NCCN Guidelines for Patients® | Lung Cancer - Non-Small Cell Lung Cancer

24 NCCN Guidelines for Patients ® : Lung Cancer – Non-Small Cell, 2018 N = Nodes Cancer cells can spread throughout the body by traveling in lymph. Lymph in lung tissue first travels to the intrapulmonary and peribronchial lymph nodes inside the lungs. See Figure 7 . From these nodes, lymph then travels to the hilar lymph nodes. Hilar lymph nodes are found right outside the lungs where the windpipe attaches to the large airway. From the hilar lymph nodes, lymph travels to nodes in the mediastinum. The mediastinum is the center of the chest where the heart is. Subcarinal lymph nodes are located right below the windpipe. Lymph also travels to nodes above the collarbone (supraclavicular) and within the neck (scalene). The N score reflects how far lung cancer has spread within the described lymph nodes. N scores for lung cancer include: † † NX means nearby lymph nodes have not been tested. † † N0 means that there is no cancer in nearby lymph nodes. † † N1 means that the cancer has spread to the peribronchial nodes and/or to the hilar and intrapulmonary nodes of the lung with the primary tumor. † † N2 means that the cancer has spread to mediastinal lymph nodes, which include subcarinal nodes, near the lung with the primary tumor. † † N3 means that the cancer has spread to the mediastinal or hilar nodes near the lung without the primary tumor, or to any supraclavicular or scalene lymph nodes. 3 Cancer staging TNM scores Figure 7 Lymph nodes to which lung cancer spreads Lung cancer can spread to lymph nodes inside the lung then to nodes in between the lungs, near the collarbone, and in the neck. subcarinal scalene supraclavicular mediastinal tumor hilar intrapulmonary peribronchial