Pancoast Tumor: Difference between revisions
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see [[Adding References|adding references tutorial]]. | see [[Adding References|adding references tutorial]]. | ||
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G Muscolino, M Valente, S Andreani. Pancoast tumours: clinical assessment and long term results of combined radiosurgical treatment. Thorax. 1997; 52: 284-6. |
Revision as of 18:57, 1 April 2012
Original Editors - Paul Clark & Sam Holzknecht from Bellarmine University's Pathophysiology of Complex Patient Problems project.
Lead Editors - Your name will be added here if you are a lead editor on this page. Read more.
Definition/Description[edit | edit source]
Pancoast tumor is an uncommon lung cancer that arises at the level of the superior sulcus and is limited to the apical segment of either lung. This is a form of non-small-cell carcinomas (NSCLCs) that are very difficult to treat because of their proximity and frequent metastasis to adjactent structures such as the subclavian vessels, lymphatic system, brachial plexus, spine, second and third ribs, stellate ganglion, and the sympathetic nervous system. NSCLCs generally grow and spread slower and are divided into three different forms of cancer: squamous cell carcinomas (45-50%), adenocarcinomas (36-38%), or undifferentiated large-cell carcinomas (11-13%). Rather than invading underlying lung tissue, this tumor presents as a abnormal patch of tissue over the lung apex and initially involves the chest wall strucutures. This can be treated if caught early on before it spreads and moves to the lymph nodes. Pancoast tumors are often mis-diagnosed and/or diagnosed too late.
Prevalence[edit | edit source]
"Lung cancers are the leading cause of death in both men and women in North American." In 2011, there was an estimated new diagnosis of 221,130 new cases of lung cancer with 156,940 deaths relating to lung cancer. Lung cancer accounts for more deaths when compared to prostate/breast, colon, and pancreatic cancer combined. Of the number of new lung cancer diagnosis, approximately 5% can be attributed to pancoast tumors. The highest occurence is found in men between the ages of 40 and 60 with a history of smoking.
Siegel, R., Ward, E., Brawley, O. and Jemal, A. (2011), Cancer statistics, 2011. CA: A Cancer Journal for Clinicians, 61: 212–236. doi: 10.3322/caac.20121
Characteristics/Clinical Presentation[edit | edit source]
Pancoast tumors are very difficult to diagnosis early on. This is based on their low prevalence rate and many differential diagnosis'. "Typical" symptoms of lung cancer such as cough, dyspnea, and haemoptysis are less frequent.
Common presentations include:
referred pain over the scapula to the shoulder
radiating pain to the ulnar side of the arm and hand (55-60%)
Horner's syndrome (30%)
atrophy of the arm, forearm, and hand
parasthesias of the hand
between the ages of 40-60
men > female
Associated Co-morbidities[edit | edit source]
muscle atrophy
cervical radiculopathy
Horner's Syndrome
COPD
vertebrae compression
bone cancer
Medications[edit | edit source]
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Diagnostic Tests/Lab Tests/Lab Values[edit | edit source]
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Etiology/Causes[edit | edit source]
Common risk factors include (similar to lung cancer):
smoking
secondhand smoke
asbestos exposure
exposure to industrial elements like gold or nickel
diesel exhaust
Systemic Involvement[edit | edit source]
Pancoast tumors are often mis-diagnosed or diagnosed too late to prevent metastisis to adjoining structures. This form of lung cancer is very dangerous because of its close proximity to other structures that include:
brachial plexus- this is commonly invaded at the ulnar distribution (C8-T1), thus atrohpy/parasthesia of the ulnar distribution is reported. This is often the patient's primary complaint/presentation to therapy with shoulder pain that radiates down to the 4th and 5th digit.
subclavian vessels- metastisis to the subclavian artery or adjoining structure may lead to deterioration or compression of blood vessels.
stellate ganglion- This is a large ganglion located at the bottom of the cervical spine in connetion with the thoracic spine and is related to the sympathetic nervous system. Invasion of this may result in Horner's Syndrome.
adjacent vertebral bodies- If the tumor is able to metastisise the vertebral bodies, this may lead to permanent paralysis of the affected area.
Medical Management (current best evidence)[edit | edit source]
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Physical Therapy Management (current best evidence)[edit | edit source]
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Alternative/Holistic Management (current best evidence)[edit | edit source]
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Differential Diagnosis[edit | edit source]
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Case Reports/ Case Studies[edit | edit source]
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Resources
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add appropriate resources here
Recent Related Research (from Pubmed)[edit | edit source]
see tutorial on Adding PubMed Feed
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References[edit | edit source]
see adding references tutorial.
G Muscolino, M Valente, S Andreani. Pancoast tumours: clinical assessment and long term results of combined radiosurgical treatment. Thorax. 1997; 52: 284-6.