1.171 Analogies to Normal Cellular Behavior

Metastasis, the movement of cancer cells to normal organs and structures seems strange. However, the processes associated with metastasis are not unique to cancer cells and the ability of cells to travel to different areas of the body is a normal and necessary process to maintain health. For example, circulating white blood cells must be able to exit the blood through the capillaries and enter infected tissues in response to the injury. During early development of an embryo, cells that become the embryo’s placenta must be able to invade the mother’s womb to allow the developing embryo to attach and grow. Healing of a cut requires the movement of different types of cells to cover the wound and re-form skin and blood vessels. Each of these processes is tightly controlled such that the invasion is limited in time and space.
The body would likely repair the leg by replenishing cells and repairing damaged sources of blood supply. With a cancer, the body believes the area is damaged, so it connects with neighboring sources of blood and nourishment to replenish the damaged area. In truth, many cancers do reflect damage to DNA, but the remedy the body creates simply spreads the cancer, rather than repair the damage.
Comparisons to the behavior of normal cells can be made:

“It is also important to remember that expression of invasion promoter genes is not a purely pathological phenomenon seen only in cancer. Certain normal cell types demonstrate different elements of the phenotype as part of their usual functions. Thus, leukocytes resemble metastatic cells in many ways since they must leave the bone marrow and move, via the circulation, to specific sites elsewhere in the body where they must penetrate to sites of infection and inflammation. Similarly, embryonic cells must move between developing tissues in a way that can be likened to tumor cell invasion.... Therefore, expression of the invasive phenotype by cancer cells should be thought of more as the activation of normal cellular programmes in an inappropriate cellular context, than as the expression of completely novel phenotypes. In this way, it may be possible to understand how and why the genes of invasion are expressed so aberrantly in tumor cells and, therefore, to generate more mechanism-based and effective treatments.” (1) Vile, at 24

1.172 Tumors Are Categorized Based Upon the Extent of Metastasis

Cancers are categorized based upon the extent of metastasis (as well as growth). Non-small cell lung cancers (the largest type of lung cancer) are classified from stage 1 to stage 4. Stage 1 tumors are limited to a defined area in a single part of the lung. Stage 4 means the tumor has metastasiZes to another organ, with stages 2 and 3 assessing the extent of movement to adjoining or distant lymph nodes. Stage one cancers are usually treated with surgical removal of the tumor, while stage four metastatic tumors treated with chemotherapy.


One writer explains:

“Even though cancers enlarge, invade adjacent body parts, and travel to distant metastatic locations, they remain unchanged. The characteristics of human tumors, with rare exceptions, are fixed for the life of every tumor, regardless of where or when distant metastasises of the tumor are found. In 1874, Dr. W. Moxon, an English pathologist, described rectum in liver, referring to rectal tumors that were growing in their original unchanged forms after metastasizing to the liver.... a prostate tumor that is diagnosed early prostate specific antigen (PSA) was detected in the blood will continue to produce PSA years later at a metastatic site.” Dermer, (3) at 46-47

This book is about lung cancer, or more specifically tumors which originate in the lung. Thus, we may discuss metastasis to other organs, which will still be treated as lung cancer in most respects.


There are two basic ways that cancers metastasize, that is spread to other organs. The most common route is by channels that exist in every part of the body called lymph channels. Lymph channels are a fine network of vessels that carry the liquid portion of the blood from different parts of the body. Returning to the bloodstream, the lymph is filtered through lymph nodes and returns to a large lymph vessel near the heart. Given the flow of lymph to and from the lymph nodes, we can understand why the finding of cancerous cells in the lymph nodes will be critical. If the tumor has moved to a lymph node, its potential for dissemination throughout the body increases. A tumor which is detected and removed before a lymph node becomes cancerous has a far better prognosis than one which has infiltrated a nearby lymph node.

1.71 Regional and Other Lymph Nodes

In staging the patient, that is ascertaining his status, doctors consider whether the lymph nodes are cancerous, and where the
cancerous nodes are located. The spread of a tumor to a lymph node located near the tumor, or a regional node, is less serious than the spread to one further away, indicating a greater spread of the tumor. A surgeon will generally obtain samples or biopsies from lymph nodes to ascertain the status of lymph nodes, and treatment will depend upon that assessment.

1.72 Blood Vessels

A tumor may also spread through the body through a blood vessel. There are various tests to ascertain the extent of cancer in the blood, however, blood vessels cannot be individually assessed as lymph nodes usually are.


Lung Cancer and Mesothelioma

This site contains over 450 pages of detailed information about treatment, research, caregiver support, chemotherapy, gene      therapy, insurance issues and legal questions, along with excerpts from our book, Lung Cancer and Mesothelioma(2005).  Order our book from or, or review the chapter excerpts below.




Tarceva and lung cancer
Analysis of Tarceva, Iressa and epidermal growth factor inhibitors. Also see Iressa 
BAC and Iressa. (Discusses results with Iressa and BAC for non-smokers)

EGFR  cell test   (Review of cell tests to determine which tumors are EGFR positive and therefore responsive to Tarceva. 
Non-smoker's lung cancer (review of treatment for non-smoker's lung cancer and recent research).


Cox2 inhibitors and lung cancer
(how Cox-2 inhibitors like Celebrex may inhibit the spread of cancer with limited side effects)
Anti-angiogenic drug overview discussion of drugs to limit cancer metastasis. 


stage 1 non small lung cancer

stage 2 lung cancer treatment
stage 3 non-small cell lung cancer treatment
stage 4 non small cell lung cancer
Small cell lung cancer staging and treatment standard and other staging methods,
surgical options, chemotherapy and drug resistance. 

Non-smoker's lung cancer (review of treatment for non-smoker's lung cancer and recent research).


Chemotherapy (What is chemotherapy)
Surgery overview


Practical questions for the Lung Cancer Patient and Family 
health insurance issues

CLINICAL TRIALS LIST (National Cancer Institute list of clinical trials) 


Over 70% of lung tumors are diagnosed at advanced stages, reducing the patient's opportunity for long term survival.   In some instances, a doctor's failure to promptly diagnose a lung tumor, and order or interpret appropriate tests may be malpractice.  Our office handles failure to diagnose lung cancer cases in New Jersey and New York.    

medical malpractice lung cancer claims     cancer malpractice statute of limitations               
New York Cancer Malpractice claims        medical malpractice and clinical practice guidelines
New Jersey cancer malpractice claims      medical malpractice liability

Medical malpractice jury instruction         New York Medical malpractice law 
medical malpractice pre-existing cause     workers' compensation doctor liability for malpractice

cancer, malpractice and informed consent article on missed and delayed diagnosis and malpractice claims


Mesothelioma chemotherapy    
Mesothelioma medical treatment
Mesothelioma surgery   pleuropneumonectomy for mesothelioma
Mesothelioma Immunotherapy
Mesothelioma overview
mesothelioma gene therapy


After smoking exposure to dusts such as asbestos and silica are the leading causes of lung cancer.  Workers exposed to asbestos or silica may have worker's compensation claims  a claims against the product manufacturers
Asbestos and Lung Cancer, compensation for lung cancer
    Silica and lung cancer, types of silica exposure,       
Benzene and leukemia.    Exposure to benzene    


cervical cancer malpractice articlescervical cancer malpractice

cervical cancer malpractice and New York statute of limitations


(links to other sites on various topics).


Lung cancer patients should consider joining Alcase, an effective lung cancer advocacy group and review materials from the Cuneo Lung Study Team, and the European Lung Cancer Working Party.  


Lung cancer and Mesothelioma ( The book Lung Cancer and Mesothelioma in Word format, formatting varies from published version)
What is cancer   basic concepts of cancer development, growth factors, oncogenes. 
cancer terminology partial and complete response, methods of evaluating drugs, causation,
how lung cancer develops concepts of genetic damage and alteration,
screening and identification of tumors
diagnostic tools and their accuracy Chest x-ray, Ct Scan, Pet Scan,
Types of lung cancer
Small cell and non-small cell distinctions

Analysis of Iressa and epidermal growth factor inhibitors. 
Cancer weight loss and fatigue   Cachexia, lung cancer pain and fatigue.
Anti-angiogenic drug overview discussion of drugs to limit cancer metastasis.
Small cell lung cancer staging and treatment standard and other staging methods,
surgical options, chemotherapy and drug resistance. 
health insurance issues
Overview of Mesothelioma 
surgery and radiation for mesothelioma 
chemotherapy for mesothelioma

Standard of care for diagnosis of lung cancer
Resource sources
Lung cancer family history and diet 
Other books on Lung Cancer

BOOK REVIEWS                                                 
Lung Cancer and Mesothelioma 

Quality Books "This book provides an invaluable resource for anyone who has or who is caring others with Mesothelioma or other Lung cancers. It provides a wealth of relevant and useful information on various types of lung cancers, medical trials, treatments and medications. This well researched and comprehensive book is quite unique on the subject. This book also contains a detailed discussion on the emotional burden of Lung Cancer upon the patient and their families and ways to manage it."
Lorraine Kember. Author of "Lean on Me - Cancer through a Carer's Eyes", "The very mention of the word Cancer, strikes fear into all of us.... From personal experience I know that knowledge is the key to providing a better "quality of life" for the cancer patient. Better understanding of the stages of the disease and of methods and medications available to treat the pain and symptoms caused by it, allow for the patient and those who care for them, to make informed decisions regarding their care. In this way, they are able to regain some control over their lives. Rarely does one find all the information they need in one book, however I believe Howard's well researched and comprehensive book "Lung Cancer & Mesothelioma", is quite unique. It provides a wealth of relevant and useful information including; how various types of cancer are formed, medical trials, available treatments and medications, insight and discussion regarding the emotional burden of cancer upon the patient and their families and ways by which to manage grief. I believe this book will provide an invaluable resource for anyone who has or who is caring for someone with cancer.


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Howard Gutman is a New Jersey attorney based in Parsippany, New Jersey who has handled numerous legal claims involving pulmonary tumors.   A member of the board of directors of a leading cancer support group and a caregiver, he is the author of the new book Lung Cancer and Mesothelioma.   In his legal capacity, he has appeared on Good Day New York, spoken at the National Press Club  and been interviewed by NBC Nightly News.

Contact Information

Howard A. Gutman, Esq.
230 Route 206,  Building 3
Flanders, New Jersey 07836, 
New York Office

305 Madison Avenue, Suite 449,

New York, New York 10165

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DISCLAIMER This page is not intended to provide medical advice or treatment.  Some of the information on this site may not be relevant to your condition, and all advice should be obtained from a physician.  The materials herein are intended to provide general information and no representation or made as to its completeness or accuracy.

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