Boys0406 wrote:... I have been trying to research and figure out which ones are considered distant and would make it stage 4 cancer. We won’t see our oncologist again for a few weeks as we see the oncology nurse this week and when we asked her last time she did not know. Does anyone out there have experience with this? Does anyone know which lymph nodes are the distant ones? ...
I do not have direct experience with metastatic lymph nodes since I have always been "N0M0", but my layman's understanding of this issue has always been the following:
1. The lymph nodes that are going to be removed by the original surgery are called "local" lymph nodes. If any of them are malignant, then these are considered "local"
metastases and this is reflected by an N coding of N1 or N2 instead of N0. (Your husband had 59 local lymph nodes removed with two of them being cancerous, resulting apparently in a staging of T4b N1a Mx, i.e., Stage III-C).
2. All the rest of the lymph nodes -- i.e., the ones not removed by the original surgery, wherever they may be located in the body -- are considered as "remote"
lymph nodes and this would be reflected by an M coding of M1a or M1b instead of M0 or MX if any of them are found to be cancerous. This would automatically classify the patient as Stage IV once these lymph nodes have in fact been confirmed as being cancerous. Confirmation of this might require an eventual biopsy of the lymph nodes in question.
Furthermore, all lymph nodes found to be cancerous, whether local or remote, are to be considered as metastases ("mets"). The main difference between the two kinds of mets is that cancerous local
lymph nodes will be removed by the original surgery and can never cause a problem again, while cancerous remote
lymph nodes still remain in the body and will be a constant menace wherever they may be located since they have not yet been removed by surgery, ablation, or neutralized by some other means.