Pancoast Tumor
Original Editors - Paul Clark & Sam Holzknecht from Bellarmine University's Pathophysiology of Complex Patient Problems project.
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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 metastisis 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 to 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.
Common risk factors include (similar to lung cancer):
smoking
secondhand smoke
asbestos exposure
exposure to industrial elements like gold or nickel
diesel exhaust
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 differential diagnosis. "Typical" symptoms of lung cancer such as cough, dyspnea, and haemoptysis are less frequent.
Common presentations include:
shoulder pain
radiating pain to the ulnar side of the arm and hand (55-60%)
Horner's syndrome (30%)
medial scapular pain
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]
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Medications[edit | edit source]
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