lymph nodes

[beatlemike]

Hi everyone,I was just reading some of the posts dealing with lymp nodes that has left me kind of puzzeled.On me yhey removed a tumor 10.5 centimeters in size(softball size) and 17 lymph nodes which 2 had been effected.Why will they do surgery on some that have node involvement and others they say they cannot do surgery because a few nodes were effected?Mine was stage2b(T2,N1,One peribronchial node and 1 10R node.grade 3 carcinoma.Does that mean my effected nodes were limited to inside the lung. I have seen many posts in here how folks with smaller tumors than mine were not elgible for surgery because of a few nodes involvement.I just wondered why they could do surgery on me and not them?Mike

[Ry]

When we went for a second opinion on surgery, the onc explained that unless they can get a clean field around the tumor, surgery might make the cancer spread. So I think part of the answer may be if the tumor cannot be removed without getting clean tissue it is safer to leave it. For John, the tumor was on his vena cava so they could not get a clean field around it.

[carolhg]

I too would like to know the answer to that Mike. I had two lymph nodes to light up on my PET scan. My surgeon insisted on me having 6 weeks of daily radiation and weekly chemo. At the end of the 6 weeks the two nodes still lit up. He said that he was going to check them on the surgery table and if they were cancerous that I would not have surgery but would continue with chemo and radiation. He removed 20 lymph nodes and one rib bone and nothing tested positive for cancer thank God. I still have one boderline lymph node that shows up on my ct scans that was left from the surgery but does not concern my doctors.

Carp;

[mary colleen]

Mike,

Dr. West would certainly give you a good answer to this on Onctalk, but in the meantime, I'll tell you what I understand as well as I can:

It's all about location with nodes.

You've probably seen the standard "TNM" staging criterion, in which a given person's combined T (tumor)N (nodes) and M (metastases/spread) characteristics determine stage.

Malignant nodes within the same lung as the primary tumor produce an N1 status. Malignant nodes in the mediastinum (middle of the chest),or in certain other locations within the chest, or in the opposite lung produce an N2 or N3 status and thus a higher stage of lung cancer than stage 2.

Most lung resection for LC is limited to people staged lower than 3B, though you will sometimes see exceptions. To be Stage 2b (same as my husband was), your nodes would need to be within the same lung as the primary, and not in any of the locations falling under the N2/N3 criteria.

Hope this helps - if anyone can do a less clumsy explanation, help us out!

[Welthy]

Mary Colleen,

You know so much about lc and I'm sure you pulled that right out of your head!

A walking encyclopedia is what you have become.

I skipped that section in my studies as it didn't apply. Thanks!

Welthy

[blaze100]

Mike, this is an excellent question.

How do they know it is best to leave the tumor if certain nodes are bad? Wouldn't it be better to take as much of the cancer out as possible and then treat anything left? Barb

[john]

For the TNM staging the N is all based on "regionally local lymph nodes" - lymph nodes in the chest area. They are lymph nodes that are at the lower part of the lung N1, middle part N2 and upper part N3.

N1 makes the cancer a Stage II cancer.

N3 makes a cancer Stage IIIb so most of the times is inoperable.

There was a case for "debulking" a tumor, but the logic now is - If a tumor is not local and can be completely removed then a "systemic" treatment such as chemo must be used.

It also partly depends on which side of the lung the surgeon is operating on. The surgeon can not get to all lymph nodes (there is no access). Surgeons don't open the whole chest up.

I guess a medianoscopy can be done on both sides of the chest to check for "contralateral" lymph nodes. If a node is positive on both sides of the chest it is inoperable.

When a surgeon goes in they can do a full lymph node disection or a sampling of nodes. Studies have shown a full lymph node disection results in longer survival.

Yes it is complicated.

[john]

For 2b they should do surgery unless like Ryan said they can not get clear margins.

A 2nd opinion is always a good idea, especially since there was bleeding. I can not say anything about the expertise of your surgeon, but having complications would have me a little concerned.

When we took slides of my mom's operation to Slone for a 2nd opinion. The 2nd opinion Dr said something like, "I have never seen a cleaner incision, completely amazing. who was the surgeon?". Make sure your surgeon is the best in the area.