“What did the lymph nodes show?” is the question whose answer is apprehensively awaited by every colon cancer patient. Even in the age of molecular medicine, the absence or presence of colon cancer spread to regional lymph nodes remains the strongest predictor of whether surgery has cured the cancer, or whether an individual may harbor occult metastatic disease and thus require adjuvant chemotherapy to reduce the risk of lethal cancer metastases recurring in distant organs (1–3). But is colon cancer spread to lymph nodes a precursor of spread to another organ (e.g., the liver) or rather an indicator of colon cancer cells’ metastatic competence? On page 55 of this issue, Naxerova et al. (4) provide molecular evidence that, in many instances, colon cancer metastases in the liver (and possibly other distant organs), originate from distinct clone(s) that differ from the founder(s) of cancer deposits in the lymph nodes.
