How Far Has the Cancer Spread in the Lymph Nodes?
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. This information is very important because if tumor has spread into the glands high in the chest or even into the opposite half of the chest cavity, the surgeon would not expect to remove all the cancer with immediate surgery.
Occasionally, the bronchoscope can be used to biopsy a node that is near the air passages. More likely, a test called mediastinoscopy is used to make 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 introduced into a low neck incision. 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.
There is a newer test called a PET scan that may also be useful to the cancer specialists. This test can give images of sugar uptake in the body. Since things like tumors grow fast and need a lot of sugar energy, lymph nodes with a lot of tumor in them can "light up" on these scans.
Occasionally, the bronchoscope can be used to biopsy a node that is near the air passages. More likely, a test called mediastinoscopy is used to make 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 introduced into a low neck incision. 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.
There is a newer test called a PET scan that may also be useful to the cancer specialists. This test can give images of sugar uptake in the body. Since things like tumors grow fast and need a lot of sugar energy, lymph nodes with a lot of tumor in them can "light up" on these scans.