small-cell lung cancer - a less common form that usually spreads faster than non-small-cell lung cancer. In 2021, an estimated 235,760 new cases of lung cancer will be diagnosed in the United States. Some lymph node stations can only be accessed by one method and not the other (for example, station 2 and 4 L and 3 are hard or impossible to see by EUS, stations 5 and 8 cannot be biopsied by EBUS). When combined, this approach has been termed “complete medical mediastinoscopy.” EUS-FNA with EBUS may allow near-complete, minimally invasive mediastinal staging in patients with suspected lung cancer [38], Lu Charles, Onn A, Vaporciyan AA et al. FDA approves atezolizumab as adjuvant treatment for non-small cell lung cancer. As a result, a given stage may have quite a different prognosis depending on which staging edition is used, independent of any changes in diagnostic methods or treatments, an effect that has been termed In medicine, lung cancer staging is the assessment of the extent to which a lung cancer has spread from its original source. Survival rates for small cell lung cancer are different for different stages of the disease. The cancer can be of any size, and may have spread to lymph nodes as well as: the other lung, the tissue lining of the lung or the heart, or another part of the . Tecentriq may be used with the chemotherapy medicines carboplatin and etoposide as their first treatment when their lung cancer: is a type called "extensive-stage small cell lung cancer," which means that it has spread or grown
The lungs are a pair of cone-shaped breathing organs in the chest. The two stages of small cell lung cancer are: Limited: Cancer is confined to one lung and nearby lymph nodes. EUS can easily sample celiac lymph nodes, which cannot be reached by the other mediastinal staging methods. Lung cancer is the result of lung cells growing abnormally and out of control.. Nearly all patients with SCLC are current or former smokers.
[18][19], In small-cell lung carcinoma, the TNM classification is often used along with an additional categorization, the Veterans Administration Lung Cancer Study Group system. [4] There is an extensive array of staging methods available, each with advantages and disadvantages. In this issue of Surgical Oncology Clinics of North America, Guest Editor Mark Krasna and colleagues discuss a wide range of topics devoted to lung cancer. Many patients will, if given a choice, prefer an instrument which is inserted into the esophagus (EUS) over one which is inserted into the trachea (EBUS). Many cancer treatment centers review newly diagnosed patients at an inter-disciplinary chest tumor board where radiologists, oncologists, surgeons, pulmonologists, pathologists and EUS specialists (endosonographers) discuss the relative merits of the available modalities and make a choice by consensus. Patients with extensive-stage small cell lung cancer (ES-SCLC) receiving standard-of-care chemotherapy regimens are at risk for the development of chemotherapy-induced myelosuppression, which can result in serious clinical consequences.
Currently, the 5-year survival rate for stage 1 is 31 percent, for stage 2, 19 percent, for stage 3 it is 8 percent and only 2 percent for stage 4 disease. In selected clinical situations confirmation of the results of the status of the mediastinal nodes by sampling will therefore be necessary.[23]. What is the prognosis for small cell carcinoma? Each is staged differently. Of considerable historical importance, Dr. Clifton Mountain, a surgeon in Texas, made significant contributions to the TNM staging system, particularly in non-small cell lung carcinoma, and the literature thus often refers to "Mountain" staging. Oncol 11, 300-311 (2016). A chest x-ray is often the first test your doctor will do to look for any abnormal areas in the lungs. Useful for station 2L and 4L, L adrenal, celiac lymph node, Cannot reliably access right sided paratracheal lymph node stations 2 R and 4R; accurate discrimination of primary hilar tumors and involved lymph nodes is important. (See "Cigarette smoking and other possible risk factors for lung cancer" .) IMFINZI is a prescription medicine used to treat adults with a type of lung cancer called small cell lung cancer (SCLC). Lung cancer biopsies can be taken for two different reasons: However, it is often possible, with proper planning, to obtain both diagnostic and staging information with a single biopsy procedure.
A. About two-thirds of the people with small cell lung cancer will . An adaptation of the endoscopic ultrasound scope originally designed for the gastrointestinal tract is known as endobronchial ultrasound (EBUS). Extensive-stage is the most common type of small cell lung cancer—almost 70% of people have this type when they are diagnosed. Chemotherapy is the keystone in the treatment of small cell lung cancer (SCLC). Extensive-stage small cell carcinoma is the lungs, has spread to other organs, and in a recurrent carcinoma, found also in the central nervous system. Larsen S et al. Generally, the higher the stage number, the more the cancer has spread. Lung Cancer 2005, 48(1):85-92. In the mediastinum, the lung cancer tends at first to stay on the side where the original tumor started. More invasive; false-negative rate approximately 10%. There has been some drift over time in what this definition means. Doctors may also use general stages for NSCLC. This book presents the Proceedings of the Second International Congress on Neo-Adjuvant Chemotherapy which took place on 19 to 21 February 1988 in Paris. Doctors Lounge Website. This series on the treatment of cancer is sponsored by the UICe. The editors and authors feel strongly that more standar dization in cancer therapy is needed on a worldwide basis. Stage 3 lung cancer encompasses many different types of tumors, some of which may have spread to nearby tissues, organs, or lymph nodes.Life expectancy for lung cancer is often expressed in 5-year survival rates, that is, how many people will be alive 5 years after diagnosis. Found inside – Page 2862At the 1.5 ng/ml cut-off, we noted a 67% sensitivity for all lung cancers. ... serum in the event of therapeutic response, make it a marker of choice in the monitoring of non-small cell cancers, and particularly epidermoid carcinomas. The underlying idea is that initially advanced cancers, previously too extensive for surgery, may have responded to chemotherapy and radiation so much that they now may be operative candidates.
2 SCLC is a highly aggressive, fast-growing form of lung cancer that typically recurs and progresses . This generally means your cancer: is only in one lung. The mainstay of non-invasive staging is a CT scan of the chest followed by metabolic imaging with a PET scan.
At this point the cancer cells can spread (metastasize) outside of the lung to lymph nodes and other parts of your body.
5 Lung cancer is broadly split into NSCLC and small cell lung cancer, with 80-85% classified as NSCLC . Stage 0 is rare and is called in situ ("in place") because cancer cells have formed in the airways, but not deeper in the lungs. If you have this type of cancer, your doctor may use the TNM system. TX.
An area of active and emerging research concerns the value of combining EUS and EBUS in a single session, one specialist following the other, or -even more convenient- a dual trained operator doing one or the other – or both- as needed. 1 Lung cancer is broadly split into non-small cell lung cancer (NSCLC) and SCLC, with about 15% classified as SCLC.
The NCCN pathways "outline the step-by-step treatment decisions from diagnosis through all phases of treatment and survivorship."[7]. Does not cover all medastinal lymph node stations, particularly subcarinal lymph nodes (station 7), paraesophageal and pulmonary ligament lymph nodes (stations 8 and 9), the aortopulmonary space lymph nodes (station 5), and the anterior mediastinal lymph nodes (station 6); false-negative rate approximately 20%; invasive, Good for inferior mediastinum, station 5 and 6 lymph nodes, Invasive, does not cover superior anterior mediastinum, More widely available than some other methods, Traverses a lot of lung tissue, therefore high pneumothorax risk, some lymph node stations inaccessible, Relatively low yield, not widely practiced, bleeding risk, Direct visualization of lymph node stations. This section focuses on the emerging role various types of endoscopic ultrasound and biopsy are playing in the diagnosis and staging of lung cancer, with an emphasis on the most common type of lung cancer, non-small cell lung cancer (NSCLC). For more information, visit Stages of Non-Small Cell Lung Cancer external icon and Stages of Small Cell Lung Cancer. Biopsy is usually performed via bronchoscopy or CT-guided biopsy. In general, more advanced stages of cancer are less amenable to treatment and have a worse prognosis. More than one-quarter of patients survived five years (26.4 percent). A total of 35 experts met to address several questions on non-small-cell lung cancer (NSCLC) in each of four areas: pathology and molecular biomarkers, first-line/second and further lines of treatment in advanced disease, early-stage disease and locally advanced disease. Treatments include surgery, chemotherapy, and radiotherapy. For limited-stage small cell lung cancer, where you're going for cure, you can cure a percentage of patients. Many doctors consider small cell lung cancer that has spread to the fluid around the lung to be an extensive stage. A favorite among residents and pulmonary fellows, this text provides all the information needed to evaluate and manage respiratory diseases and critically ill patients and to pass the American Board of Internal Medicine's subspecialty exam ... EUS-FNA in enlarged discrete mediastinal lymph nodes had an excellent pooled sensitivity (8 studies) of 90% (95% CI, 84 to 94%) and specificity of 97% (95% CI, 95 to 98%). From Kim Thiboldeaux, Executive Chair of the Cancer Support Community, Your Cancer Road Map provides a comprehensive, reassuring guide to individuals facing cancer and their families.
The diagnosis of lung cancer is based on chest radiograph and computer tomography (CT) scans, and is confirmed by biopsy. Stage 4 non-small cell lung cancer (NSCLC) is found in both lungs, in the fluid that surrounds the lungs or heart, or has spread to other parts of the body, such as the liver, brain, or bones. Small cell lung cancer is staged in this way because it helps separate tumors that can be treated more effectively with radiation therapy from those which cannot. We have more information about lung cancer stages. Endoscopic ultrasound guided biopsy versus mediastinoscopy for analysis of paratracheal and subcarinal lymph nodes in lung cancer staging. The majority of lung cancer cases are non-small cell lung cancer (NSCLC). American Joint Committee on Cancer. This book describes the molecular mechanisms of lung cancer development and progression that determine therapeutic interventions in the era of genomics, when the rapid evolution in lung cancer diagnosis and treatment necessitates critical ... Holland-Frei Cancer Medicine.
These techniques have been reviewed extensively[24][26] and have attained substantial consensus in guidelines such as from the NCCN. While referencing advances in traditional therapies and treatments such as chemotherapy, this book also highlights advances in biotherapy including research using Interferon and Super Interferon, HecI based and liposome based therapy, gene ... The stage III treatment plan your doctor produces will depend on the sub-stage non-small cell lung cancer is in, as tumors spread to different places. How long can you live with stage 4 small cell lung cancer? Lorem ipsum dolor sit amet, consectur adipig elit. A. With the aid Read more…, Contract management is one of the most essential parts of the legal industry, and today, it is quickly changing due to the application of AI technology. Herth F et al.
An operation to remove the lung cancer and a small portion of healthy tissue is called a wedge resection. N1 : Nodal metastasis in ipsilateral pulmonary or hilar lymph nodes; N2 : Nodal metastasis in ipsilateral mediastinal/subcarinal lymph nodes; This page was last edited on 20 November 2021, at 17:32. One way to describe NSCLC is by its clinical or pathologic stage. The initial evaluation of non-small cell lung cancer staging uses the TNM . This volume offers a comprehensive visual guide to diagnosis, management, and post-treatment care for all stages of lung cancer. It discusses lung cancer in both adults and children. (See "Cigarette smoking and other possible risk factors for lung cancer" .) March 24, 2021. The ACCP guidelines recommend invasive staging for patients with or without mediastinal lymph node enlargement on CT regardless of the PET scan findings. In other words, an EUS that has a positive result (shows cancer) will avoid further needless surgery, whereas a result not showing cancer may be false-negative, and probably requires an excisional biopsy technique for confirmation, such as VATS or mediastinoscopy. This work has been selected by scholars as being culturally important, and is part of the knowledge base of civilization as we know it. EUS has the highest yield in the posterior inferior mediastinum, and EBUS is strongest for the superior anterior mediastinum. This tells your doctor how far the cancer has grown or spread. Yasufuku K et al. Staging for Small-Cell Lung Cancer. This fifth edition of the TNM Supplement: A Commentary of Uniform Use offers practitioners a wealth of material intended to complement the system's day-to-day use. The volume features: Updated definitions of terms used in cancer staging. Shortness of breath. This dissertation, "The Role of Computed Tomography Volumetry in the Assessment of Advanced Lung Cancer and Oesophageal Cancer" by Tsz-chung, Yip, 葉子仲, was obtained from The University of Hong Kong (Pokfulam, Hong Kong) and is being ... The aim of this book is to provide an exciting read on strategies in the diagnosis and therapy of lung cancer.
Lung cancer in non-smokers, who account for approximately 15% of cases, is often attributed to a combination of genetic factors, radon gas, asbestos, and air pollution. Two scenarios were considered: the setting of enlarged lymph nodes on CT (suggestive but not diagnostic of cancer), and the obverse scenario of an absence of lymph node enlargement on CT (suggestive but not diagnostic of no cancer). [14] The changes have been reviewed in detail, including an extensive presentation (with multiple tables and detailed discussion) of prognostic data for both 6th and 7th edition, looking at both individual T, N and M descriptors, and at overall stage groups. Eventually, a tumor forms and the cancer can spread (metastasize) to other areas of the body. This special edition of Frontiers in Oncology reviews the current efficacy and limitations of surgical and radiotherapeutic management of lung cancer and provides insight into how local management options may change in the future. In preparing this book, we have considered and reflected on the concept of the recent advances in cancer management and therapy as well as molecular applications in cancer therapy. [14] [citation needed]. Highlights the full text of a document with patient information on small cell lung cancer, provided by the University of Pennsylvania Trustees. Stage 4 lung cancer, also known as metastatic or secondary lung cancer, is the most advanced stage of lung cancer. Shortness of breath. Types of Treatment. EUS-FNA in the setting of no enlarged mediastinal lymph nodes on CT had a pooled sensitivity (4 studies) of 58% (95% CI, 39 to 75%) and specificity of 98% (95% CI, 96 to 99%). : Real-time endobronchial ultrasound guided transbronchial needle aspiration for sampling mediastinal lymph nodes.
Signs and symptoms of lung cancer typically occur when the disease is advanced. NCCN Guidelines for patients: non-smallcell lung cancer; 2010. Typically, if lung cancer spreads, it first goes to close-by lymph nodes, followed by lymph nodes further away located between the lungs in a space called the mediastinum. PLYMOUTH MEETING, Pa., Nov. 11, 2021 /PRNewswire/ -- The National Comprehensive Cancer Network ® (NCCN ®) Oncology Research Program today announced new funding for projects to improve patient care and outcomes in early-stage non-small cell lung cancer (NSCLC).Funding will be provided through support from AstraZeneca. Signs and symptoms of lung cancer typically occur when the disease is advanced. A growth or lump that may be malignant (cancer) or benign.
Real-time endoscopic ultrasound-guided fine-needle aspiration of a mediastinal lymph node. [31], The potential utility of EUS-FNA in restaging of the mediastinum in patients who have undergone chemotherapy and radiotherapy for N2 or N3 disease is under investigation. Systemic therapy with chemotherapy or targeted therapy is the mainstay of treatment for most patients.
Am J Respir Crit Care Med 2007, 175(4):345-354. De la Guerra. Stages of Lung Cancer: An Overview After a lung cancer diagnosis has been made, tests are conducted to determine if cancer cells have spread within the lungs or to other parts of the body ( see Lung Cancer Staging ). Thorax 2006, 61(9):795-798. Objective remission and good palliation is achieved in ∼80% of the patients, but the remissions are in general short (mean <1 yr), and few are cured. Detailed results from an updated analysis of the Phase III CASPIAN trial showed AstraZeneca's Imfinzi (durvalumab) in combination with a choice of chemotherapies, etoposide plus either carboplatin or cisplatin, demonstrated a sustained, clinically meaningful overall survival (OS) benefit for adults with extensive-stage small cell lung cancer (ES-SCLC) treated in the 1st-line setting. After this, using the TNM descriptors, a group is assigned, ranging from occult cancer, through stage 0, IA (one-A), IB, IIA, IIB, IIIA, IIIB to IV (four). Practically all a majority of these Read more…, Home security is a substantial industry; however, you do not have to enlist the services of a professional to install an installed and contracted security system in order to protect your property. Endoscopy 2007, 39(1):65-71. AJCC Cancer Staging Manual 6th edition; Chapter 19; Lung - original pages 167-177http://www.cancerstaging.org/products/csmanual6ed-4.pdf, AJCC Cancer Staging Manual 5th edition; Chapter 19; Lung - original pages 127-137http://www.cancerstaging.org/products/csmanual5ed_3.pdf, AJCC Cancer Staging Manual 4th edition; Chapter 19; Lung - original pages 115-122, AJCC Cancer Staging Manual 3rd edition; Chapter 18; Lung - original pages 114-121http://www.cancerstaging.org/products/csmanual3ed_2.pdf, AJCC Cancer Staging Manual 2nd edition; Chapter 16; Lung - original pages 99-105http://www.cancerstaging.org/products/csmanual2ed.pdf, AJCC Cancer Staging Manual 1977; Chapter 6; Lung - original pages 59-64http://www.cancerstaging.org/products/csmanual1ed.pdf. In the future, the TNM staging system should be integrated into the classification of SCLC. Gastrointest Endosc 1993, 39(3):429-431, Annema J, Rabe K: State of the art lecture: EUS and EBUS in pulmonary medicine. Highlights the full text of a document with patient information on non-small cell lung cancer, provided by the University of Pennsylvania Trustees. Standard-of-care first-line treatment for extensive-stage small-cell lung cancer is platinum chemotherapy (carboplatin or cisplatin .
At stage IV lung cancer, cancer could have made its way to the bones, at which point symptoms would consist of bone pain or easy breaks. 8th edition. Lung cancer is the leading cause of cancer-related mortality worldwide. T2a: Primary tumor is >3 and ≤5 cm in greatest dimension. N0. Stage 0 (carcinoma/tumor in-situ) non-small cell lung cancer is an early stage of lung cancer that is only in the top lining of the lung or bronchus and has not spread. If needle techniques are used (such as EUS-NA, TBNA, EBUS-NA, or TTNA) a non-malignant result should be further confirmed by mediastinoscopy as explained above.
They’ll measure the size of your tumor in centimeters to give it a number. Each lung has sections called lobes.The left lung has two lobes. No evidence of primary tumor. Small cell lung cancer (SCLC) is an aggressive form of lung cancer.
Squamous cell lung cancer can spread to multiple sites, including the brain, spine and other bones, adrenal glands, and liver. Generally, treatment options at this level can include a combination of chemotherapy, radiation, and maybe surgery. There was an increase in stage I NSCLC incidence from 10.8 to 13.2 per 100,000. Numerous subsequent studies have shown this general methodology to be effective, very safe, minimally invasive, and very well tolerated. In the following table they are arranged from the most to the least invasive. You and your doctors can then talk about the best treatment choices for you.
It’s important to know the stage of your lung cancer. This stage group assists with the choice of treatment and estimate of prognosis. Lung cancer is the leading cause of cancer death among both men and women and accounts for about one-fifth of all cancer deaths. Insights on the differences between . Anatomic stage/prognostic groups. Clinical staging is done by a combination of imaging and sampling (biopsies), or stated differently, non-invasive (radiological) and invasive (biopsy) methods.
Lung cancer has emerged as the leading killer of men and women stricken with invasive cancer, affecting husbands and wives, friends and neighbors, and causing suffering for many families. Together, EBUS and EUS cover the entire mediastinum (except possibly station 6) and complete mediastinal staging should be possible with a combination of these two procedures. Found inside – Page 43motherapy and surgery with surgery alone in resectable stage IIIA non - small cell lung cancer . J Natl Cancer Inst 86 : 673- 689 , 1994 . 19. Rosell R , Gomez - Codina J , Camps C , et al : A randomized trial comparing preoperative ... Stages of non-small cell lung cancer. These cells can be carried away in blood or float away in the fluid, called lymph, that surrounds lung tissue. The National Comprehensive Cancer Network's Oncology Research Program to oversee projects focused on improving patient care and outcomes in early-stage non-small cell lung cancer. A total of 35 experts met to address several questions on non-small-cell lung cancer (NSCLC) in each of four areas: pathology and molecular biomarkers, first-line/second and further lines of treatment in advanced disease, early-stage disease and locally advanced disease. In the superior mediastinum the trachea is somewhat to the right of the esophagus which makes it often possible to reach left-sided area 2 and 4 lymph nodes and, less often, right sided paratracheal lymph nodes. This compilation represents the first phase of a more extensive process to integrate all prognostic factors in cancer to further enhance the prediction of outcome following treatment. However, the established management paradigm of platinum-based chemotherapy has reached an . PET/CT combined the benefits of functional assessment with PET and anatomic assessment with CT. PET/CT represents a significant advance for staging of patients with lung cancer with management impact in the order of 40%[20] and discordant findings compared with conventional imaging in half of patients. 1; Survival rates of small cell lung cancer by stage. Noninvasive staging of non-small cell lung cancer: ACCP evidenced-based clinical practice guidelines (2nd edition). This book provides a comprehensive and up-to-date account of the physical/technological, biological, and clinical aspects of SBRT. It will serve as a detailed resource for this rapidly developing treatment modality. In practice, CT or MRI scans are used to detect brain metastases. Yours may use the TNM system and numbers to stage your cancer in each of these: American Lung Association: “Lung Cancer Staging.”, LungCancer.org: “Types and Staging of Lung Cancer.”, American Cancer Society: “Non-Small Cell Lung Cancer Stages.”. Many patients will also present with advanced disease at diagnosis, so it is essential that clinicians continue to optimize the management of extensive-stage small cell lung cancer (ES-SCLC). New TNM Classification for Lung Cancer. Rather than immediately proceeding to thoracotomy based on CT or PET results, which could lead to an “open and close” thorax surgery, restaging, including invasive staging, may deselect non-responders, missed on imaging tests alone. Stage grouping. One way to determine the staging of NSCLC is to find out whether the cancer can be completely removed by a surgeon.
[21] The main benefit of PET is to identify distant metastatic disease, thereby indicating futility of locoregional approaches such as surgery or curative intent radiotherapy.
While patients with small cell lung cancer can be responsive to initial treatment with chemotherapy, relapse is an important consideration for clinicians. The few general onco logy textbooks are generally out of date. Single papers in specialized journals are informative but seldom comprehensive; these are more often preliminary reports on a very limited number of patients. Limited and extensive small cell lung cancer stages; Stage 1; Stage 2; Stage 3; Stage 4; Grades of lung cancer . "[16] The technologies used to assign patients to particular categories have changed also, and it can be seen that increasingly sensitive methods tend to cause individual cancers to be reassigned to higher stages, making it improper to compare that cancer's prognosis to the historical expectations for that stage.[17]. The primary risk factor is tobacco use; almost all affected individuals smoke or have a history of smoking. If tumors have metastasized to the liver, a patient could experience nausea, fatigue, bloating, or swelling in the fingers and toes. Non-small cell lung cancer is a disease in which malignant (cancer) cells form in the tissues of the lung. The initial evaluation of non-small cell lung cancer staging uses the TNM classification. may be in nearby lymph nodes - for example, in the centre of the chest or above the collar bone. There are two types of EBUS bronchoscopes available: radial catheter probe and convex probe EBUS (CP-EBUS),[33] but only the latter concerns us here. Table 1. Lung cancer surgery can involve removing a portion of the lung or the entire lung. Detterbeck F et al. Doctors describe small cell lung cancer as limited if the cancer is contained in a single area on one side of the chest. Limited: Limited stage means that the cancer is only in one part of the chest, and radiation therapy could be a treatment option.
Stage I non-small cell lung cancer (NSCLC) is divided into two sub-stages, 1A and 1B, based on the size of the tumor. About one out of three people with SCLC have limited stage disease when first diagnosed. The other type of lung cancer-small cell lung cancer-is even more aggressive. According to the American Cancer Society, the overall survival rate for lung cancer as of Jan. 1, 2014 stands at just 3%. Patients with extrapulmonary small cell carcinoma who present with localized disease may be treated with chemotherapy and local therapy in the form of surgery or radiation therapy. N2, and particularly N3 lymph nodes, affect the clinical stage very significantly. When cancer makes its way to the brain, it could cause neurological issues . Often the stages 1 to 4 are written as the Roman numerals I, II, III and IV. Stage 3A lung cancer is classified as locally advanced disease.This means that cancer has spread to lymph nodes on the same side of the lung as the primary tumor.Cancer may also be found in the same side of the chest or throat, in the bronchus, pleura, diaphragm, chest wall, breastbone, backbone, phrenic nerve, pericardium, vena cava, aorta, pharynx, trachea, esophagus, and/or carina (the area . According to the American College of Chest Physicians (ACCP) Non-Invasive Staging Guidelines for Lung Cancer (2007),[22] the pooled sensitivity and specificity of CT scanning for identifying mediastinal lymph node metastasis are 51% and 85%, respectively and for PET scanning 74% (95% CI, 69 to 79%) and 85% (95% CI, 82 to 88%), respectively. Chest 2004, 126(1):122-128, Yasufuku K et al. Non-small cell lung cancer (NSCLC) and small cell lung cancer (SCL C) are the two most common types.. Staging[2] is the process of determining how much cancer there is in the body and where it is located. Pathological staging is also called surgical staging and reflects not only the results of non-surgical biopsy, but is evaluated either intra- or post-operatively and is based on the combined results of surgical and clinical findings, including surgical sampling of thoracic lymph nodes.[1].
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