Sentinel node biopsy for diagnosis of pelvic lymph node involvement in early stage cervical cancer

© 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. This is a protocol for a Cochrane Review (Diagnostic test accuracy). The objectives are as follows: To assess the diagnostic accuracy of sentinel lymph node biopsy in the identification of lymph node involvement in patients with early stage cervical cancer (Stage IA2 to IIA). We will first explore the impact of major factors for heterogeneity such as tumour size, FIGO stage and timing between application, detection of tracers, tracer substance used, surgical approach, experience of the operator and use of histological ultra-staging techniques. Then, we may consider other factors such as previous treatment to the cervix (including conisation), patient age and body mass index, as these have previously been suggested as possible factors associated with success or failure of sentinel node identification (Sinno 2014; Tanner 2015; Wuntakal 2015)

Cell–cell and cell–matrix dynamics in intraperitoneal cancer metastasis

The peritoneal metastatic route of cancer dissemination is shared by cancers of the ovary and gastrointestinal tract. Once initiated, peritoneal metastasis typically proceeds rapidly in a feed-forward manner. Several factors contribute to this efficient progression. In peritoneal metastasis, cancer cells exfoliate into the peritoneal fluid and spread locally, transported by peritoneal fluid. Inflammatory cytokines released by tumor and immune cells compromise the protective, anti-adhesive mesothelial cell layer that lines the peritoneal cavity, exposing the underlying extracellular matrix to which cancer cells readily attach. The peritoneum is further rendered receptive to metastatic implantation and growth by myofibroblastic cell behaviors also stimulated by inflammatory cytokines. Individual cancer cells suspended in peritoneal fluid can aggregate to form multicellular spheroids. This cellular arrangement imparts resistance to anoikis, apoptosis, and chemotherapeutics. Emerging evidence indicates that compact spheroid formation is preferentially accomplished by cancer cells with high invasive capacity and contractile behaviors. This review focuses on the pathological alterations to the peritoneum and the properties of cancer cells that in combination drive peritoneal metastasis