The lymph node is named after the famous German pathologist Rudolf Virchow (1821-1902). It is a lymph node located in the left supraclavicular fossa and receives lymphatic vessels from the abdominal cavity. It is thus the entrance of the thoracic duct into the jugular vein. When patients have tumors in the chest (esophageal cancer), abdomen (gastric cancer), or even pelvis (rectal cancer), especially esophageal abdominal cancer and gastric cancer, cancer cells can flow backwards to the left supraclavicular lymph node through the intestinal trunk to the thoracic duct and left cervical lymphatic trunk, so metastasis to the left supraclavicular lymph node often occurs, and generally speaking, metastasis to this area is one of the advanced symptoms of gastric cancer. Generally speaking, lymph node metastasis in this area is one of the advanced symptoms of gastric cancer. The enlarged and hard lymph nodes can often be touched at the angle between the posterior edge of sternocleidomastoid muscle and the superior clavicle edge. Many patients with gastric cancer or esophageal cancer were first found to have swollen nodes in this area before further examination and discovery. Some people do not understand why the vast majority of gastric cancer metastases to the left supraclavicular lymph nodes, while the right side rarely metastasizes. This is mainly determined by the pathway of lymphatic circulation and special anatomical structure. The main metastatic pathway of gastric cancer is lymphatic metastasis. Firstly, it metastasizes in the lymph nodes around the stomach, and then enters the thoracic duct through a specific lymphatic drainage pathway, which passes through the venous angle on the left side and converges into a vein. Lymph of stomach – intestinal trunk – thoracic duct – left venous angle. Schematic diagram of the lymphatic circulation Next open to see what the venous angle is anatomically. The internal jugular vein and the subclavian vein on the same side converge behind the sternoclavicular joint to form the cephalobrachial vein (also known as the innominate vein), and the angle of the convergence is called the venous angle. There are two venous angles, with the thoracic duct injecting on the left and the right lymphatic duct injecting on the right. When cancer cells are blocked from converging into the venous angle through the thoracic duct, they may enter the left supraclavicular lymph node through the lymphatic ducts in reverse, where they take root and continue to grow until they form an enlarged nodule that can be directly palpated on the body surface. Single or multiple, varying in size in diameter, peanut rice size to egg size. Whole body lymph node pattern diagram Metastasis in the left supraclavicular lymph node is generally considered advanced gastric cancer. How to diagnose left supraclavicular lymph node metastasis. In other words, is an enlarged left supraclavicular lymph node necessarily a metastasis of gastric cancer. In reality, it may not be so. The swollen left supraclavicular lymph nodes may not be caused by benign diseases, such as skin inflammation in the neck, gingivitis, inflammation of tonsils and so on. It also does not exclude swelling caused by other malignant tumors, such as thyroid cancer of the neck, laryngeal cancer, squamous skin cancer of the head and neck, and breast cancer, which can all cause swelling. Neck lymph node palpation examination For patients with gastric cancer, ultrasound examination of the neck should be done during the initial staging examination for diagnosis. An experienced ultrasonographer can make an initial judgment by ultrasound whether it is benign or malignant. For example, the common ultrasound report of eccentric target ring enlargement is usually considered benign enlargement, if the shape is irregular and shows hypoechoic performance, to high height can be. The best way to confirm the diagnosis is to send an ultrasound-guided lymph node aspiration biopsy for pathological examination, which is the gold standard for confirmation. This is the gold standard for confirming the diagnosis. It can tell the benign and malignant nature of the lymph node, and also the nature of the tumor, and the origin of the primary tumor can be roughly determined. However, sometimes it is difficult to puncture the biopsy, especially when the enlarged lymph nodes are small and deep, so it is difficult to puncture or the risk of puncture is high. At this time, we can combine ultrasound images and PET/CT findings to roughly determine whether gastric metastasis is present. At this time, it is necessary to combine the patient’s symptoms and other examinations such as gastroscopy and enhanced CT examination of the chest, abdomen and pelvis to diagnose and differential diagnosis, which can basically be clarified. Ultrasound-guided aspiration biopsy The treatment of gastric cancer neck lymph node metastasis is not yet completely the same standard. At present, the mainstream clinical treatment plan is to consider it as one of the advanced manifestations of gastric cancer and not to consider surgery first. Systemic chemotherapy is generally recommended to control the progression of the disease. However, the actual treatment plan should be considered in combination with the patient’s overall condition, physical status and treatment intention. If the patient’s physical condition is good, the primary focus does not locally invade the blood vessels and important organs around the stomach, and the systemic examination excludes distant metastases from other sites such as liver, lung and bone, and only perigastric lymph node metastases and supraclavicular lymph node metastases are present. If the patient and family members are willing to treat actively, the primary foci can be removed surgically on the basis of systemic chemotherapy, and the systemic chemotherapy can be continued to control the disease after surgery, combined with radiotherapy of the cervical lymph nodes when necessary, and sometimes the treatment effect is far beyond expectation and long-term survival is possible. The earliest one is a female patient in her 40s in Hebei, who has been treated for 5 years. Recently, there is no change in the lymph nodes in the neck on review, the tumor markers are normal, and there is no sign of tumor recurrence in the whole body. It far exceeds the general survival time of advanced gastric cancer. If the patient has distant metastasis in other parts besides lymph node metastasis in the neck, such as liver, lung, bone or even intra-abdominal metastasis, surgery is not recommended even if the treatment will be strong. Of course, treatment should consider the patient’s physical condition. If the patient is very weak and cannot tolerate anti-tumor treatment, do not continue the treatment, and symptomatic supportive treatment to reduce the patient’s pain should be the main focus. There is no fixed standard recommended plan or treatment guideline for the treatment of patients with cervical lymph node metastasis from gastric cancer. Treatment should be individualized according to the patient’s specific situation. If there is no metastasis from other sites and resection of the primary site is not difficult, I suggest a relatively aggressive treatment plan, in which case the patient will have a great survival benefit. If one simply thinks that it is advanced and cannot be treated surgically, and only regulated or unregulated drug or conservative treatment can be given, sometimes a good treatment window is wasted, and there is no chance once there is extensive metastasis throughout the body.