pancoast tumor

A Pancoast tumor is a type of lung cancer located at the apex (top) of either lung. It is also called a superior sulcus tumor. These tumors are often non-small cell lung carcinomas, such as squamous cell carcinoma or adenocarcinoma.

Key Features:

• Location: Apex of the lung, where it can involve nearby structures.
• Involvement of nearby structures: Because of its location, a Pancoast tumor may invade the:
  • Brachial plexus (causing arm and shoulder pain, weakness, or numbness)
  • Sympathetic chain (leading to Horner’s syndrome)
  • First and second ribs
  • Vertebrae

Clinical Presentation:

• Shoulder and arm pain: Radiating along the distribution of nerves arising from C8, T1, and T2.
• Horner's syndrome: Characterized by ptosis (drooping eyelid), miosis (constricted pupil), and anhidrosis (loss of sweating) on the affected side of the face, due to sympathetic chain involvement.
• Weakness or muscle wasting: Due to nerve involvement.
• Other systemic symptoms: Weight loss, chronic cough, hemoptysis may or may not be present.

Diagnosis:

• Imaging: Chest X-ray can show a mass at the apex of the lung. CT scan and MRI are used to define the extent of the tumor and involvement of adjacent structures.
• Biopsy: Usually performed via CT-guided needle biopsy to establish histological diagnosis.
• Additional tests: PFTs, PET scan, and mediastinoscopy may be used for staging.

Treatment:

• Pancoast tumors were traditionally considered inoperable because of local invasion, but combined modality treatment has improved outcomes.
• Multimodal approach:
  • Neoadjuvant (preoperative) chemoradiotherapy to shrink the tumor.
  • Surgical resection, which can be complex due to involvement of chest wall and nerves.
  • Postoperative radiation or chemotherapy depending on residual disease.

Prognosis:

• Depends on the stage at diagnosis and successful resection.
• Early detection and multimodal treatment provide the best outcomes.

If you want information on symptoms, diagnosis, treatment options, or something specific about Pancoast tumors, feel free to ask!