Unfortunately, patients with cancer continue to present themselves to the surgeon at an unduly late stage of the disease. The diagnosis of the primary lesion in late cases is usually obvious, and the main problem that confronts the surgeon is the detection of the early distant metastases which contraindicate operation.
The more diligently and more intelligently that metastases are sought, the more commonly are they found, and futile operations on the primary lesion are prevented. Experience has shown that cancer exhibits a predilection to spread along certain pathways that differ with the various organs and tissues. In a few instances the blood stream plays the prominent rôle in conveying cancer cells to a distant focus, especially the lungs; but in the great majority of cases the dominant factor in distant cancer dissemination is lymphatic permeation, as described by Handley in his book on "Cancer of the Breast." I agree with
JOHN BERTON CARNETT. MALIGNANT METASTASES OTHER THAN TO THE REGIONAL LYMPH NODES. Arch Surg. 1929;18(3):811–818. doi:10.1001/archsurg.1929.04420040043004