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What Is a Pancoast Tumor?

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Updated April 11, 2014

Question: What Is a Pancoast Tumor?
Answer:

Pancoast tumors are lung cancers that begin at the top of the right or left lung and invade the chest wall. They are also called superior sulcus tumors. Pancoast tumors often come along with unique symptoms known as “pancoast syndrome,” which consists of pain in the shoulder and the inside of the arm and hand. Most of these tumors are non-small cell lung cancers, usually stage 2B.

Definition of a Pancoast Tumor

Pancoast tumors occur in the upper part of the right or left lung (the apical region) and invade structures near this area. These can include:
  • Ribs and vertebrae
  • The brachial plexus – a cluster of nerves located near the armpit
  • Nerves or blood vessels near the top of the lungs

Symptoms

Symptoms of a pancoast tumor are due to compression of structures that lie near the upper part of the lung where the cancer is present. These may include:
  • Arm and shoulder pain, with pain frequently radiating down the arm (especially the inside part of the arm)
  • Weakness in hand muscles
  • Tingling and prickly sensations in the hand, especially the ring and pinky fingers
  • Flushing and/or sweating on one side of the face, and eventual lack of sweating on one side of the face
  • A droopy eyelid (Horner’s syndrome)

Diagnosis

Diagnosis of pancoast tumors is frequently delayed for two reasons. These tumors are less likely to have typical lung cancer symptoms, such as shortness of breath and coughing, and people often first see an orthopedic surgeon or neurologist for their symptoms. Pancoast tumors are also difficult to see on chest x-rays due to their location. A combination of CT scans and MRI (to look for nerve involvement) is often done, followed by a biopsy to confirm the diagnosis.

Treatment

A combination of chemotherapy and radiation therapy, followed by surgery (when possible), is often used to treat pancoast tumors. If treatment aimed at a cure is not possible, radiation therapy can still be helpful as a palliative therapy -- one used to relieve pain and other symptoms. Pancoast tumors are quite rare, and clinical trials are in progress to evaluate new treatments.

Prognosis

In general, pancoast tumors have a better prognosis than tumors that are located more centrally in the lungs, and the survival rate may be better than other cancers at a similar stage. The 5-year survival rate for pancoast tumors overall is around 30%, which is a significant improvement that has been achieved in the past few decades.

Further Reading:

Sources:

Rusch, V. Management of Pancoast Tumors. Lancet Oncology. 2006. 12:997-1005.

Shen, K. et al. Special Treatment Issues in Lung Cancer. ACCP Evidence-Based Clinical Practice Guidelines (2nd Edition). Chest. 2007. 132(no. 3 suppl):290S-305S.

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