Dr. Joseph S. Friedberg and a team of oncologists at the University of Maryland School of Medicine (UMSOM) have made a discovery that may revolutionize medical experts’ ability to predict pleural mesothelioma prognosis. Dr. Friedberg’s team discovered a group of lymph nodes in the chest can help determine the likely outcome for mesothelioma patients.
Chest Lymph Nodes Indicate Low Mesothelioma Survival
In the UMSOM research, patients who had mesothelioma cells in their posterior intercostal lymph nodes were twice as likely to have their mesothelioma recur or result in death. In 7% of the studied patients, these lymph nodes were the only indicator a patient’s cancer had spread. No other lymph nodes were affected.
Yet, doctors have not been paying attention to these lymph nodes when staging, diagnosing, or treating patients—until now.
“These nodes warrant further investigation, including non-operative techniques to identify them and factor them into treatment decision-making,” said Dr. Friedberg, the Head of the Division of Thoracic Surgery at UMSOM.
The posterior intercostal lymph nodes are located between the ribs and are part of the larger lymphatic system.
Lymph Node Involvement in Diagnosing Pleural Mesothelioma
Pleural mesothelioma is diagnosed using stages—a rating system related to how far the mesothelioma has spread. While most people are familiar with cancer stages 1-4, there are also numerous stage groupings that go into greater detail about the severity and location of the cancer.
Each stage and stage group corresponds to different treatment approaches and medical recommendations that would be appropriate for that stage.
For example, mesothelioma that has spread to nearby lymph nodes is considered a minimum of Stage 2 mesothelioma, with a subgrouping of N1. Stage 2 mesothelioma is typically treated with surgery, chemotherapy and radiation therapy—a multimodal approach.
Finding this lymph node group impacts how doctors might now diagnose pleural mesothelioma in two ways:
- Patients may be misdiagnosed as Stage 1 when they are at least Stage 2. Surgeons should be looking for signs of cancer in the posterior intercostal lymph nodes, which is not currently a standard place to check during routine screening. Doctors do check other lymph nodes, but not these specific ones.
- Mesothelioma located in these specific lymph nodes may need to be staged higher, as they have a direct, negative impact on patient prognosis. Patients with mesothelioma in their posterior intercostal lymph nodes may require more aggressive treatment approaches.
Because staging is such an essential part of the mesothelioma diagnosis and treatment process, its critical that the results are as accurate and detailed as possible. The recent research by UMSOM gives mesothelioma experts the opportunity to improve the staging process.
“Malignant pleural mesothelioma is a very difficult cancer to treat, and Dr. Friedberg’s research advances our ability to understand how we might incorporate these newly-identified lymph nodes into better staging and treatment for our patients,” said Dean E. Albert Reece, UMSOM Executive Vice President for Medical Affairs.
Lymph Node Involvement in Treating Pleural Mesothelioma
The discovery of mesothelioma in the posterior intercostal lymph node is also likely to change the treatment protocol to make it better at preventing mesothelioma recurrence. To improve mesothelioma prognosis, the UMSOM team is recommending that surgeons remove the lymph nodes during pleural mesothelioma surgery.
Although larger studies are needed, we believe that these lymph nodes should routinely be removed during any surgery with therapeutic intent for malignant pleural mesothelioma, especially as they may be the only lymph nodes to harbor metastatic disease. — Dr. Joseph Friedberg
Current standard surgeries for resectable (removable by surgery) pleural mesothelioma often involve removing nearby lymph nodes, either because they are already involved or are at high risk of becoming involved. However, Dr. Friedberg and his team are recommending a change in the standard practice for all pleural mesothelioma surgical cases.
Closer to a Cure for Pleural Mesothelioma
Every year, we get closer to finding a cure for pleural mesothelioma. UMSOM’s research into the posterior intercostal lymph nodes is one example of how cancer researchers continue to discover new information about the disease and then act upon it.
UMSOM’s findings, and others like it, are critical to improving mesothelioma prognosis, refining staging standards and developing new treatment protocols.
