For cancer of the lower lobe of the right lung, the first, intrapulmonary stage of metastasis is the lymph nodes at the base of the lower lobe bronchus and the lower interlobar. Further, spreading through the lymphatic vessels of the interlobar fissure and along the trunk of the pulmonary artery, metastases reach the lower terminal lymph nodes. The lymph nodes of the right pulmonary ligament are also often affected.
In individual cases, the metastasis of cancer of the lower lobe can be more extensive and also affect the lymph nodes of the upper interlobar group within the intrapulmonary collector.
Within the mediastinum, the most regular and frequent for cancer of the lower lobe of the right lung is metastasis of the bifurcation and peresophageal groups of the lymph nodes. Then, the upstream right tracheobronchial and pretracheal lymph nodes are involved in the tumor process. With an upward lymphatic current, metastases reach the lymph nodes of the right paratracheal group and the right supraclavicular. Often marked metastases in the lymph nodes of the right prepericardial group, mainly located along the lower third of the trunk of the phrenic nerve.
In case of cancer of the upper lobe of the left lung (Fig. 6) within the intrapulmonary part of the regional lymphatic collector, the lymph nodes located near the upper lobar bronchus are first affected by metastases, especially between the site of bronchial formation of the upper three segments and the reed. When the tumor is located in the reed segments of the upper lobe, the lymph nodes of the interlobar group — along the pulmonary artery — are also involved in the tumor process.
Within the lung root, metastases are naturally found in the lymph nodes of the upper and anterior groups. In the middle, the lymph nodes of the preaortocarotid, left tracheobronchial and paratracheal groups are the most common site of development of cancer metastases of the upper lobe. For tumors localized in the reed segments of the upper lobe, metastasis to the bifurcation lymph nodes is also frequent. However, as a rule, such a metastasis pathway is more often observed only with a significant lesion of the superior pre-aortocarotid and left tracheobronchial groups of lymph nodes, i.e. when a retrograde outflow of lymph occurs before the formation of collaterals.
Further, with an upward lymphatic current, metastases along the collectors of the left vertical path reach the lymph nodes of the left supraclavicular region.
When the tumor is located in the lower lobe of the left lung, the first stage of lymphogenous metastasis is the intrapulmonary group of lymph nodes located near the lower lobe bronchus. Then, through the vessels in the interlobar fissure, they reach the root of the lung. here metastases most often affect the lymph nodes of the lower group and located in the left pulmonary ligament.
Within the mediastinum, with cancer of the lower lobe of the left lung, the lymph nodes of the bifurcation and perioesophageal groups are regularly metastasized, and the next stage is the left tracheobronchial and pre-aortocarotid. The final stage of lymphogenous metastasis is the lymph nodes of the left supraclavicular region.