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Using post-operative colon cancer lymph node metrics to develop a novel quality index

Project reference number – 0074

Principal investigator – Prof Simon Buczacki

Plain language summary – Bowel cancer is the 4th most common cancer in the UK, accounting for 11% of all new cancer cases. Bowel cancer cells can break away from the cancer and spread via the lymphatic system to lymph nodes which are an important part of the immune system. The lymph nodes are classed as ‘positive’ if cancer cells are found within them and are a sign that the cancer has started to spread.

Surgery to remove the primary cancer, and the lymph nodes connected to that part of the body, remains the main treatment for bowel cancer. Following surgery, a pathologist examines the removed tissue to identify the number of lymph nodes and whether any are positive. The presence of positive lymph nodes helps determine the patient’s stage of bowel cancer. 

Previous research studies have noted that the number of lymph nodes removed during surgery may be linked to improved survival. This has led to surgical and pathological practice changing to maximise the number of lymph nodes removed during surgery. Our own research suggests that bowel cancers where an increased number of lymph nodes are found have a different tumour structure. We believe this tumour structure causes a greater immune response to the cancer and could explain better survival in these patients. As this immune response is not affected by surgical and pathological practice, the use of more extensive surgery or re-examining for more nodes might be unnecessary.

Our research project aims to suggest an ideal range for the number of lymph nodes gathered during bowel cancer surgery along with lymph node positivity rates. This information can then be used to guide and improve the quality of bowel cancer care.