood? Doc says spread to brain is higher risk…that's it…that's why treatment wants to start ASAP.
Best treatments now? Yervoy? IL-2? Trials? I'm told my disease burden is low.
This melanoma is turning out to be tricky.
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- November 27, 2013 at 2:26 pm
When melanoma cells in a skin lesion escape, they are usually trapped by the draining lymph nodes (called the "sentinal lymph nodes"). The melanoma cells start to form a small tumor in the lymph node and subsequent escapees get caught by the next lymph nodes in the series. So what one usually sees is that the regional lymph nodes around a lesion light up on PET scans and the patient is considered to be Stage III. Eventually, the melanoma cells can escape from the lymph system and get into the blood stream where they can lodge in other organs distant from the original lesion–lungs, liver and brain are the favored sites. Then the patient is considered Stage IV.
I don't know that mellanoma cells in the blood stream are necessarily more aggressive than other melanoma cells in terms of their rate of proliferation or ability to evade immune system detection. However, once melanoma is found in one non-lymph organ, it could already be getting a foothold in other non-lymph organs. In other words, in a case like yours where you can't find the original lesion and the first tumor is found in a distant organ, who knows where else it could be right now? That is why your doctor wants you to do a systemic treatment rather than just surgically removing the one lesion and thinking that everything will be OK. That makes good sense to me.
The best results are now being seen with anti-PD1 therapies, which are still in clinical trials. Some trials are using anti-PD1 alone and others are trying to combine anti-PD1 with other immune treatments like ipi (Yervoy) or IL-2. I suggest you look into those first. Ask your doctor or check the clinicaltrials.gov web site to find out if you are elegible for any clinical trials in your area.
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- November 27, 2013 at 2:26 pm
When melanoma cells in a skin lesion escape, they are usually trapped by the draining lymph nodes (called the "sentinal lymph nodes"). The melanoma cells start to form a small tumor in the lymph node and subsequent escapees get caught by the next lymph nodes in the series. So what one usually sees is that the regional lymph nodes around a lesion light up on PET scans and the patient is considered to be Stage III. Eventually, the melanoma cells can escape from the lymph system and get into the blood stream where they can lodge in other organs distant from the original lesion–lungs, liver and brain are the favored sites. Then the patient is considered Stage IV.
I don't know that mellanoma cells in the blood stream are necessarily more aggressive than other melanoma cells in terms of their rate of proliferation or ability to evade immune system detection. However, once melanoma is found in one non-lymph organ, it could already be getting a foothold in other non-lymph organs. In other words, in a case like yours where you can't find the original lesion and the first tumor is found in a distant organ, who knows where else it could be right now? That is why your doctor wants you to do a systemic treatment rather than just surgically removing the one lesion and thinking that everything will be OK. That makes good sense to me.
The best results are now being seen with anti-PD1 therapies, which are still in clinical trials. Some trials are using anti-PD1 alone and others are trying to combine anti-PD1 with other immune treatments like ipi (Yervoy) or IL-2. I suggest you look into those first. Ask your doctor or check the clinicaltrials.gov web site to find out if you are elegible for any clinical trials in your area.
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- November 27, 2013 at 2:42 pm
I don't know the answer to that; I'm not sure that anyone does. However, I think the theory is that sometimes a melanoma lesion can ulcerate and release melanoma cells into the blood stream without going through the lymph system. Then the immune system attacks and heals the original lesion (called "regression" of the lesion) so the evidence of it is gone. But that's just my guess.
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- November 27, 2013 at 2:42 pm
I don't know the answer to that; I'm not sure that anyone does. However, I think the theory is that sometimes a melanoma lesion can ulcerate and release melanoma cells into the blood stream without going through the lymph system. Then the immune system attacks and heals the original lesion (called "regression" of the lesion) so the evidence of it is gone. But that's just my guess.
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- November 27, 2013 at 2:42 pm
I don't know the answer to that; I'm not sure that anyone does. However, I think the theory is that sometimes a melanoma lesion can ulcerate and release melanoma cells into the blood stream without going through the lymph system. Then the immune system attacks and heals the original lesion (called "regression" of the lesion) so the evidence of it is gone. But that's just my guess.
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- November 27, 2013 at 3:04 pm
Sentinel Lymph node biopsies have never had a 100% success rate. I read one article (can't find it now) that discussed there is a certain amount of timing involved in the procedure and that it is possible that the sentinel node could be missed if the timing is off. Also, the SNB is a snapshot in time. So if the melanoma cells have left the primary but have not yet traveled to the lymph node basin, again this may be missed. And the other option is another primary that might be undiscovered. No one knows for certain, but the SNB is not a guarantee of anything. It's a diagnostic tool.
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- November 27, 2013 at 3:04 pm
Sentinel Lymph node biopsies have never had a 100% success rate. I read one article (can't find it now) that discussed there is a certain amount of timing involved in the procedure and that it is possible that the sentinel node could be missed if the timing is off. Also, the SNB is a snapshot in time. So if the melanoma cells have left the primary but have not yet traveled to the lymph node basin, again this may be missed. And the other option is another primary that might be undiscovered. No one knows for certain, but the SNB is not a guarantee of anything. It's a diagnostic tool.
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- November 27, 2013 at 3:04 pm
Sentinel Lymph node biopsies have never had a 100% success rate. I read one article (can't find it now) that discussed there is a certain amount of timing involved in the procedure and that it is possible that the sentinel node could be missed if the timing is off. Also, the SNB is a snapshot in time. So if the melanoma cells have left the primary but have not yet traveled to the lymph node basin, again this may be missed. And the other option is another primary that might be undiscovered. No one knows for certain, but the SNB is not a guarantee of anything. It's a diagnostic tool.
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- November 27, 2013 at 2:26 pm
When melanoma cells in a skin lesion escape, they are usually trapped by the draining lymph nodes (called the "sentinal lymph nodes"). The melanoma cells start to form a small tumor in the lymph node and subsequent escapees get caught by the next lymph nodes in the series. So what one usually sees is that the regional lymph nodes around a lesion light up on PET scans and the patient is considered to be Stage III. Eventually, the melanoma cells can escape from the lymph system and get into the blood stream where they can lodge in other organs distant from the original lesion–lungs, liver and brain are the favored sites. Then the patient is considered Stage IV.
I don't know that mellanoma cells in the blood stream are necessarily more aggressive than other melanoma cells in terms of their rate of proliferation or ability to evade immune system detection. However, once melanoma is found in one non-lymph organ, it could already be getting a foothold in other non-lymph organs. In other words, in a case like yours where you can't find the original lesion and the first tumor is found in a distant organ, who knows where else it could be right now? That is why your doctor wants you to do a systemic treatment rather than just surgically removing the one lesion and thinking that everything will be OK. That makes good sense to me.
The best results are now being seen with anti-PD1 therapies, which are still in clinical trials. Some trials are using anti-PD1 alone and others are trying to combine anti-PD1 with other immune treatments like ipi (Yervoy) or IL-2. I suggest you look into those first. Ask your doctor or check the clinicaltrials.gov web site to find out if you are elegible for any clinical trials in your area.
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