Table 3.

The Fisher (alternative) hypothesis of tumor biology (1968)

There is no orderly pattern of tumor cell dissemination.
Tumor cells traverse lymphatics by embolization, challenging the merit of en bloc dissection.
The positive lymph nodes are an indicator of a host-tumor relationship that permits development of metastases, rather than the instigator of distant disease.
Regional lymph nodes are ineffective as barriers to tumor cell spread.
Regional lymph nodes are of biological importance.
The blood stream is of considerable importance in tumor dissemination.
Complex host-tumor interrelationships affect every facet of the disease.
Operable breast cancer is a systemic disease.
Variations in local-regional therapy are unlikely to substantially affect survival.