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For your mom to be state IV there has to be mets to other organs.

N2 refers to lymph nodes. They sometimes will refer to the thoraic regional lymph node map. The lower numbers are "worse" and the higher numbers are better.

N2 would mean stage IIIa, so there is a chance for surgery. My mom was diagnosed stage I - clinically. Then when they operated, a dissection of the lymph nodes was done. They found cancer cells at level 5 (essentially N2), that made her IIIa.

If they are saying stage IV there HAS TO BE METS.

In anycase make sure you find out the grade of the tumor, this is the aggressiveness of the tumor. If they remove the lung they will keep the specimen so tests can be done on it.

IT IS VERY important to know the grade. The higher the grade the more

aggressive they should be with treatment.

My mom did not make it and I think there were a few mistakes, though who knows if she received chemo (it still may not have worked)

http://www.chestx-ray.com/StagingLungCa ... aging.html

God bless,


If you have any questions please ask. And make sure you get all medical records and keep your records. They can and should be used to get second opinions.

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There is a spot on her stomach about the size of a pencil eraser but due to the location of that spot they say they cant do a biopsy. They would have to go through the lung to reach it and then make sure they didnt go too far and hit her liver. She did have a pet scan which showed the mass on her lung as cancerous but they said they couldnt distinguish (per the pet scan) if for sure the spot on her stomach was cancerous or not. she had a cat scan and all neurological tests came back fine (normal). The confusing part was that on her med records they stated stage IV and then as i read further on they kept saying N2 disease. The oncology dr wrote stage IV and the pulmonary dr wrote the N2.

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Dear Ralph,

Regional Lymph nodes (N)




N2 Metastasis to ipsilateral mediastinal and/or subcarinal lymph node(s)


Distant metastasis (M)


M) M1


Primary Tumor (T)









Stage Grouping - TNM Subsets

Stage IIIA





Stage IIIB








Stage IV

Any T Any N M1


If I were you, I would get a LOT more information from the doctor's then what you have at this point. I can understand why your confused, so am I! There has to be a lot more to your mom's records then what you have relayed here, (I hope)! Check it out and let us know how it goes. This is a very confusing disease and very baffling. Also, what kind of Lung cancer does your mom have? Small Cell or Nonsmall Cell or Large Cell?

Good Luck to you and your mom.

Warm and Gentle Hugs,

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So there was also uptake or spots lighting up on the mediastinum?

They have to show mets in other areas to definetly make it stage IV.

The PET scan can detect mediastinal metastasis.

The best cure rate is for surgery. What is the size and location of the lung tumor? Is there only one or multiple? If there are multiple are they on the same side or both sides of the lung?

If they are on both sides of the lung. The only surgery options is maybe radio frequency ablation or Dr Lederman at statin island hospital does whole body streotatitic radiation (of a few clinics in the world that does this).

In anycase like connie said they may have to do a biopsy to determine if it is large cell or small cell

God bless,


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her records read

5cm mass in right upper lobe also right hilar lymphadenopathy but adrenals were normal as well as liver. No thyromegaly or cervical lymphadenopathy. neurological scan completely normal. Left lung clear. Confined to chest area. N2 disease.

spot on stomach - behind liver, very subtle . because of location biopsy almost impossible without going through lung. pet scan possible lighting. Not 100% sure it is cancerous. Because of the possible metastasis to stomach stage IV.

based on lymph node and stomach involvement non surgical candidate. Very difficult to remove all lymph nodes, even if stomach is not cancerous due to lymph node involvement surgery not an option.

recommendation chemo every three weeks, carboplatin and taxol. Recheck after 3rd treatment. (she has had 2 treatments so far, last one 3-26-03) prognosis 9-12 mo life expectancy.

lung cancer with hilar adenopathy is the most likely explanation.

Non small cell carcinoma

radiation not an option due to the possible metastasis to the stomach and lymph nodes.

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Dear Ralph,

I'm sorry, but I am STILL confused (although that's no big shock) :) on what it is they are TRYING to say your mom has! Of course I am NOT a doctor and I don't know all the doctor garble! However, I mentioned in another message to you, have you considered taking your mom to MAYO Clinic?

If that report you just wrote to us was MY report, I would be asking my Doctor to EXPLAIN in LAYMENS terms, ENGLISH or just what ever it takes to make me understand. But, from what you wrote, I understand them to read (THEY ARE NOT SURE)?!

You might want to ask Sam on the board here if maybe just maybe he can explain this to you. He's got the MD behind his name! :) Or like I said, I would sure ask her doctor's to explain this. Or I would go to Mayo for a SECOND opinion! Might be worth the ride.

Oh one more thing, my Pulm. Doc told me a long time about that Staging can be VERY CONFUSING at times even to doctor's. Soooooooo......

Good Luck,

Warm And Gentle Hugs,

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Hi guys,

I'll throw in my 2 cents. Connie's right, the N2 relates to the status of the chest lymph nodes and, by definition, N2 node status would make her at least Stage IIIA if she is NSCLC (non small cell lung cancer) but she would still only be a LS-SCLC (limited stage small cell lung cancer).

Metastatic tumors to the stomach are very rare and a lot depends on whether or not that is actually what she has. If it is, then she has stage IV NSCLC or extensive stage SCLC. The treatments and prognosis are very different based on that one little spot.

First, she need a biopsy of the primary lung tumor which I assume could be done by brochospy or needle biopsy. A CT-PET combination scan might give a better idea on the stomach spot. A lot depends on what that spot is or is not.

God bless us all


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Guest JohnPlaschke

Dr Sam,

Thanks for still posting here. How are you? I thought stomach mets were rare. Couldnt find any reference on the net. Brain, liver, bones, adrenals I believe are the most common for lung cancer.

Anyway it is good to know a doctor is here

God bless,


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