Cancer, from anatomy to the ward
Most of what you need to catch and stage a cancer is anatomy: where a lump sits, which nodes it drains to, which nerve or vessel it invades. Start with a patient, see the tumour in 3D, then test yourself.
Start with a patient
Each case unfolds step by step, from the first symptom to the anatomy behind the diagnosis and treatment.
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See it in 3D
Tumours and the structures every cancer case turns on.
Osteosarcoma
Watch a tumour grow at the knee, break through the cortex and spread to the lungs.
Bone metastases
Deposits in the spine, pelvis and ribs, up to spinal cord compression.
Pectoralis minor
The muscle that divides the axillary lymph nodes into levels I, II and III.
Lymph nodes of the neck
Where head and neck cancers spread, and where the Virchow node sits.
Oesophagus and larynx
Why a tumour of the oesophagus can make the voice hoarse.
Retina and optic nerve
Where retinoblastoma starts, and the route it takes to the brain.
How cancers spread
The routes examiners ask about, all taken from the cases.
| Cancer | Spreads first to | Why | |
|---|---|---|---|
| Breast | Axillary nodes (levels I to III); internal thoracic nodes from the inner breast | About three quarters of breast lymph drains to the axilla | Case |
| Cervix | Parametrium, then pelvic nodes (obturator, internal and external iliac) | The ureters pass 1.5 to 2 cm beside the cervix, so spread blocks them | Case |
| Prostate | Bones of the spine and pelvis | Valveless vertebral venous (Batson) plexus | Case |
| Colon and rectum | Liver | Gut blood drains through the portal vein to the liver first | Case |
| Anal canal (below the pectinate line) | Superficial inguinal nodes | Lymph follows the skin drainage, not the bowel | Case |
| Stomach | Left supraclavicular (Virchow) node, umbilicus, ovaries | Abdominal lymph runs up the thoracic duct to the left venous angle | Case |
| Oesophagus (middle third) | Local invasion of the left recurrent laryngeal nerve | The nerve runs between the trachea and oesophagus | Case |
| Tongue (side) | Submandibular, then deep cervical nodes | Tip drains submental; central parts can drain to both sides | Case |
| Retinoblastoma | Optic nerve to the brain | Removed with a long stump of optic nerve | Case |
| Osteosarcoma | Lungs | Spreads through the blood | Case |
| Testis | Para-aortic nodes | The testis descends from near the kidney and keeps its lymphatics |
Read
Every article links back to its case.
Test yourself on cancer
Exam-style oncology questions with explanations, saved to your progress.
Coming next: new 3D organs (breast, cervix, prostate, liver, bowel, lungs) and a staging simulator where you grow a tumour from T1 to T4, watch it spread along real lymph routes, and assign the stage. Lecturers who want to help design it can tell us.