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So one of the big reasons that the N stage is so important, particularly for us as surgeons, is that it has a big impact on whether or not we decide that surgery is going to be advantageous for that particular tumor. The N 1 lymph nodes, those ones that are actually in the lung in the same lobe that we would be taking to remove the lung cancer, so those N 1 lymph nodes being positive doesn’t proclude surgery. Because those come out at the time of surgery. The mediastinal lymph nodes, we’re a little more careful about. So there are some circumstances where if there’s only one mediastinal lymph node that’s positive, and it’s on the same side as the tumor, and it’s not terribly bulky, then there may be some consideration for surgery, either upfront or after chemotherapy or potentially even radiation therapy. On the other hand, if the N 3 nodes are positive, the ones that are on the other side of the chest from the tumor in the mediastinum, then surgery is rarely offered because it’s not found to have much of a benefit in the overall survival.
