Lymph Nodes, "N"

Sometimes the CT scan can be very clear that tumor has spread to lymph glands (nodes) by showing very abnormal enlargement. Unfortunately this test can occasionally miss lymph node spread or perhaps even worse, can indicate spread when actually the lymph nodes are enlarged for other reasons. In this case, a PET scan may be recommended.

This information is very important because if tumor has spread into the glands high in the chest (mediastinum) or even into the opposite half of the chest cavity, the surgeon would not expect to remove all the cancer with surgery alone. This also indicates that the cancer cells have started to spread through the bloodstream to areas away from where the tumor started.

Occasionally, bronchoscopy can be used to biopsy a node that is near the air passages. More likely, a test called mediastinoscopy is used to take exact biopsies of the glands around the airway to give the cancer team precise information. There are some glands in the left chest that cannot be reached by the mediastinoscope. A mediastinotomy (Chamberlain procedure) can be used if needed to reach a suspicious gland in the left chest. A small incision is made near the breastbone and a small piece of rib is removed to allow access to that area.