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Lung cancer can start in various portions of the lung. From there it spreads in fairly predictable pattern. Typically, if lung cancer spreads, it first goes to nearby lymph nodes, followed by lymph nodes further away located between the lungs in a space called the mediastinum.
Small cell mesothelioma – an extremely rare subtype of lung cancer – can be mistaken for small cell lung cancer. [10] Small-cell carcinoma is most often more rapidly and widely metastatic than non-small-cell lung carcinoma [11] (and hence staged differently). There is usually early involvement of the hilar and mediastinal lymph nodes. [12]
[29] [30] Lymph node staging depends on the extent of local spread: with the cancer metastasized to no lymph nodes (N0), pulmonary or hilar nodes (along the bronchi) on the same side as the tumor (N1), mediastinal or subcarinal lymph nodes (in the middle of the lungs, N2), or lymph nodes on the opposite side of the lung from the tumor (N3). [30]
Surgery is normally followed by chemotherapy. In cases where tumour were found in the lymph nodes, radiation therapy to the chest is usually advised after resection. The International Association for the Study of Lung Cancer (IASLC) Lung Cancer Staging Project demonstrated five‐year survival rates after resection as below: [8]
Lymphovascular invasion, especially in carcinomas, usually precedes spread to the lymph nodes that drain the tissue in which the tumour arose. Conversely, cancers with lymph node spread (known as a lymph node metastases), usually have lymphovascular invasion. Lymph node metastases usually precede secondary tumours, i.e. distant metastases.
[3] [13] [14] Diagnosis, if enlarged lymph nodes are present, is usually by lymph node biopsy. [1] [2] Blood, urine, and bone marrow testing may also be useful in the diagnosis. [2] Medical imaging may then be done to determine if and where the cancer has spread. [1] [2] Lymphoma most often spreads to the lungs, liver, and brain. [1] [2]
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