Case

A 75-year-old patient comes in complaining of abdominal discomfort and have been unable to defecate for 3 days.  They feel bloated with crampy pain from the abdomen.  On physical examination the left lower quadrant is tender to the touch.  

Endoscopy imaging is also performed and a large mass in the sigmoid colon wall identified.  A needle biopsy is performed and evaluated, showing a large bowel carcinoma is present with evidence is had entered a metastatic stage.

 

Question 3/4 - If this carcinoma metastasizes, map out the route cancerous cells would follow to the heart if they follow the lymphatic pathways?

Click on your selected option(s) below  (correct = 2, over-thinking = 3+)

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- Inferior mesenteric lymph nodes
- Cisterna chyli
- Thoracic duct
- Left venous angle
- Left brachiocephalic vein
- Superior vena cava

Lymph follows the vasculature back to the aorta and ascends along periaortic lymph channels to the cisternae chyli. This is a collection point for all lymph from below the diaphragm. That then ascends in the posterior mediastinum in the thoracic duct to join the left venous angle.  

Once entering the venous circulation at the left venous angle, the lymph follows the left brachiocephalic vein to the left superior vena cava. At this point we have reached the heart.