Lymph nodes: at the intersection of cancer treatment and progression.

Lymph nodes (LNs) are frequent sites of metastasis and serve as a source of tumor-specific immune tolerance. It is unclear whether LN dissection improves the prognosis for many solid organ malignancies. LNs are crucial sites of immune education and activation in response to immunotherapy. Therapeutic approaches aimed at reprogramming immune responses in LNs may prove more efficacious than lymphadenectomy. Metastasis to lymph nodes (LNs) is a common feature of disease progression in most solid organ malignancies. Consequently, LN biopsy and lymphadenectomy are common clinical practices, not only because of their diagnostic utility but also as a means of deterring further metastatic spread. LN metastases have the potential to seed additional tissues and can induce metastatic tolerance, a process by which tumor-specific immune tolerance in LNs promotes further disease progression. Nonetheless, phylogenetic studies have revealed that distant metastases are not necessarily derived from nodal metastases. Furthermore, immunotherapy efficacy is increasingly being attributed to initiation of systemic immune responses within LNs. We argue that lymphadenectomy and nodal irradiation should be approached with caution, particularly in patients receiving immunotherapy. [ABSTRACT FROM AUTHOR]