Importance of the Lymph Nodes Nodes on the side (hilar or N1) are not as significant if nodes in the middle or higher up are involved (N2 or mediastinal nodes)
Lymph Node Stations N2 Nodes: all N2 nodes lie within the mediastinal pleural envelope on the ipsilateral side 10. hilar, 11. interlobar, 12 lobar nodes bronchi, 12 segmental, 14. subsegmental N1 Nodes: all N1 nodes lie distal to the mediastinal pleural reflection and within the visceral pleura 1. highest mediastinal, 2. upper paratracheal, 3. prevascular/ retrotracheal, 4. lower paratracheal, 5. subaortic/AP window, 6. para-aortic, 7.subcarcinal, 8. paraesophageal, 9. pulmonary ligament
Superior Mediastinal Nodes (1-4) 1. Highest Mediastinal: above the left brachiocephalic vein. 2. Upper Paratracheal: above the aortic arch, but below the left brachiocephalic vein. 3. Pre-vascular or Pre-vertebral: these nodes are not adjacent to the trachea like the nodes in station 2. They are either anterior to the vessels (3A) or behind the esophagus, which is prevertebral (3P). 4. Lower Paratracheal (including Azygos Nodes): below upper margin of aortic arch down to level of main bronchus. Aortic Nodes (5-6) 5. Subaortic (A-P window): nodes lateral to ligamentum arteriosum. These nodes are not located between the aorta and the pulmonary trunk, but lateral to these vessels. 6. Para-aortic (ascending aorta or phrenic): nodes lying anterior and lateral to the ascending aorta and the aortic arch. Inferior Mediastinal Nodes (7-9) 7. Subcarinal. 8. Paraesophageal (below carina). 9. Pulmonary Ligament: nodes lying within the pulmonary ligaments. Hilar, Interlobar, Lobar, Segmental and Subsegmental Nodes (10-14) 10-14: these are located outside of the mediastinum. They are all N1-nodes.
PET/CT Scan showing lung cancer in three different planes
Types of Lung Cancer <ul><li>Non-small cell carcinoma (NSCC) </li></ul><ul><ul><li>Adenocarcinoma </li></ul></ul><ul><ul><li>Squamous cell </li></ul></ul><ul><ul><li>Large cell </li></ul></ul><ul><li>Small cell carcinoma </li></ul>
Stages of Lung Cancer <ul><li>Stage I – small spot no nodes </li></ul><ul><li>Stage II – larger or nodes on the side of the lung (hilar or N1 nodes) </li></ul><ul><li>Stage III – very large tumor or lymph nodes in the middles of the chest (mediastinum or N2 nodes) </li></ul><ul><li>Stage IV – metastases to other organs </li></ul>
Treatment of Lung Cancer <ul><li>Stage I and II – surgery (if possible) and sometime postOp chemo or radiation </li></ul><ul><li>Stage III – usually chemo plus radiation, sometime followed by surgery </li></ul><ul><li>Stage IV – chemo or radiation, depending on the site of spread </li></ul>
In the simulation process the CT and PET scan images are used to create a computer plan