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Confused about lymph node involvment results


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Duplicate post from SL board:

On 6/14/06 I had a mediastinoscopy and bronchoscopy to determine if PET scan was accurate indicating that two lymph nodes were involved in my NSCLC. The doctor called me tonight and unfortunately I'm still learning that I should ask more questions.

They biopsied all of the mediastinum lymph nodes and only #7 (1 node) is cancerous. He said as he previously recommended, Chemo, Radiation and then surgery was the course of action. I have my appointment with the medical oncologist and radiation oncologist on Friday to plan the chemo and radiation.

My primary tumour is in the right upper lobe. They had staged me IIIA. Question: I read that cancer in certain nodes is worse than others although all is not great. Once chemo and radiation is done, and they do surgery do they remove the lymph node? My husband will be with my on friday and I'm going to write down my questions before we go but if anyone understands any of this, some insight would be great.


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Nodes that are on the opposite side (contralateral) are worse than nodes on the same side (ipsilateral) as the primary tumor

Yours is lymph station #7 which is a N2 node.

Lymph nodes numbered 10-14 are N1 nodes.

N3 nodes mean a latter stage than yours IIIB and

N1 nodes mean a earlier stage.

I think with a medianoscopy they remove the nodes that they can reach. One can not determine by size if a lymph node is cancerous

I would ask the doctor this.

It is best to do a full lymph node disection during surgery versus a sampling.

I would want all the lymph nodes that can be removed during surgery to be removed, though (I think it can cause lymphodema - swelling)

During surgery all the lymph nodes can not be reached usually but I would ask your questions to the doctor

From what I have read a full disection (removing all the lymph nodes) is the best as far as preventing recurrence

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When we got a second opinion on surgery the doctor explained the necessity of getting a "clean field". They need to get all the cancer and make sure the surrounding area is good tissue or the cancer will spread.

Most likely they will take the cancerous lymph node to make sure they get everything. I am glad that surgery is an option for you, and I hope the treatment plan goes well.

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I know nothing about this, but wanted you to know that you have my support and prayers. My mom finally got a three ring binder that she was able to write things down, keep all information, and everything. That has been a huge help. She also calls all of us kids before she takes my dad to any appointments. God Bless.

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I had surgery first because there was no evidence of lymph node involvement from the scans I had. When the surgeon opened me up, he knew by sight that at least two of the lymph nodes were positive and took out five more. Of the seven removed, three were positive, putting me at IIIa and not earlier stage. Also, instead of removing a single lobe of my right lung, two were removed to grant "clear margins" around the tumor.

I was given radiation after surgery, but chemo was not recommended (that opinion has changed in newer cases that I've seen). One thing you NEED to be sure of is that your radiation oncologist is in on the "plan" and you do not receive too much radiation to have surgery. (Yes, it IS possible to get too much - you then would not be a candidate for surgery due to scar tissue and a lower ability to heal.)

Good luck to you, it all sounds about right so far! (...and you can STILL get other opinions is you want to, might give you better peace of mind)

Take care,


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Len was also staged at IIIA with a small tumour in his upper right lobe and one node in the mediastinum (which they didn't discover until surgery and subsequent biopsy). They obviously removed that one, along with others that turned out not to be cancerous. After surgery, he had chemo, then after chemo radiation -- but largely targetted at the mediastinum. And so far, so good....he's doing well and, touch wood, two years after surgery, no signs of recurrence.

By all means ask all those questions. We asked as many as we could think of and this forum helped us enormously to think of things that might not have occurred to us otherwise.


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